| Objectives: Subacute thyroiditis is a common painful thyroid disease,although its incidence rate is not high,the obvious pain causes great distress to the patient’s life.Western medicine mainly focuses on non-steroidal anti-inflammatory drugs or glucocorticoids,but long-term use of them leads to more adverse reactions,and prone to recurrence.TCM can not only effectively relieve the symptoms and signs of patients with subacute thyroiditis,but also have few adverse reactions and low recurrence rate.In this study,literature metrology method was firstly adopted to extract the clinical research literature of Chinese medicine intervention in subacute thyroiditis.The randomized controlled study was taken as the statistical object to scientifically summarize the use of literature prescriptions and reveal the application characteristics of prescriptions.Then,by applying the methods of systematic evaluation and meta-analysis,and taking Qingre jiedu as one of the representative treatments,to investigate the clinical effect of Chinese medicine prescription on subacute thyroiditis and provide evidence-based medical evidence for its clinical application.Methods:Design scientific and effective strategy of literature retrieval,comprehensive database retrieval domestic large Chinese,including Chinese journal full-text database(CNKI,1979~2019),the Chinese biomedical literature database(Sinomed,1979 ~ 2019),chongqing weipu full-text database(VIP,1989~2019)and wanfang database(WF,1998~ 2019)and Pubmed,CNKI including Chinese periodical literature database,important meeting full-text database,Master and doctoral thesis database.All searches are until January 2019.Literature of randomized controlled trial on TCM intervention in subacute thyroiditis was collected.End Note X9 document manager was adopted to realize the process control of original documents,and the document information extraction table was established with Excel.Extract the application of traditional Chinese medicine in the treatment of subacute thyroiditis,Summarize the high frequency use of prescription type,prescription dosage form by bibliometrics method to Lay a philological foundation for the later evaluation and analysis of evidence-based medicine.By adopting the research method of evidence-based medicine systematic evaluation and Meta analysis to research yinqiao powder and Xiaochaihu Decoction which were high frequent used in the treatment of Qingre jiedu.Relevant randomized controlled trials were collected from all Chinese database until January 2019.Quality assessment of evidence-based medicine was conducted in accordance with Cochrane Review Handbook5.0.Rev Man5.2 software was used for statistical analysis.To explore the clinical efficacy and safety of traditional Chinese medicine(TCM)in the treatment of subacute thyroiditis based on the above prescriptions,and to compare its efficacy with that of conventional western medicine.Results:There were 245 included clinical randomized controlled trials,most of which were parallel control of two groups.Among the 245 trials,200 literatures explicitly reported the name of the prescription,or the formulations found in the self-developed prescriptions after the researchers’ extraction,among which the formulations involved in Qingre jiedu were the most.The treatment of subacute thyroiditis meta analysis by yingqiao powder showed that: 1.The clinical treatment of efficient analysis: All the 19 included literatures took commonly used western medicine as the control group to compare and analyze the clinical treatment efficiency.In 10 studies,yinqiao powder plus or minus combined with western medicine was used as the experimental group,and the results showed that the curative effect was better than western medicine alone [RR=1.25,95% CI(1.17,1.33),P<0.00001];In 9 studies,yinqiao powder as the experimental group,and the results showed that the curative effect was better than that of western medicine alone[RR=1.18,95%CI(1.11,1.26),P < 0.00001].2.Recurrence rate analysis: the recurrence rate of yinqiao powder plus or minus combined western medicine treatment is lower [OR=0.14,95%CI(0.05,0.37)],and the recurrence rate of yinqiao powder plus or minus control western medicine is lower [OR=0.18,95%CI(0.07,0.48),P=0.0006].3.Clinical symptoms analysis: yinqiao powder combined western medicine therapy of TCM symptom score improvement is better than that of control group [MD=1.64,95% CI(2.97,0.30),P=0.02),and ease the pain [MD=2.08,95% CI(2.35,1.81)],Goiter detumescence[MD=4.30,95% CI(4.71,3.90)] and lower erythrocyte sedimentation rate[MD=6.04,95%CI(9.63,2.46),P=0.0009)were better than the control group;The TCM symptom scores of yinqiao powder plus or minus control the western medicine group were improved [MD=-1.37,95%CI(-2.37,-0.36),P=0.008],Goiter detumescence [MD=-3.41,95%CI(-5.48,-1.35),P=0.001].pain relief [MD=-1.72,95%CI(-4.93,1.49),P=0.29],and lower ESR[MD=-1.17,95%CI(-4.14,1.80),P=0.44],which were comparable to the western medicine treatment alone.There was no statistical difference.Meta-analysis of xiaochaihu decoction as the basis for the treatment of subacute thyroiditis showed that:1.Clinical effective rate analysis: the effective rate of xiaochaihu decoction combined with western medicine was better than western medicine alone [OR=4.46,95%CI(2.75,7.25),P<0.00001];2.Recurrence rate analysis: the recurrence rate of xiaochaihu decoction combined with western medicine was lower than control[OR=0.15,95%CI(0.08,0.27),P<0.00001].3.Syndrome score of traditional Chinese medicine: xiaochaihu decoction combined with western medicine was better than western medicine [MD=-6.89,95%CI(-8.05,-5.74),P<0.0001].Xiaochaihu decoction plus or minus western medicine is better than western medicine alone in improving clinical efficacy and TCM syndrome score [MD=-7.50,95%CI(-8.88,-6.12),P<0.00001]Conclusion:Whether used alone or in combination with western medicine,the clinical efficiency of yinqiao powder in treating subacute thyroiditis is higher than that of western medicine alone,and it has the advantages of low clinical recurrence rate and fewer adverse reactions.In terms of improving clinical symptoms,yinqiao powder plus or minus combined with western medicine can significantly reduce the patient’s ESR,shorten the pain relief time and thyroid retraction time;Yinqiao powder was superior to western medicine in pain relief time.Whether used alone or in combination with western medicine,xiaobuhu decoction is superior to western medicine in clinical efficiency,recurrence rate,improvement of clinical symptoms and lowering erythrocyte sedimentation rate.To sum up,Qingre jiedu method of traditional Chinese medicine treatment of subthyroiditis has a definite effect. |
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