| ObjectiveTo evaluate the efficacy and safety of traditional Chinese medicine in the treatment of myasthenia gravis through the systematic review.Investigating the characteristics of myasthenia gravis,including the TCM Pathogenesisthe rules of treatment and the chinese herbal medicine used By analysising the RCTs included in this study.MethodSearching the Chinese and the English databases,then collected the clinical trials of traditional Chinese medicine in the treatment of MG according to the standard as mentioned.Assess the methodological quality of the included studies and extract the relevant information.Use the Revman 5.3 to analyze some of the outcome indicarors.AS the same time,analysing the TCM Pathogenesis、the rules of treatment and the chinese herbal medicine of the disease.ResultsThis systematic review includes 31 studies,2922 MG patients,The quality of the literature included in the study is generally not high.We divide the 31 studies into two subgroups:traditional Chinese medicine combined with western medicine VS western medicine,and traditional Chinese medicine VS western medicine.The results are as follows:1 Primary Outcome indicator1.1 The incidence rate of MG crisisThe incidence of MG crisis was significantly decreased compared with Western medicine alone,whose treated by the traditional Chinese medicine combined with western medicine,and the difference was statisti-cally significant(FE,OR=0.08,95%CI=[0.02,0.23],P<0.00001);There was no significant difference in the incidence of MG crisis between traditional Chinese medicine and western medicine(OR=0.19,95%CI=[0.01,4.07],P=0.29);1.2 Relapse rate of MGTraditional Chinese medicine combined with the western medicine is superior to Western medicine alone in reducing the relapse rate of MG(FE,OR=0.08,95%CI=[0:05,0.15],P<0.00001);Simply using traditional Chinese medicine is also better than using Western medicine alone in this outcome(OR=0.03,95%CI=[0.01,0.14],P<0.00001);1.3 Quality of LifeThe three studies were compared between traditional Chinese Medicine combined with Western medicine and western medicine alone:He T 2016 has a large heterogeneity with two other studies so it was analyzed separately.The results showed that SMD=0.62,95%CI =[0.11,1.14].P=0.02;the remaining two studies(Ma Y 2016,Qian RY 2017)were combined to analyze,the results were:SMD=0.30,95%CI=[-0.90,0.29],P=0.32>0.05,The difference was not statistically significant.2 Secondary Outcome2.1 Effective rateThere was no significant difference in efficacy between TCM and western medicine(RE,OR=3.30,95%CI=[0.68,15.98];P=0.14);the efficacy of TCM combined with western medi-Cine in treating this disease was higher than that of western medicine group(RE,OR=4.07,95%Cl=[2.72,6.11],P<0.00001);2.2 Efficacy of TCM syndromesThe combination of TCM with western medicine and simple use TCM was superior to western medicine alone.The results were:OR=4.15,95%CI=[1.87,9.20],P=0.0005,OR=10.29,95%CI=[4.35,24.37],P<0.00001;2.3 Clinical Absolute ScoresThe score of TCM combined with western medicine group is lower than that of western medicine group(RE,SMD=0.40,95%CI=[-0.67,-0.13],P = 0.003);There was no significant difference between the TCM group and the western medicine group(Chang YT 2016,SMD=-1.05,95%CI=[-1.57,-0.52],P<0.0001;Xu FQ 2006,SMD=-0.03,95%CI=[-0.54,0.47],P=0.89);2.4 The score of QMGThe score of QMG in the TCM combined with western medicine is superior to western medicine alone(FE,SMD=-0.66,95%CI=[-0.97,-0.35],P<0.0001);2.5 The scores of TCM syndromeBoth TCM combined with western medicine group and TCM group are superior to western medicine group in reducing the scores of TCM syndrome.The results are:FE,SMD=-0.70,95%CI=[-0.87,-0.54],P<0.0001;SMD=-3.98,95%CI=[-4.87,-3.08],P<0.00001.2.6 AChRab levelsThere is no definitive conclusion on the improvement of AChRab levels between the TCM combined with western medicine group and western medicine group:(Bao B 