Study On The Efficacy Of Integrated Traditional Chinese And Western Medicine In The Treatment Of Hepatitis B-related Acute On Chronic Liver Failure Based On Data Mining

Objective1.Based on the theory of attribute partial order,taking "Chinese Medical Classics" as the research object,this paper collects the medical records of jaundice treated by famous doctors in the late Ming and early Qing Dynasties,analyzes the medication experience and syndrome differentiation and treatment rules of jaundice treated by doctors in the late Ming and early Qing Dynasties,in order to provide reference for the treatment of jaundice.2.Based on the four Chinese databases commonly used in China,this paper uses the partial order theory to mine the data of clinical research on the treatment of HBV-ACLF with traditional Chinese medicine,and studies the rules of prescription,traditional Chinese medicine and dosage involved in the treatment of HBV-ACLF with traditional Chinese medicine,so as to provide reference for the treatment of HBV-ACLF with traditional Chinese medicine.3.In this paper,we introduced the characteristic methods of traditional Chinese medicine in the treatment of HBV-ACLF,including traditional Chinese medicine decoction,injections,oral administration,retention enema,and other different usages.On the basis of various mainstream comprehensive therapies of Western medicine,we applied one or more of them in a randomized controlled trial,using the evaluation system and Stata method proposed by international famous Cochrane The statistical software comprehensively studied the curative effect of single or multiple traditional Chinese medicine methods in the treatment of HBV-ACLF on the basis of comprehensive therapy of Western medicine,respectively from the aspects of heat cleaning and blood cooling method,heat cleaning and dampness removing method,oral Chinese medicine of Warming Yang and removing blood stasis method and clinical curative effect of rhubarb and Wumei Decoction enema combined with western medicine in the treatment of HBV-ACLF,and further studied the effect of combined treatment of traditional Chinese medicine and Western Medicine on HBV-ACLF The purpose of this study is to find a better scheme for the clinical treatment of HBV-ACLF,and to provide data support and theoretical basis for the discussion of the mechanism of the treatment of HBV-ACLF.Methods1.Taking the medical records as the object,symptoms,prescriptions,drugs and drug dose as the attributes,the partial order structure chart of each attribute is generated to further analyze the medication experience and the rule of syndrome and treatment of jaundice in the late Ming and early Qing Dynasties.2.Based on the core prescription,traditional Chinese medicine and dosage used in clinical research,the formal backgrounds of "research prescription","research traditional Chinese medicine" and "research dosage" were constructed.And optimize,generate partial order structure diagram,further study of traditional Chinese medicine treatment of HBV-ACLF involved in the prescription,traditional Chinese medicine,the law between the dose.3.Referring to Cochrane's manual on literature evaluation,the related literatures were searched mainly by computer and assisted by hand,and the RCT literatures of HBV-ACLF treated by Integrated Traditional Chinese and Western medicine were screened out.After the preliminary screening of the literature,further review of its abstract and full text,screened out the different methods and outcome indicators of traditional Chinese and Western medicine comprehensive treatment of HBV-ACLF RCT literature.The literatures were screened according to the inclusion criteria and exclusion criteria,and the included literatures were extracted one by one according to the relevant information in the table.The quality of the included articles was evaluated according to the bias risk assessment tool of Cochrane Handbook version 5.1 and the improved Jadad score scale.Stata 12.0 software was used for statistical and meta-analysis.Results1.1 Taking the case as the object and symptoms as the attribute,we found the typical phenotypes of jaundice,that is,yellow eyes,yellow body and yellow urine.However,the medical records in the late Ming and early Qing Dynasties mainly described red urine.In addition,jaundice is more damp and hot,which is easy to cause the problem of insufficient acceptance of the spleen and stomach,so it is also a common symptom.1.2 Taking cases as the object and prescriptions as the attribute,it is found that famous doctors in the late Ming and early Qing dynasties used less direct prescriptions in the treatment of jaundice,and more flexible addition and subtraction with syndrome.1.3 Taking the case as the object,taking the traditional Chinese medicine as the attribute,the most commonly used traditional Chinese medicine include Artemisia capillaris,Poria cocos,Gardenia jasminoides,Alisma orientalis.There are also common combinations,such as Yinchen and gardenia,tangerine peel,Magnolia officinalis and licorice;Poria cocos is often used with gardenia,Alisma orientalis,tangerine peel,Magnolia officinalis and Fructus aurantii;gardenia is often used with Alisma orientalis,Atractylodes macrocephala,coix seed,licorice and trichosanthin.1.4 It is difficult to compare and unify the different doses of drugs used by various doctors.Combined with the dose unit of Qing Dynasty and the conversion