| Objective Psoriasis is a kind of chronic inflammatory disease characterized by red spots or papules covered with silvery white scales.According to different clinical symptoms,psoriasis can be divided into four types: ordinary type,pustular type,arthropathy type and erythroderma type,of which psoriasis vulgaris is the most common [1].The treatment of this disease has always attracted much attention.Western medicine mainly focuses on relieving symptoms,and most patients have a high recurrence rate after withdrawal of medicine,and the side effects are relatively large;compared with western medicine therapy,traditional Chinese medicine related therapy is more moderate,emphasizing individualized treatment,applying medicine according to people,with good curative effect and low recurrence rate,and less side effects.However,at present,there are many traditional Chinese medicine treatments for psoriasis vulgaris,and the previous clinical studies on the treatment of psoriasis vulgaris generally exist in the improper use of research methods,most of them stay in the summary of clinical experience,the efficacy evaluation indicators are not targeted,the number of cases is small,the research design is not standardized,and so on.From the perspective of evidence-based medicine,the level of clinical research is not high,and the lack of standardization of clinical literature reports.Therefore,it is urgent to seek more powerful evidence to guide clinical practice.This project takes psoriasis as the starting point,carries out evidence-based medicine research by using network-meta analysis to explore the better therapeutic intervention measures of Chinese Medicine in treating psoriasis,obtains high-quality evidence that can guide clinical practice.Methods First of all,the inclusion and exclusion criteria are set,and the retrieval of Chinese and English keywords is established.The first access is to search the professional literature databases at home and abroad in detail, and the other is to search the relevant literature in the manual retrieval of clinical trial registration system,clinical trial report papers,literature review,etc.We conducted a comprehensive search of Medline,EMBASE,Cochrane Library,CNKI,VIP,Wan Fang data from inception to January01,2020 by using Chinese and English terms such as“ Psoriasis”,“Papulosquamous”,“Palmoplantaris pustulosis”,“psoriaasics”,“acupuncture”,“electro-acupuncture”,“warming needling”,“fire needling”,“bloodletting”,“auriculoacupuncture”,“auricular”,“moxibustion”,“cupping”.According to the content of the extraction table,the evaluation form is designed in advance with the data extraction spreadsheet,in which during the data extraction process the quality evaluation of each study is carried out independently by two researchers from the clinical research and data center of Guangzhou University of traditional Chinese medicine acupuncture and rehabilitation clinical medical college(when the information extracted by the two persons is inconsistent,they shall discuss with each other to solve the problem first.If it still can not be solved,ask the person in charge of the data center to handle it.).The PASI score,total effective rate and adverse reactions of different intervention measures in the treatment of psoriasis vulgaris were evaluated by network diagram.The network-meta analysis based on Bayesian framework is calculated by using the “gemtc”(Version: 0.8-2)package under R(Version: 3.5.2)software,and the Monte Carlo simulation of Markov chain is carried out by calling JAGS(Version: 4.3.0)through “gemtc”,which was used to compare the curative effect of different acupuncture and moxibustion intervebtions in the literature by direct and indirect comparison involing the method of node separation used to show the forest maps,and the relative effect of each intervention on PASI score of psoriasis vulgaris was compared by ladder tables under Bayesian framework,combined with the probability maps.The best interventions were selected and the higher quality evidences are acquired by quantitative sequencing.Results Included results:by searching the databases of Chinese and foreign country,15057 results were identified.The number of hits in each database is as follows:Pub Med 1666,EMBASE 4046,Cochrane Library 1638,CNKI 2302,VIP 524,Wanfang1520,CBM 3361,of which 7707 are Chinese and 7350 are English according to inclusion and exclusion criteria,1139 repetitive articles were eliminated,8717 articles were eliminated by reading titles and abstracts,and 4992 literatures were eliminated by reading the full text of the remaining 5201 articles,we identified 209 eligible randomised controlled trials,which published in 1997-2019 and basic information,subjects,sample size,intervention measures,treatment course and outcome indicators of RCTs were extracted.All of eligible studies were conducted in China and published in Chinese or English.Basic characteristics: 209 articles were published from 1997 to 1997 In2019,the language of publication was Chinese or English.After quality evaluation,it was found that the literature generally had defects such as insufficient randomization,concealment of distribution,lack