Systematic Evaluation And Clinical Study On Treatment Of Minimal Hepatic Encephalopathy With Traditional Chinese Medicine

Objective: To systematically evaluate the effectiveness and problems of randomized clinical controlled trials of traditional Chinese medicine in the treatment of minimal hepatic encephalopathy.Based on the results of systematic evaluation,to optimize the clinical research program of compound rhubarb decoction in the treatment of minimal hepatic encephalopathy,and to observe the clinical efficacy and safety of compound rhubarb decoction.Methods:Systematic evaluation: According to the established retrieval strategy,we retrieve the CNKI,Wanfang,VIP,Pubmed,Chi CTR and Sino Med databases by computer.The retrieval time was until August 2019.Retrieving conference papers and library collections.Asking the author for help through E-mail for papers with incomplete data or unreported clinical data.Two researchers screened and included the literature according to inclusion and exclusion criteria.And through reading the full text of the literature,extracting the data were,including the basic situation of the literature,baseline data of the research object,intervention measures,outcome indicators,etc.The included study was assessed by Cochrane bias risk assessment tool.Revman5.3 software was used for data analysis,and the research results were showed by drawing forest map and funnel map.Clinical study: 72 patients who met the inclusion criteria were randomly divided into compound rhubarb decoction group(group A),western medicine basic treatment group(group B)and rhubarb decoction group(group C),with24 cases in each group.All three groups received basic western medicine treatment.Group A was treated with compound rhubarb decoction retention enema on the basis of western medicine treatment,while group C was treated rhubarb decoction retention enema on the basis of western medicine treatment once a day for 7 days.Observing and comparing the clinical efficacy and safety of the three groups.To observe and compare the changes of digital connection test A(NCT-A),digital symbol connection test(DST),blood ammonia(BA),glutamic pyruvic transaminase(ALT)and total bilirubin(TBIL)before and after treatment in the three groups.To compare the comprehensive neuropsychological efficacy and safety of the three groups.Results:Systematic evaluation:(1)41 articles were included in this study,with 1318 subjects in the experimental group and 880 subjects in the control group.The publication year was from 1999 to 2019.(2)There are various bias possibilities in the studies.Only 18 studies used the random number table method or SPSS system to generate random serial numbers.Only 1 study used blind method and 14 studies reported shedding,but no intentionality analysis was carried out.2 studies mentioned follow-up,and and 41 studies did not allocate hiddenly.(3)Meta analysis results:Reduce the time of number connection test A(NCT-A): 17 studies show that Chinese herbal pieces are better than western basic therapy(SMD=-0.84,95%CI[-1.29,-0.38]).8 studies show that Chinese herbal pieces plus western medicine is better than western medicine(SMD=-0.83,95%CI[-1.27,-0.39]).11 studies show that Chinese patent medicine is superior to western basic therapy(SMD=-0.49,95%CI[-0.65,-0.33]).1 study shows that the curative effect of Chinese patent medicine plus western medicine is equivalent to the western medicine.(SMD=-0.51,95%CI[-1.14,0.12]).Blood ammonia reduction(BA)level: 14 studies show that Chinese herbal pieces are more effective than western basic therapy(SMD=-2.1,95%CI[-2.92,-1.28]).8 studies show that the therapeutic effect of Chinese herbal pieces plus western medicine is significantly better than western medicine(SMD=-1.09,95%CI[-1.63,-0.55]).8 studies show that Chinese patent medicine is more effective than western basic therapy(SMD=-0.21,95%CI[-0.38,-0.03]).Lowering ALT level: 11 studies show that Chinese herbal pieces are better than western basic therapy(SMD=-1.14,95%CI[-1.51,-0.77]).6 studies show that Chinese herbal pieces plus western medicine was better than western medicine(SMD=-0.63,95%CI[-1.13,-0.13]).8 studies show Chinese patent medicine is better than western basic therapy(SMD=-0.56,95%CI[-0.75,-0.37]).Clinical Efficacy: 5 studies show that Chinese herbal pieces are superior to western basic therapy(RR=1.25,95%CI[1.12,1.40]).2 studies show that Chinese herbal pieces plus western medicine is better than western medicine(RR=1.15,95%CI[1.01,1.31]).4 studies show that Chinese patent medicine is superior to western basic therapy(RR=1.21,95%CI[1.06,1.38]).Clinical study: 72 patients were included in the study,24 patients in groups A,B and C respectively.In terms of improving NCT,DST detection,lowering ALT,TBIL and BA levels,group A and C are superior to groupB(P<0.05),and group A and group C have the same curative effect(P>0.05).In the comprehensive curative effect of neuropsychological examination,group A is superior to groups B and C(P<0.05),and group C is superior to group B(P<0.05).In terms of safety,there was no significant difference in the incidence of adverse events among the three groups(P>0.05).Systematic evaluation: although there is generally high risk bias in this included study and there are defects in the design of research scheme,Meta analysis results show that traditional Chinese medicine treatment for mild hepatic encephalopathy has better effect in reducing NCT-A time,reducing blood ammonia and glutamic-pyruvic transaminase levels,and comparing clinical efficacy with western medicine treatment,thus providing direction for optimizing future clinical research scheme.Clinical study: 72 patients were included in the study,24 patients in groups A,B and C respectively.In terms of improving NCT,DST detection,lowering ALT,TBIL and BA levels,group A and C are superior to group B(P<0.05),and group A and group C have the same curative effect(P>0.05).In the comprehensive curative effect of neuropsychological examination,group A is superior to groups B and C(P<0.05),and group C is superior to group B(P<0.05).In terms of safety,there is no significant difference in the incidence of adverse events among the three groups(P>0.05).Conclusion:Systematic evaluation: While there are various bias possibilities in the studies,and there are defects in the design of the research scheme,Meta analysis results show that traditional Chinese medicine treatment for minimal hepatic encephalopathy is superior to western medicine in reducing NCT-A time,lowering BA and ALT levels,and improving the clinical efficacy.According to the results of this systematic evaluation,it can provide direction for optimizing the future clinical research.Clinical study: Compound rhubarb decoction has obvious clinical effect in treating minimal hepatic encephalopathy without adverse reactions.In terms of improving neuropsychological tests,reducing blood ammonia level and improving liver function,compound rhubarb decoction is superior to basic western medicine treatment,but has the same curative effect as rhubarb decoction..In the comprehensive curative effect of neuropsychological examination,compound rhubarb decoction has the best curative effect.