A Network Meta-analysis Of Traditional Chinese Medicine Injection In The Treatment Of Acute Exacerbation Of COPD

Purpose:In this study,the network meta-analysis method was used to systematically study the efficacy of Chinese medicine injection on all aspects of acute exacerbation of chronic obstructive pulmonary disease（COPD）,so as to obtain the best therapeutic intervention measures and provide higher quality evidence-based evidence for TCM treatment of acute exacerbation of COPD in clinical practice.Materials and Methods:Randomized controlled trials（RCTS）of different Chinese medicine injections in the treatment of acute exacerbation of COPD were collected by searching CNKI,Wanfang Medical Database,VIP,Sinomed and other databases.The retrieval time was from January 2006 to December 2020,and the library collection was manually searched in order to supplement and obtain relevant references.Two researchers independently conducted literature screening,data acquisition and cross-checking.The quality of the included literatures was evaluated with reference to the Cochrane systematic evaluation manual.Addis software was used to conduct mesh meta-analysis of the data.Results:Fifty-six randomized controlled trials involving 5267 patients with acute exacerbation of COPD were included,with 56 references.Involved a total of 13 kinds of traditional Chinese medicine injection will net injection（blood,phlegm hot fluids,xi phlogistic flat injection,asarone injection,qing ling injection,toxic heat ning injection,and attached to the injection and salvia miltiorrhiza injection,injection,Dan red injection,huangqi injection,injection of"chuan xe,heartleaf houttuynia herb injection）and eight different ending index（total effective rate,FEV₁ and FVC%,PaO₂,PaCO₂,CRP and PCT,the WBC）.The results of mesh meta-analysis show that:1.The total effective rate was a dichotomous variable,and 0R was taken as the effect size.As can be seen from the figure,compared with the conventional treatment of western medicine,the intervention measures of traditional Chinese medicine injection combined with conventional treatment except Qingkailing and Shenfu were all superior to conventional treatment of western medicine（P<0.05）.2.Lung function:FEV₁%was a continuous variable,and MD was selected as the effect size.As can be seen from the figure,there was no statistically significant difference between various interventions.MD was used as the effect size for FVC,and there was no statistically significant difference among the interventions in the figure.3.Blood gas index:MD was selected as the effective quantity of PaO₂.Compared with conventional treatment,Reduning（MD:10.48,95%CI:3.06,17.78）showed a statistically significant difference（P<0.05）,while other intervention measures showed no statistically significant difference.Md was selected as the effect size of PaCO2.Compared with conventional treatment,Asarum brain（Md:-14.12,95%CI:-23.23,-2.87）showed statistically significant difference（P<0.05）.There was no significant difference among other interventions.3.The inflammatory indicators:CRP using MD as the effect quantity.Compared with conventional treatment,Reduning（MD:-19.17,95%CI:-27.23,-10.64）and Tanreqing（MD:-5.12,95%CI:-8.94,-1.63）had the ability to reduce CRP,and the difference in CRP was statistically significant（P<0.05）.Pairwise comparison among all injections showed that Reduning was better than Shenfu,Shenmai and Tanreqing（P<0.05）,and there was no statistical significance in the pairwise comparison among other interventions.MD was selected as the effect size for PCT.According to the data in the figure,there was no statistical significance in the pair comparison results between the intervention measures for the outcome indicator PCT.MD was selected as the effect size for WBC,and pairwise comparison of drugs showed no statistically significant difference.Addis software is used to sort the probability.1.In terms of total efficiency,the order of total efficiency probability from high to low is:Astragalus membranaceus injection+conventional treatment Rank1 probability（0.37）>clear open spirit injection+conventional treatment Rank1probability（0.26）>ginseng injection+conventional treatment Rank1 probability （0.12）>Dan red injection+conventional treatment Rank1 probability（0.11）>asarone injection+conventional treatment Rank1 probability（0.06）>injection+conventional treatment can be cured for（0.02）Rank1 probability=salvia miltiorrhiza injection+conventional treatment（0.02）Rank1 probability=blood will net injection+conventional treatment Rank1 probability（0.02）>xi phlogistic flat to note Ejection fluid+conventional treatment（RANK1 probability 0.01）=Tanreqing injection+conventional treatment（RANK1 probability 0.01）>Reduning injection+conventional treatment（RANK1 probability 0.00）=conventional treatment of Western medicine（RANK1 probability 0.00）.2.In terms of improving FEV₁%,the ranking of FEV₁%probability from high to low is:Heartleaf houttuynia herb injection+conventional treatment（Rank1 probability of 0.19）>xi phlogistic flat injection+conventional treatment（Rank1 probability of 0.15）>astragalus membranaceus injection+conventional treatment（Rank1 probability of 0.12）>phlegm heat injection+conventional treatment（Rank1 probability of 0.10）=and injection+conventional treatment（Rank1 probability of 0.10）>blood will net injection+conventional treatment（Rank1 probability of 0.08）>toxic heat ning injection+conventional treatment（Rank1 probability of 0.07）>salvia miltiorrhiza injection+conventional treatment（Rank1 probability is 0.06）>for injection+conventional treatment can be cured（Rank1 probability of 0.04）=Dan