A Systematic Evaluation Of The Clinical Efficacy Of Integrated Traditional Chinese And Western Medicine In The Treatment Of Acute Respiratory Distress Syndrome

ObjectiveThis paper was aimed to evaluate the clinical efficacy and safety of integrated Chinese traditional and Western medicine therapy in the treatment of acute respiratory distress syndrome through qualitative systematic review and Meta-analysis of systematic reviews.MethodsLiterature retrieval:the subject headings and free words are combined with Boolean logic to work out retrieval strategies and retrieving expressions.The computer retrieval method is used to search the China National Knowledge Infrastructure,Wanfang Database,VIP Database,Chinese Biological and Medical Database,Traditional Chinese Medical Literature Analysisand Retrieval Database,PubMed,Embase,Cochrane Central Register of Controlled Trials,Chinese Clinical Trial Registry,and Clinical Trials.The published literatures,grey literatures,and unpublished research results about clinical randomized controlled trials are retrieved,which use TCM WM therapy to treat ARDS.The search period ranges in date from the day of construction to January 2017,and the retrieval language is Chinese and English.Literature management:The literatures are managed through NoteExpress 3.2.Appropriate literatures are found out whose data are collected according to the inclusion criteria and exclusion criteria for literature screening.The risk of bias about the appropriate literatures is evaluated through the Cochrane Collaboration's tool for assessing risk of bias.Statistical analysis:Meta-analysis is performed with Review Manager 5.3.The dichotomous variables select the relative risk as the effect-quantities,and the continuous variables select the weighted mean difference or standardized mean difference as the effect-quantities.Heterogeneity of some research results is tested,and the results of heterogeneity tests are expressed as I² values.The fixed effect model or the random effect model is used to merge effect-quantities.The sensitivity analysis is used to find the heterogeneity source and evaluate whether or not some results of Meta-analysis is stable and reliable.If the heterogeneity is too large to solve,only the descriptive analysis will be performed with the merger undone.The combined effect-quantities are tested by the u test and the 95%confidence interval.Meta-analysis results are illustrated in forest graphs and a funnel plot is drawn to identify whether there is a publication bias.ResultsSearch and screening results:3625 articles were searched.16 articles that meet the criteria were found out.Meta-analysis results:compared with Western medicine treatment,the addition of Traditional Chinese Medicine,?could reduce mortality[I² = 0%,RR = 0.51,95%CI =?0.40,0.64?,P<0.00001],which was reliable result,and of which publication bias was small;?improve the effective rate of clinical treatment[I² = 0%,RR= 1.32,95%CI=?1.11,1.57?,P = 0.002],which was reliable result;?reduce the mean duration of mechanical ventilation[I² = 0%,SMD =-1.31,95%CI =?-1.75,-0.88?,P<0.00001],which was reliable result;?improve Pa02/Fi02[I² = 0%,MD = 34.76,95%CI =?27.20,42.31?,P<0.00001];?reduce IL-6[I² = 0%,MD =-9.97,95%CI =?-12.47,-7.48?,P<0.00001];?reduce IL-8[I² = 0%,MD =-7.46,95%CI =?-9.77,-5.15?,P<0.00001].Results of descriptive analysis:compared with the control group,TCM WM therapy could reduce APACHEII score,down TNF-?.No evidence showed that the addition of Traditional Chinese Medicine would increase the adverse drug reactions.ConclusionsClinical efficacy evaluation:based on the result of this systematic review,TCM WM therapy for ARDS was comparatively much promising.?Compared with Western medicine treatment,TCM WM therapy could significantly reduce mortality,reduce APACHEII score,improve disease prognosis.?Compared with Western medicine treatment,TCM WM therapy could significantly improve the efficiency of clinical treatment,manifested in the improvement of PaO₂/FiO₂,reduction of the mean duration of mechanical ventilation,and the promotion of respiratory function recovery and so on.Therapeutic mechanism:compared with Western Medicine treatment,TCM WM therapy could significantly down-regulate IL-6,IL-8 and TNF-?,which may reduce inflammation and decrease lung tissue injury by down-regulating inflammatory mediators.Safety analysis:no evidence showed that the addition of Traditional Chinese Medicine would increase the adverse drug reactions.The systematic review has some limitations.The reliability of the systematic review conclusions was limited.So these conclusions need more large samples,high-quality clinical randomized controlled trials to reevaluate.