of blind method and failure to describe the number of dropouts.Among them,154 articles related to PASI,200 articles related to total effective rate and 139 literatures mentioned adverse reactions.In terms of randomization,there were69 articles that used random number table method,1 paper used random envelope method,1 paper used coin throwing method,1 paper used random drawing method,1 paper used SPSS random and SAS random,1 article used block random,13 articles according to the order of treatment,and 112 articles mentioned random number table method,and 9 articles were not clear whether they were random.From the perspective of distribution concealment,there are 1 article that is not perfect,205 articles are not explained clearly,only 3 articles are correctly allocated and hidden,and 3 of them adopt the sealed envelope method to realize the hidden grouping.From the perspective of the application of blind method,there were 8 articles correctly using blind method,including4 articles with double-blind method,2 articles with wrong blind method,and199 articles without mentioning blind method.From the integrity of the results,most of the data reported missing cases,a total of 192 complete reports,some reports of shedding and follow-up were not paid attention to,there were 5incomplete reports and 12 unclear reports.According to the selective reports,there were 38 complete reports and 171 unclear reports.Most of them did not mention the registration of clinical studies or the publication of protocol.The information was insufficient and difficult to judge.Most of them were unknown risks.Other aspects of bias are not clear.Results:(1)in terms of PASI score,only fire needle [-4.79(-7.64,-1.96)],cupping [-4.25(-7.58,-0.94)],traditional Chinese medicine prescription [-3.77(-5.82,-1.71)],traditional Chinese medicine bath [-4.13(-6.45,-1.80)],Tripterygium Glycosides [-4.04(-6.41,-1.68)] and total glucosides of paeony [-4.29(-7.36,-1.25)] were better than placebo(P < 0.05).(2)Compared with placebo,there were only fire needle [2.64(1.80,3.49)],walking cupping [4.00(2.75,5.34)],self blood therapy [2.77(1.30,4.32)],TCM prescription [2.41(1.77,3.09)],Chinese patent medicine [2.04(1.31,2.80)],TCM bath [2.80(2.06,3.55)],ointment [2.16(1.41,2.93)],compound glycyrrhizin [2.24(1.47,3.04)],total effective rate [2.04(1.31,2.80)],bath [2.80(2.06,3.55],ointment [2.16(1.16(1.41,2.93)],compound glycyrrhizin [2.24(1[2.53(1.30,83)] were higher and statistically significant(P < 0.05).(3)In terms of the incidence of adverse reactions,the adverse reactions reported in this study included mild gastrointestinal discomfort,dry skin erythema,dyslipidemia,cheilitis,headache and tinnitus,liver and kidney dysfunction and other adverse reactions,which are all mild reactions,and can be recovered by stopping taking drugs or basic symptomatic treatment.Compared with placebo,only Tripterygium wilfordii polyglycoside[-39.13(-86.49,-5.07)],xiyaogao [-42.67(-123.27,-1.76)] and diyinpian[2.14(0.26,4.16)] had higher adverse reaction rate,and the difference was statistically significant(P < 0.05).Under the Bayesian framework,by comprehensively comparing the MD value of PASI score,or value of total effective rate and or value of adverse reaction rate of different intervention measures,the advantages and disadvantages of efficacy and safety were sorted,and finally the PASI score of traditional Chinese medicine treatment of psoriasis vulgaris was obtained.The results were as follows: Traditional Chinese Medicine > ultraviolet radiation >acitretin > xiyaogao > compound glycyrrhizin > electroacupuncture > conclusion:Traditional Chinese Medicine > ultraviolet radiation > acitretin > xiyaogao >compound glycyrrhizin > electroacupuncture > traditional Chinese Medicine >ultraviolet radiation > Avia > Diyin tablet > xiyaogao > compound glycyrrhiz Results: the order of total effective rate was as follows: Traditional Chinese medicine prescription > electroacupuncture > Chinese medicine bath >traditional Chinese medicine bath > electroacupuncture > traditional Chinese medicine bath > tripterygium glycosides > fire needle > moving cupping > fire needle > moving cupping > Oxymatrine > compound glycyrrhizin > Chinese patent medicine > total glucosides of paeony > acupuncture > Western Medicine > ultraviolet radiation > auricular acupuncture > Avia > Diyin tablets > Western Medicine > bloodletting therapy > self blood therapy The order of adverse reaction rate was: Tripterygium wilfordii polyglycoside > western medicine ointment > fire needle > Western Medicine > Chinese patent medicine > placebo >traditional Chinese medicine bath > Chinese medicine ointment > matrine >compound glycyrrhizin > western medicine ointment > total glucosides of paeony > electroacupuncture > acitretin > ultraviolet radiation > Diyin tablets > moving cupping > auricular acupuncture.Conclusion In this study,we compared the efficacy of various Chinese Medicine therapies onpsoriasis by using Network meta method and found that ZYF treatment may be the best therapy in improving the score of PASI and increasing overall response rate and found that it was safety in treating psoriasis. |