2016:SMD=-0.26,95%CI=[-0.77,0.25],P =0.32;Jiao J 2011:SMD=0.02,95%CI=[-0.52;0.57],P＝0.93;Jiang JD 2003:SMD=-0.17,95%CI=[-0.66,0.31],P=0.48;Shows that there is no Obvious difference between the two groups,but Tian T 2013:SMD=-1.01,95%CI=[-1.54,-0.47],P=0.0003;Wang SH 1999:SMD=0.65,95%CI=[0.25,1.05],P=0.001;Niu GH 2009:SMD＝-1.26,95%CI=[-1.82,-0.71];P<0.00001;Wu XC 2006:SMD=-1.07,95%CI=[-1.41,-0.73],P<0.00001;Yin YJ 2002:SMD=-0.80,95%CI=[-1.15,-0.44],P<0.0001;Zhang MZ 2010:SMD=-1.07,95%CI=[-1.61,-0.54],P<0.0001;Qi GY 2017:SMD=-1.24,95%CI=[-1.53,-0.94],P<0.00001,shows that the TCM combined with western medicine group is superior to the Western medicine group in improving AChRab levels in patients;There was no significant difference between the TCM group and the Western medicine group in improving AChRab levels(FE,SMD=0.16,95%CI=[-0.12,0.43],P=0.26);2.7 RNSThe results show that there is no significant difference between the TCM group and the Western medicine group(FE,SMD=0.06,95%CI=[-0.17,0.30],P=0.59).3 Safety Outcomes IndicatorsIn general,the mumber and types of adverse reactions in the control group are more than those in the test group.This systematic review selected three adverse reactions for analysis:①Gastrointestinal adverse reactions:The gastrointestinal adverse reactions of the TCM combined with western medicine group are less than that of the western medicine group(FE,OR=0.09,95%CI=[0.02,0.39],P=0.002);there was no obvious difference betweenTCM group and the western medicine group.(RE,OR=0.68,95%CI=[0.02,22.30],P=0.83);② Hair growth:This adverse reaction in the TCM combined with Western medicine group is lower than in the Western medicine group:Wu XC 2006(OR=0.10,95%CI=[0.04,0.25],P<0.00001);Wang HT 2010(OR=0.01,95%CI=[0.00,0.05],P<0.00001);③Central obesity:This adverse reaction both in the TCM combined with Western medicine group and in the TCM group is lower than in the Western medicine group(FE,OR=0.07,95%CI=[0.03,0.14],P<0.00001;FE,OR=0.05;95%CI=[0.01,0.40],P＝0.005).4 The TCM Pathogenesis、the rules of treatment and the chinese herbal medicineThere are 28 studies refer the TCM Pathogenesis、the rules of treatment.In terms of the viscera,the disease was located in the spleen,kidney and liver.Among them,the spleen has a maximum of 22 times,accounting for 78.57%,followed by the kidneys,accounting for 60.71%,and once on the liver,accounting for 3.57%.There are four studies that suggest that the disease is closely related to the meridians,accounting for 14.29%.From the perspective of qi-blood-body fluid,The disease mainly involves qi and blood,and a few mention the deficiency of body fluids;From the perspective of excessive pathogen,the disease is related to wind evil,damp evil,and Toxin.A total of 60 Chinese herbs were included.The top ten were Astragalus,Atractylodes,Cimicifuga,Angelica,Codonopsis,Bupleurum,Licorice,Citrus,Poria,and Ephedra.The top eight Chinese herbs constitute Buzhong Yiqi Decoction.ConclusionsThe TCM combined with Western medicine can improve the clinical efficacy of MG,especially in the incidence of MG crisis,MG recurrence rate,effective rate,TCM syndrome efficiency,clinical symptoms,TCM syndrome scores.The use of TCM alone is equivalent to the use of western medicine,and its efficacy is only better than that of western medicine in terms of MG relapse rate,TCM syndrome efficiency,and TCM syndrome scores;Using TCM to treat this disease is safe and its side effects are small;The disease was located in the spleen,kidney and liver.The deficiency syndrome、deficiency syndrome and combination of both are the main TCM syndrome.The treatment consists of reinforce spleen and kidney together.A few scholars believe that its treatment should include soothing the Liver,it also should include dispelling、xeransis、detoxication.The most used drug is Astragalus(15-120g).The most commonly used formula is Buzhong Yiqi Decoction. |
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