A Systematic Review Of Chinese Medicine Enema For Hepatic Encephalopathy

Objective：To critically appraise the existing randomized controlled trials（RCT） on Traditional Chinese medicine enema（TCM enema） for hepaticencephalopathy （HP）, summarize the status of clinical research evidence,evaluate the efficacy and adverse reactions systematically. In order to providea higher level of evidence for clinical.Material and Methods：In this study, the systematic review of Cochranewas used to assess the RCTs included, extract and analyze the data, report anddiscuss the results, and give suggestions for improving:Search strategy The literature search was conducted in CNKI, VIP, CBM, WanFang DATA, and Medicine until December2013.Inclusion criteria All RCTs evaluate the efficacy and safety of enema for HPwere included.Enema versus non special treatment, placebo,or conventionaldrugs, such as various types of amino acids for the treatment of HP, etc. TCMenema used in combination with Western medicine medline combined therapy versusthe same therapy, placebo or another conventional drugs. Outcomes was the totalefficiency (including cure rate, markedly effective rate, efficient rate),recovery time,and blood ammonia levels.Data extraction and analysis The data was extracted according to the dataextraction methods in the Cochrane Collaboration Handbook,and I use the specialsoftware RewMan5.2review for the analysis and synthesis of the data. The meandifference (mean difference, MD) was used as effect evaluation for the Continuousvariables, and95%CI (confidence interval, CI) was provided; And relative risk(risk ratio, RR)was used for the discrete variables. Then I use Meta-analysisto test the heterogeneity for the studies that reported the same outcome,andselect the corresponding effects model.Results：30articles were included in the study, of which22reported a total efficiency (a total of935patients),10reported recovery time (a total of781patients),15reported the blood ammonia before and after the test(a total of1149patients).27trials reported total efficiency,of which13has the samecriteria according to the staging of HP developed, Meta-analysis of the overallefficiency of the13studies showed that there are differences(RR=1.19,95%CI:1.08-1.32, P <0.05)of the effect between the two groups, indicating thatthe test group was1.19times comparing the efficacy of the cure rate of thecontrol group, and the TCM enema treatment can improve the clinical effectiveness.10trials reported recovery time,the differences (RR=-13.45,95%CI:-13.78～-13.11, P <0.01),indicated that the recovery time of the test group is shorterthan the control group;13trials reported the blood ammonia, the difference(RR=-1.90,95%CI effect:-2.81～-0.99, P <0.01)indicated that the experimentalgroup has a better effect in reducing blood ammonia levels. Only two of the30articles reported there were no adverse reactions,the rest articles did notmention the problem.Conclusion：This systematic review showed that TCM enema has better clinicalefficacy. But due to the low quality of the research methods, we need more highschool quality, high homogeneity and completely reporting in results RCTs toget more specific accordance about the effect of TCM enema for HP, and determinethe effect better.