System Evaluation Of TCM Therapy For Chronic Heart Failure

ObjectivesThis research conducts the quality analysis of scientific research desigh on the literatures about the treatment to chronic heart failure by Chinese medicines. In light with the principles and methods of chinical epidemiology/DME, a "Review Form on Systenm of Literature About the Treatments to Chronic heart Failure through Chinese Medicine" is enacted, and the areas cover the general sysptoms of such disease, standards of incorporation and eliminaction, experimental desigh scheme(conditions of control, sample size, inter-group balance and conditions for the use of control drug, randomized status, condition of the application of bline method), intervention measures and drug use, standards of efficacy judgmnd, application of statistical method, standardization of testing factors, analysis of the exit and lost, records and analisis of the adverse reaction, conclusion derivation and the rationatity of the conclusion, etc. The literatures are ones of randomized control clinical research about the threatments to chronic heart failure by Chinese medicine therapy pubilished in domestic medicine journals from1970to2012. As these literatures are further conducted the evaluation, researches conformed to the conditions are the conducted the quantitative Meta analysis prior to evaluating efficacy and safety of Traditional Chinese Medicine used in the chronic heart failure, then filtrate advantageous therapeutic methods and commendatory herbs and formula.Methods1. traditional Chinese medicine combine system evaluation of chronic heart failureThe chlinical research into the treatments to chronic heart failure by Chinese medicine therapy published from1970to2012in domestic medicine journals literatures are the research subjects. Read tentatively first, the content of the articles is briefed on the clinincal research report with the chronic heart failure. It’s materials content, in order to contrast at random, whether used blind method. And the exclusion standard of the literatures includes, the materials content randomized controlled, the animal tests, to only-managing the law simply with Chinese medicine. External application, acupuncture and moxibustion, masseage, qigong, case report, documents of summary of experience, the theory probes into documents, ect.Supplements and complilation of data. Use the Excel to establish assessment from first database and input data checked, and then analysise data with the software SPSS13.0.2. traditional Chinese medicine combine Meta analysis of chronic heart failureDomestic all is it treat clinical random document that comparative study be tested, chronic heart failure to combine about traditional Chinese medicine to happen to examine at computer to2012since the1979.Including criteria standartion:1. Major including the treatment of Chinese medicine randomized controlled trial whether using bline method. The intervention measures is the treatment of Chinese medicine or Chinese and Westernal medicine which positive control is routine treatment of Westen medicine. The harmony among the group is better, have comparativity.It is the same and clear that curative effect evaluates the indicator.2. The treat way whether traditional Chinese medicine or Chinese and Western combine mainly at getting rid of standard. And the obvious effect of combine medicine on significant influence is excluded. The stochastic methods obviously wrong or random method is not described. Select qualified literature according to the criteria and exclusion standard and evaluatethethem. According to the main clinical symptom, sign and the grade of heart function, the dfficacy index is determined. Draw the method in clinical document data with RevMan5.0.Result1. Appraise systematicallyPass three computer databases (VIP, CKNIand Ten thousand Party Database) examine with hands:The Communist Party of China got2412documents of chronic heart failure since14years.358of them with therm "Randomized" or "Control" or" Grouped"or"Contrast"about treatments to chronic heart failure by Chinese medicine therapy upon passing the reading title and abstract are selected. Follwing the circumspect reading of those358articles, there are144to be not conformity to the incorporated standards that are eliminated, eventually leaving214pieces of article. Study the unit,214articles are in the domestic. Traditional Chinese and Western medicine that diagnostic shandard adopt to have89, it is suitable to include in the standard to be have from214documents that are screened, there is rational clear getting rid of standard documents that there are50. In the literature design quality, most sample is it treat group and contrast content of group among50-425. The screening of having the case of no document is written down, has not written down the estimation that any document referred to the content of sample in advance either. There are some literature briefly mentioned each situation also lists some data (such as age, gender, duration, etc), but most and there is no mention is balanced between groups.214are contrasted at random in documents, there are the demographic complete characteristics of65documents.180articles the mentions that contrast and treat the group among them, it is constant, have not difference. It is withdraw P value source statistical method only6,6this is it mention statistical method have X2examine, Ridit is examined, t is examined to have.At the method at random,33documents use the random method. In a blind law application,14article have mentioned the blind,6article is single blind, double blind have8article. There are not been all tried to looking like complying with test in214documents. There are only8written down cases for withdrawing and losing visiting, coming off.While following up a case by regular visits to and appraising of214, have6to follow up a case by regular visits to register. In the statistical methods, All214article randomized controlled literature for all data statistics processing, used chi-square test methods,t test, Ridit analysis, rank and inspection, etc. All138references predetermine the literature statistics. Not a literature use statistical methods to sets the correct balance between variables. All article outcome measures statistical method is right general. The judge index in the description of the statistics, there are specific test statistics and P value is given there were2article. In the results derived, there are159studies whose the main research conclusion of outcome measures and standard statistical inference reason to the results,50articles push representative discussion with the outside of the sample.2. Meta analysisBy reading214articles, according to the criteria standartion and the exclusion standard, select44conformity article. Have44left adop simple Western medicine manage do to have41, simple placebo do contrast have3.44are in Jadad scale grade:43articles can be regarded in low quality,1article can be regarded in high quality. In the blind law application, double blind have3articles. At the method at random,5documents use the simple random method,1document use the block random method, they all don’t report the concealment of the random program. There are only1written down case for withdrawing and losing visiting, coming off. The Meta analysis of chronic heart failure with traditional Chinese medicine manage show that Chinese traditional medicine can improve chronic heart failure patients’overall effect, EF levels, BNP levels and the six minutes walk test level, the difference was not statistically significant (P>0.05). At heterogeneitying on inspection,1group of research suggests the presence of heterogeneity, using random effects model others are heterogeneity inspection homogeneity. Sensitivity analysis of the study on different research quality test results show that the sensitivity analysis is a relatively stable. Sexual bias detection published showed that, there differences Meta analysis of research showed there are certain funnel figure asymmetry, so these literatures included in the research may be some published sex bias.Conclusion1. The literature research quality analysis results show that the traditional Chinese medicine for the treatment of chronic heart failure controlled clinical research the literatures, but there are many problems. The main performance of epidemiology in the application of the methodology is not enough attention, the standardization of clinical trials is poorer, clinical research conclusion is difficult to be recognized.2. Meta analysis shows that Chinese traditional medicine can improve chronic heart failure patients’overall effect, EF levels, BNP levels and the six minutes walk test level. Because the quality of study incluede is generally low, and exists clinical heterogeneity and published sex bias, and other influence factors such as stay evaluation research,these are all descreasing the reliability of the system evaluation conclusion in different degrees So the evidence of safety and efficacy of TCM therapy for patients with chronic heart failure is not enough. In order to verify its effectiveness and safety further, we still need to design reasonable, implementing strict, multicenter dogs and follow-up time enough samples of randomized controlled trials. Additional, in order to better verify its effectiveness and safety, in choosing standard to effect, besides using laboratory test and the relevant index, also should choose and the end sentenced to effect indexes which is more relational with people, the practical value is high, such as the mortality rate, the quality of life, evaluation, etc.