| The paper is composed of literature review and systematic review.Literature reviewLiterature review of western medicine systematically summarized the research progress of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in definition,epidemiology,biomarkers,symptom assessment tools,treatment and prevention.Literature review of Traditional Chinese Medicine(TCM)summarized the research progress of COPD and AECOPD in name,symptom,etiology and pathogenesis,syndrome differention,treatment and rehabilation of TCM,and introduced the TCM treatment in mechanism of AECOPD,and put forward the prospect of TCM in the treatment of AECOPD.Systematic reviewObjects:To evaluate the efficacy and safty about AECOPD curing with TCM syndrome differentiation and treatment,and analyse the existing problem in RCTs of TCM intervention.Methods:To carry out computer retrieval about the published clinical studies of randomized controlled trials and relative Meta-analysis on AECOPD by TCM syndrome differentiation and treat-ment through CBM,CNKI,VIP,Wan Fang database,Cochrane Library,PubMed and Embase database using subject and random words like " acute exacerbation of chronic obstructive pulmonary disease ","Traditional Chinese Medicine","randomized",and the deadline till Jan.1,2017.And manage the literature by the software named EndNote8.Two researchers select literatue and extract information independently according to the inclusion and exclusion criteria.The third party handles the different ideas when they cannot reach an agreement.Then,to evaluate the methodology and reporting quality of the related literature according to the information of the RCTs.Extract data by software named Excel 2013 and analyse the data through Revman 5.3 and Stata 14.0.Results:18 pieces of randomized controlled trials,1955 patients were included.Two trials were published in English magazine,and all trials were carried out in China.There was no low-risk trials according to Cochrane bias risk assessment tools.There were 12 high-quality research and 6 low-quality research based on Jadad scale.Meta-analysis showed that TCM syndrome differentiation and treatment can increase clinical curative effect[n=1247;RR 1.19;95%(1.13,1.24);P<0.00001],shorten stays in hospital[n=413;MD-1.49;95%CI(-2.74,-0.24);P=0.02],decrease the score of TCM symptom[n=664,MD-1.95,95%CI(-2.67,-1.23),P<0.0001],relieve cough[n=660,MD-0.32,95%CI(-0.44,-0.20),P<0.00001],reduce the amount of phlegm[n=660,MD-0.24,95%CI(-0.37,-0.10),P=0.0004],improve FEV1[n=534,MD0.13,95%CI(0.05,0.21),P<0.0001]andFEV1/pred[n=626,MD4.56,95%CI(1.71,7.41),P=0.002],lower the CRP[n=120,SMD-0.4,95%CI(-0.76,0.03),P=0.03],regulate the balance of PH[n=604,MD 0.24,95%CI(0.08,0.40),P=0.003]and promote carbon dioxide discharge[n=724,SMD-0.39,95%CI(-0.54,-0.25),P<0.00001].Sensitivity analysis showed that the results of the Meta-analysis were stable and reliable.TCM are similar to western medicine in reducing the amount of leukocyte and percentage of neutrophile granulocyte(p>0.05),and the results were stable.TCM may superior to western medicine in remitting wheeze[n=660,MD-0.24,95%CI(-0.46,-0.02),P=0.03]and rhonchus[n=240,MD-0.33,95%CI(-0.64,-0.03),P=0.03],but both of the results are unstable.About 3/4 trials showed that TCM was similar to western medicine in controlling fever and 1/6 trials show that TCM much better in increasing FVC.Most studies showed that TCM was similar to western medicine in improving oxygenation.There was no serious adverse effect of TCM.Conclusion:Chinese medicine syndrome differentiation and treatment on AECOPD has good clinical effects and safety.These conclusions cannot be widely promoted due to the low-quality of the included research,not very reasonable index,unclear source of heterogeneous and publication bias.We need much more scientific and precise trials to evaluate the TCM intervwention and we should design the tirals according to the CONSORT statement. |
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