Systematic Evaluation And Meta - Analysis Of The Therapeutic Effect Of Traditional Chinese Medicine On Cardiac Neurosis

Research purpose:Collecting completely randomized trial study literature on cardiac neurosis treated with traditional Chinese medicine,using system evaluation method to evaluate the efficacy,aiming at providing reliable evidence of evidence-based medicine on treating cardiac neurosis with traditional Chinese medicine.Research methods:According to the retrieval strategy,using the computer retrieve the database, including the PubMed、Cochrane Library, Embase、Wed of Science and CBM^ CNKI、VIP、Wang Fang resource database,the time limited to the database setup time to 2016.02.28,through the retrieved review and clinical research literature references for retrospective retrieval and citation retrieval to supplement.According to include and exclude standards to deal with literature,data acquisition by two researchers independently.According to the Cochrane collaboration bias risk assessment tools to evaluate risk of bias,furthermore extracting information and carry on meta-analysis.with the help of Revman5.2 software for the data analysis,through combined statistics,heterogeneity,mapping the forest figure and funnel, sensitivity analysis and subgroup analysis come to the comprehensive conclusion.Research results:Total in 10 completely randomized controlled study on the traditional Chinese medicine in the treatment of cardiac neurosis,a total of 928 cases,of which the traditional Chinese medicine group 475cases and controlled group 453 cases.In the 10 research:100% research whose randomizing method based on completely randomized digital table,10% research mentioned the production of random number and allocation concealment.100% research didn’t mention blind method.40% research mentioned the condition of withdraw and exit,in addition,these cases which dropped out were just to be eliminated.100% research didn’t mention estimation of sample size and intention to treat.100% research had inclusion criteria,100% research had exclusion criteria.100% research mentioned that baseline is consistent,two group was comparable.100% research had diagnostic criteria according to the modern medicine,50% research had diagnostic criteria according to the traditional Chinese medicine.40% research payed attention to the adverse reaction.Statistics method of all was similar,20% research provided the P value.50% research had informed consent form,10% research had ethical committee approval.Meta-analysis results:1. Curative effect evaluation:Overall effect:10 research RR=1.24,95%CI[1.17,1.32],P<0.00001,indicating that the traditional Chinese medicine is superior to the western medicine;The same evaluation standard:8 research RR=1.23,95%CI[1.15,1.31],P<0.00001,indicating that the traditional Chinese medicine is superior to the western medicine;Curative effect main symptoms of the traditional Chinese Medicine:2 research palpitation RR=1.27,95%CI[1.10,1.46],P=0.0010, fatigue RR=1.66,95%CI[1.32,2.08],P< 0.0001,depression RR=1.52,95%CI[1.16,2.00],P=0.003,all of them have significant statistical significance, dyspnea and pain of chest RR=1.97,95%CI[0.94,4.11],P=0.07,insomnia RR=1.84,95%CI[0.83,4.08],P=0.13 there is no statistical significance.This outcome shows that the traditional Chinese medicine improve the symptoms including palpitation、fatigue、 depression is better than western medicine,but there is no difference in the efficacy of dyspnea and pain of chest and insomnia between them.2.Group of curative effect evaluation:Traditional Chinese medicine dialectical treatment in experimental group:4 research RR=1.29,95%CI[1.17,1.42],P<0.00001 pointing that dialectical treatment is better than the western medicine;Self-ordained Chinese herbal medicine prescription in control group:4 research RR=1.26,95%CI[1.14,1.39],P<0.00001 pointing that the self-ordained Chinese herbal medicine prescription is better than the western medicine;Control group used β-blockers:4 research RR=1.18,95%CI[1.08,1.29],P=0.0003 indicating the traditional Chinese medicine is superior to the β-blockers;Control group used β-blockers+oryzanol:4 research RR=1.27,95%CI[1.16,1.38], P<0.00001 indicating the traditional Chinese medicine is superior to the β-blockers+oryzanol.3. Rating scale of curative effect evaluation:The general rating scale of symptoms in traditional Chinese medicine:3 research; SMD=-0.86,95%CI[-1.16,-0.55],P< 0.00001,indicating the traditional Chinese medicine is superior to the western medicine in reducing the general rating scale of symptoms; The rating scale of main symptoms in traditional Chinese medicine:2 research palpitation MD=-0.29,95%CI[-1.16,-0.55] P=0.001, short breath MD=-0.28,95%CI[-0.46,-0.10] P=0.003, dyspnea SMD=-0.29,95%CI[-0.56,-0.01],P=0.04,chest pain MD=-0.24,95%CI[-0.43,-0.06] P=0.01,indicating the traditional Chinese medicine is superior to the western medicine in the improvement of main symptoms;SDS score:2 research MD=-4.76,95% CI[-6.76,-2.76],P<0.00001,indicating the traditional Chinese medicine is superior to the western medicine by lower the SDS score;SAS score:2 research SMD=-0.96,95%CI[-1.30,-0.02],P< 0.00001 indicating the traditional Chinese medicine is superior to the western medicine by lower the SAS score.4.the security and adverse reaction:4 research has pay attention to the adverse drug reaction, in result,there is no obvious adverse reactions.5.Other outcome indicators:there is single research has pay attention to the time of therapy and the time began to effective-. the score of HAMA、the function of cardiac autonomic nerve,the outcome shows that traditional Chinese medicine is superior to western medicine,there is no statistical significance in recurrence rate and holter monitor for 24 hours comparing among two groups.Research conclusion:the study by the system evaluation and meta-analysis shows that the traditional Chinese medicine single treatment to cardiac neurosis with good curative efficacy and security.effectively of improving the main clinical symptoms including heart palpitations,fatigue,depression,the general rating scale of symptoms in traditional Chinese medicine,SDS score,SAS score is better than the conventional treatment of western medicine,but it is necessary to improve the methodological quality of the traditional Chinese Medicine clinical trails.