A Meta-analysis Of Reinforcing Qi,Nourishing Yin,Dissolving Phlegm And Dispelling Blood Stasis Method In Treating Idiopathic Pulmonary Fibrosis

Objective:On the basis of the measures of Meta-analysis,the clinical therapeutic effect and safety of traditional Chinese medicine with the function of reinforcing Qi,nourishing Yin,dissolving phlegm and dispelling blood stasis in the treatment of idiopathic pulmonary fibrosis were assessed,and then to give evidence-based support for the extensive clinical application of traditional Chinese medicine to treat idiopathic pulmonary fibrosis.Methods:Using"reinforcing Qi","tonifying qi","nourishing Yin","tonifyingyin","enrichingyin","dissolvingphlegm","activating blood","eliminating the stagnant blood","dispelling blood stasis","dredging collaterals","idiopathic pulmonary fibrosis"and other search terms,we will search CNKI,CBM,Wanfang,VIP and Pubmed databases to collect all randomized controlled trials on the treatment of idiopathic pulmonary fibrosis by traditional Chinese medicine with the effect of reinforcing Qi,nourishing Yin,dissolving phlegm and dispelling blood stasis from database establishment to December 2021.In terms of a customized inclusion and exclusion criteria,two researchers separately screened the literature and extracted relevant information.Then Review Manager 5.4 software was used to merge and analyze the same items of data included in the study.Results:（1）Finally,19 articles were included for Meta-analysis and the total number of IPF patients was 1238,including 620 patients in the experimental group（reinforcing Qi,nourishing Yin,dissolving phlegm and dispelling blood stasis method alliance with Western medicine）and 618 patients in the control group（western medicine alone）.The maximum number of IPF patients included in the study was 110,and the lowest number was 30.The quality of the included studies was evaluated by the Improved Jadad Rating Scale,containing 4 articles of high quality and 15 articles of low quality.（2）The analysis results are shown below:The alliance of traditional Chinese medicine with the effect of reinforcing Qi,nourishing Yin,dissolving phlegm and dispelling blood stasis therapy with Western medicine improved the therapeutic effect of IPF patients（RR=1.38,95%CI（1.27,1.50）,P<0.00001）,alleviated the overall symptoms（WMD=-3.92,95%CI（-4.69,-3.16）,P<0.00001）,cough（WMD=-0.73,95%CI（-0.95,-0.52）,P<0.00001）,expectoration（WMD=-0.50,95%CI（-0.61,-0.39）,P<0.00001）,chest tightness（WMD=-0.57,95%CI（-0.87,-0.26）,P=0.0003）,shortness of breath（WMD=-1.07,95%CI（-1.63,-0.52）,P=0.0001）,wheezing（WMD=-0.76,95%CI（-0.99,-0.54）,P<0.00001）,fatigue（WMD=-0.81,95%CI（-1.25,-0.38）,P=0.0003）,and the therapeutic effect is far better than Western medicine alone;In reducing SGRQ score（WMD=-7.01,95%CI（-10.00,-4.02）,P<0.00001）,prolongating6-minute walking distance（WMD=31.36,95%CI（21.11,41.61）,P<0.00001）,improving lung function TLC%（WMD=5.00,95%CI（2.77,7.23）,P<0.0001）,FVC（WMD=0.4,95%CI（0.24,0.57）,P<0.00001）,FEV1/FVC%（WMD=6.59,95%CI（5.37,7.80）,P<0.00001）,DLCO%（WMD=4.40,95%CI（2.67,6.13）,P<0.00001）,decreasing Pa CO₂（WMD=-2.95,95%CI（-3.98,-1.91）,P<0.00001）,increasing Pa O₂（WMD=6.75,95%CI（4.32,9.19）,P<0.00001）,down-regulating serum TGF-β1（SMD=-0.89,95%CI（-1.57,-0.22）,P=0.01）and laminin（WMD=-13.70,95%CI（-20.40,-7.01）,P<0.0001）levels,the alliance of traditional Chinese medicine with the efficacy of reinforcing Qi,nourishing Yin,dissolving phlegm and dispelling blood stasis therapy with Western medicine is better than that of Western medicine alone.The adverse reactions occurred in 4 literatures described the two groups after treatment（RR=0.49,95%CI（0.20,1.18）,P=0.11）,and the results suggested that the occurrence of adverse events did not differ obviously between the two groups.The funnel plots of both the clinical therapeutic effect and cough score were asymmetric,suggesting that there was publication bias in the included literature.Conclusion:Using the method of reinforcing Qi,nourishing Yin,dissolving phlegm and dispelling blood stasis of traditional Chinese medicine has better effect than Western medicine treatment alone on improving clinical efficiency,allieviating IPF patients’symptoms,improving hypoxia,prolonging 6-minute walking distance,improving pulmonary function,reducing SGRQ score,down-regulating serum TGF-β1 and laminin levels.However,on account of the low overall quality of the literature included in this Meta-analysis,we need to carry out more high-quality clinical studies in the future,so as to improve the scientificity and rigor of the research and enhance the persuasion of the research results.