Chinese Medicine Combined With Western Medicine In The Treatment Of Spontaneous Bacterial Peritonitis In Liver Cirrhosis: Systematic Review And Meta Analysis

Purpose: Integration of traditional and Western medicine(ITWM)has been widely used in China for the treatment of many diseases.Spontaneous bacterial peritonitis(SBP)is one of the most common complications of liver cirrhosis.Antibiotics are the main treatment regimen of SBP.ITWM may be a promising alternative for the treatment of spontaneous bacterial peritonitis(SBP).Our study aimed to 1)evaluate the effcacy and safety of ITWM for the treatment of SBP in liver cirrhosis and 2)overview the efficacy of Xuebijing injection combined with antibiotics for the treatment of SBP.Material and method:1.Pub Med,China National Knowledge Infrastructure,Wanfang,and VIP databases were searched electronically from inception to July 2016 to collect all randomized controlled trials(RCTs)about ITWM for the treatment of SBP in cirrhotic patients;2.We searched the Pub Med,Embase,China National Knowledge Infrastructure,VIP,and Wanfang databases.The search items included “Xuebijing”,“peritonitis”,“liver cirrhosis”,and “random” to identify all relevant RCTs.The Cochrane risk of bias tool was used to assess the study quality.The odd ratios(ORs)with 95% confidence intervals(CIs)were calculated by using a random-effect model.Heterogeneity was also calculated.Results 1.A total of 42 RCTs were included.Rhubarb,Red Paeony Root,and Danshen Root were the three most commonly used traditional Chinese medicine(TCM)drugs;the third-generation cephalosporins were the most commonly used antibiotics.All included studies reported the effectiveness rate(ITWM group: 58.33–96.00%;control group: 32.20–93.75%);41 studies showed a higher effectiveness rate in the ITWM group;and 38 studies found a significant difference.All included studies reported the cure rate(ITWM group: 9.00–95.00%;control group: 3.00–77.00%);41 studies showed a higher cure rate in the ITWM group;and 10 studies found a significant difference.Four studies reported the mortality(ITWM group: 5.10–18.33%;control group: 7.69–52.78%)and showed a lower mortality in the ITWM group;and two studies found a signifcant difference.Six studies reported the adverse events(ITWM group: 0.00–13.33%;control group: 0.00– 59.52%);fve studies showed a lower rate of adverse events in the ITWM group;and four studies found a signifcant difference.2.A total of 9 RCTs were included.The study quality was unsatisfied.The overall(OR=2.95,95%CI=1.97-4.42,p<0.00001)and complete(OR=2.18,95%CI=1.57-3.04,p<0.00001)responses were significantly higher in the Xuebijing injection combined with antibiotics group than the antibiotics alone group.The incidence of cirrhosis related complications,including hepatic encephalopathy and hepatorenal syndrome,was lower in the Xuebijing injection combined with antibiotics group than the antibiotics alone group.No significant heterogeneity was observed among studies.Conclusion 1.ITWM might be effective and safe for the treatment of SBP.Further well-designed highquality studies are needed to confrm the effectiveness and safety of ITWM for the treatment of SBP.2.Additional use of Xuebijing injection may improve the efficacy of antibiotics for the treatment of SBP in liver cirrhosis.However,due to a low level of current evidence,we did not establish any recommendation regarding the use of Xuebijing injection for the treatment of SBP.