red injection+conventional treatment（Rank1 probability of 0.04）=asarone injection+conventional treatment（Rank1 probability of 0.04）>and attached injection+conventional treatment（Rank1probability of 0.02）>clear open spirit injection+conventional treatment（Rank1probability of 0.00）=western medicine routine treatment（Rank1 probability is 0.00）.3.In terms of improving FVC,the order of FVC probability from high to low is:Heartleaf houttuynia herb injection+conventional treatment（Rank1 probability of0.49）>xi phlogistic flat injection+conventional treatment（Rank1 probability of0.19）>and attached injection+conventional treatment（Rank1 probability of 0.12）>xe injection+conventional treatment（Rank1 probability of 0.10）>asarone injection+conventional treatment（Rank1 probability of 0.08）>Dan red injection+conventional treatment（Rank1 probability of 0.02）>salvia miltiorrhiza injection+conventional treatment（Rank1 probability of 0.01）>phlegm heat injection+conventional treatment（Rank1 probability is 0.00）=Xuebijing injection+conventional treatment（RANK1 probability:0.00）=conventional treatment of Western medicine（RANK1 probability:0.00）.4.In terms of improving PaO₂,the order of probability of PaO₂ from high to low is:Toxic heat ning injection+conventional treatment（Rank1 probability of 0.55）>astragalus membranaceus injection+conventional treatment（Rank1 probability of 0.18）>phlegm heat injection+conventional treatment（Rank1 probability of 0.08）>xe injection+conventional treatment（Rank1 probability of 0.07）>ginseng injection+conventional treatment（Rank1 probability of 0.06）=xi phlogistic flat injection+conventional treatment（Rank1 probability of 0.06）>conventional western medicine therapy（Rank1 probability is 0.00）.5.In terms of improving PaCO₂,the order of probability of PaCO₂ from high to low is as follows:Asarone injection+conventional treatment（Rank8 probability of 0.77）>astragalus membranaceus injection+conventional treatment（Rank8 probability of 0.10）>ginseng injection+conventional treatment（Rank8 probability of 0.05）>xi phlogistic flat injection+conventional treatment（Rank8 probability of 0.04）>toxic heat ning injection+conventional treatment（Rank8 probability of 0.02）=phlegm heat injection+conventional treatment（0.02）>for injection+conventional treatment can be cured（Rank8 probability of 0.01）>conventional western medicine therapy（Rank8 probability is 0.00）.6.In terms of improving CRP,the order of CRP probability from high to low is as follows:Toxic heat ning injection+conventional treatment（Rank10 probability of 0.97）>asarone injection+conventional treatment（Rank10 probability of 0.02）>for injection+conventional treatment can be cured（Rank10 probability of 0.00）=salvia miltiorrhiza injection+conventional treatment（Rank10 probability of 0.00）=Dan red injection+conventional treatment（Rank10 probability of 0.00）=and attached injection+conventional treatment（Rank10 probability of 0.00）=and injection+conventional treatment（Rank10 probability of 0.00）=phlegm heat injection+conventional treatment（Ran K10 probability 0.00）=Xuebijing injection（RANK10probability 0.00）=conventional treatment of Western medicine（RANK10 probability 0.00）.7,in terms of improving the PCT,the probability of PCT sort order from high to low is:Dan red injection+conventional treatment（Rank6 probability of 0.51）>blood will net injection+conventional treatment（Rank6 probability of 0.23）>salvia miltiorrhiza injection+conventional treatment（Rank6 probability of 0.12）=phlegm heat injection+conventional treatment（Rank6 probability of 0.12）>conventional western medicine therapy（Rank6 probability is 0.00）.8.In terms of improving WBC,the order of probability of WBC from high to low is:Toxic heat ning injection+conventional treatment（Rank7 probability of 0.29）>blood will net injection+conventional treatment（Rank7 probability of 0.25）=heartleaf houttuynia herb injection+conventional treatment（Rank7 probability of 0.25）>astragalus membranaceus injection+conventional treatment（Rank7 probability of 0.11）>clear open spirit injection+conventional treatment（Rank7 probability of 0.08）>phlegm heat injection+conventional treatment（Rank7 probability of 0.01）>conventional western medicine therapy（Rank7 probability is 0.00）.Conclusion:1.General conclusion:Chinese medicine injection can effectively improve the level of lung function,blood gas index and inflammatory index in patients with acute exacerbation of chronic obstructive pulmonary disease.2.Total effective rate:Astragalus injection combined with western medicine conventional treatment had the best effect,and all kinds of Chinese medicine injection combined with conventional treatment had certain effect.3.Lung function:Houttuynia cordata combined with western medicine had the best effect.Xiyanping injection combined with conventional treatment was the second.4.Blood gas index PaO₂:Reduning injection combined with western medicine conventional treatment has the best effect.Blood gas index PaCO₂:Asarone injection combined with western medicine conventional treatment had the best effect.5.Inflammatory indexes CRP and WBC:Reduning injection combined with conventional treatment of western medicine had the highest probability of the best effect,and Reduning injection combined with conventional treatment was the best in improving CRP.Inflammatory index PCT:Danhong injection combined with western medicine conventional treatment had the highest probability of the best effect.6.Different TCM injections have their own advantages in improving different outcome indicators,and clinicians should choose the best TCM injection according to the specific situation of AECOPD patients.