of current dose,the total dose of Gardenia jasminoides Ellis is about 8 g,Alisma orientalis is about 6 g and tangerine peel is about 4 G.2 Combined with the prescriptions involved in each cluster layer in the partial order structure diagram of prescriptions,it is found that the method of clearing heat and cooling blood is a common basic method for the treatment of hbv-aclf.On the basis of cooling blood and detoxifying,the method of removing blood stasis is often used.The method of clearing heat and removing dampness is also a common method for the treatment of hbv-aclf.In addition,some of them also use the method of Warming Yang and removing blood stasis for the treatment of hbv-aclf.Artemisia capillaris,radix paeoniae rubra and Radix Salviae Miltiorrhizae are commonly used in the treatment of hbv-aclf.The commonly used drug pairs also include radix salviae miltiorrhizae,Rhizoma Atractylodis Macrocephalae,Rhizoma Atractylodis Macrocephalae and Fructus Gardeniae.In terms of dosage,Yinchen 30 g is the most commonly used,followed by Danshen 30 g,Baizhu 30 g,Yujin 15 g,Chishao 60 g,Hedyotis diffusa 30 g,Fuling 15 g,gardenia 10 g.Combined with the included studies,it is found that the drug group is the core drug of Liangxue Jiedu Huayu Prescription.3.1 All the literatures included in this study are in Chinese,which do not involve the description of blind method and random allocation concealment.The Jadad score shows that the highest score is only 3 points,and the overall quality of the literature is relatively general.3.2 The results showed that the combined effect value of 20 RCT literatures on PTA evaluation was 0.88,95% CI(0.77,0.99),19 literatures on TBIL evaluation,SMD was-1.22,95% CI(-1.62,-0.83),18 literatures on clinical efficacy evaluation,and the homogeneity was good,the combined effect value RR was 1.25,95% CI(1.16,1.35),17 The combined effect value(SMD)was-0.89,95% CI(-1.25,-0.53),and the combined effect value(SMD)was-0.70,95% CI(-1.00,-0.39).The survival rate and ALB were evaluated in 13 RCT literatures.The results showed that the combined effect value of Qingre Liangxue regimen on HBV-ACLF was-0.70,95% CI(-1.00,-0.39)The improvement of TBIL,PTA,alt,AST,ALB,effective rate and survival rate of the patients was better than that of the single regimen,and there was a statistically significant difference(P < 0.0001).3.3 The 8 RCT literatures on the evaluation of PTA were homogeneous,and the combined effect value(SMD)was 0.69,95% CI(0.53,0.85).A total of 7 literatures were involved in the evaluation of clinical efficacy and alt.Six studies on standard ALB were included,and the combined effect value(SMD)was 0.74,95% CI(0.30,1.18).Five studies on the change of TBIL were included,and the combined effect value(SMD)was-0.94,95% CI(-1.39,-0.50).Four literatures evaluated the standard ast,and the combined effect value(SMD)was-0.56,95% CI(-0.92,-0.21).It suggested that the clinical effective rate of combined therapy of cleaning heat and diuresis on patients and PTA,alt,ALB,AST,TBIL It is better than western medicine alone.3.4 The method of Warming Yang and removing blood stasis can improve HBV-ACLF The combined effect value(SMD)was 0.95,95% CI(0.37,1.53).There were 5 studies on the changes of AST and TBIL.The combined analysis showed that the improvement of PTA,AST and TBIL in the combined treatment group was significantly better than that in the control group.3.5 Using rhubarb and mume as the main medicine enema external treatment combined with western medicine routine treatment can improve HBV-ACLF The clinical effective rate and survival rate of TBIL were 1.03,95% CI(0.63,1.42),1.0,95% CI(-1.58,-0.43)and-1.05,95% CI(-1.36,1.42)respectively,-74),there were 5 literatures on ALT and AST indexes,which were analyzed respectively after combination.The results showed that the improvement of liver function indexes such as effective rate,survival rate,PTA and blood ammonia of combined treatment scheme was significantly better than that of simple western medicine scheme.Conclusion1.This study is the first study on jaundice and HBV-ACLF by using the theory of attribute partial order.It is also an innovative summary of the treatment experience of jaundice in the special historical period of late Ming and early Qing Dynasty,and excavates the prescriptions and rules of clinical research on HBV-ACLF by Chinese Medicine published in China.Although its deep-seated laws need to be further explored,it is of certain reference value to apply this theory with distinctive mathematical characteristics to the inheritance of the experience of famous Chinese medicine and the treatment experience of famous doctors in past dynasties.2.At present,the RCT literature of integrated traditional Chinese and Western medicine in the treatment of HBV-ACLF are all concentrated in Chinese language,and the overall quality is low.On the basis of comprehensive treatment of Western medicine,combined with Qingre Liangxue method,Qingre Lishi method,Wenyang Huayu method,Dahuang Wumei Decoction enema can improve the efficiency of clinical treatment of HBV-ACLF patients,reduce the short-term mortality of patients,and effectively reduce the liver enzyme index and bilirubin level of patients,so as to improve the liver function and coagulation function.The safety of integrated traditional Chinese and Western medicine in the treatment of HBV-ACLF is high,and the incidence of adverse events is low.