Can Chinese Herbal Medicine Adjunctive Therapy Improve Outcomes of Senile Vascular Dementia? Systematic Review with Meta‐analysis of Clinical Trials

Many publications have reported the growing application of complementary and alternative medicine, particularly the use of Chinese herbal medicine (CHM) in combination with routine pharmacotherapy (RP) for senile vascular dementia (SVD), but its efficacy remains largely unexplored. The purpose of this study is to evaluate the efficacy of CHM adjunctive therapy (CHMAT), which is CHM combined with RP, in the treatment of SVD. Publications in seven electronic databases were searched extensively, and 27 trials with a total of 1961 patients were included for analysis. Compared with RP alone, CHMAT significantly increased the effective rate [odds ratio (OR) 2.98, 95% confidence interval (CI) 2.30, 3.86]. In addition, CHMAT showed benefits in detailed subgroups of the Mini‐Mental State Exam (MMSE) score from time of onset to 4 weeks (WMD 3.01, 95% CI 2.15, 3.87), 8 weeks (weighted mean difference (WMD) 2.30, 95% CI 1.28, 3.32), 12 weeks (WMD 2.93, 95% CI 2.17, 3.69), and 24 weeks (WMD 3.25, 95% CI 2.61, 3.88), and in the activity of daily living scale score from time of onset to 4 weeks (WMD ?4.64, 95% CI ?6.12, ?3.17), 8 weeks (WMD ?4.30, 95% CI ?6.04, ?2.56), 12 weeks (WMD ?3.89, 95% CI ?4.68, ?3.09), and 24 weeks (WMD ?4.04, 95% CI ?6.51, ?1.57). Moreover, CHMAT had positive effects on changes in the Hasegawa dementia scale, National Institutes of Health Stroke Scale, Clinical Dementia Rating, and Montreal Cognitive Assessment scores, as well as blood fat levels (total cholesterol, triglyceride, high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol, and apolipoprotein E), platelet aggregation rate (1‐min platelet aggregation rate, 5‐min platelet aggregation rate, and maximal platelet aggregation rate), and blood rheology (whole‐blood viscosity and hematocrit). No serious or frequently occurring adverse effects were reported. Weaknesses of methodological quality in most trials were assessed using the Cochrane risk of bias tool, while the quality level of Grades of Recommendations Assessment Development and Evaluation (GRADE) evidence classification indicated ‘very low’. This systematic review suggests that CHM as an adjunctive therapy can improve cognitive impairment and enhance immediate response and quality of life in SVD patients. However, because of limitations of methodological quality in the included studies, further research of rigorous design is needed. Copyright © 2015 John Wiley & Sons, Ltd.     

喜炎平与利巴韦林治疗小儿手足口病疗效和安全性的系统评价

目的：从循证医学的角度系统评价喜炎平与利巴韦林治疗小儿手足口病的疗效和安全性。方法：通过全面检索喜炎平与利巴韦林治疗小儿手足口病相关的随机对照研究文献,进行质量评价,纳入合格文献进行Meta分析。结果：10个随机对照实验纳入系统评价,均为Jadad评分≥3分的研究。Meta分析结果显示喜炎平联合常规治疗在整体临床症状、退热、皮疹和口腔疱疹消退时间等方面均优于使用利巴韦林。整体临床疗效比较OR值为3.01,95%可信区间为2.41,4.23;退热、皮疹消退、口腔疱疹消退时间比较分别为[WMD=-0.85,95%CI（-0.99,-0.71）,P<0.000 01],[WMD=-1.65,95%CI（-1.82,-1.47）,P<0.000 01]和[WMD=-0.87,95%CI（-1.03,-0.71）,P<0.000 01],不良反应发生率对比OR值为0.39,95%可信区间为0.19,0.78。结论：喜炎平联合常规治疗用于小儿手足口病可能取得较利巴韦林联合常规治疗更好的效果且安全性良好,但由于纳入的研究方法学质量不高,尚需更多设计合理的高质量临床试验加以验证。     

Effectiveness and safety of Shenmai injection in treatment of shock:a Meta-analysis

OBJECTIVE:To evaluate the effectiveness and safety of Shenmai injection for shock.METHODS: Randomized controlled trials(RCTs)that evaluated the therapeutic effect of Shenmai injection on shock(including septic shock, cardiogenic shock, hypovolemic shock, neurogenic shock and anaphylactic shock) were included in this analysis. The major electronic databases were searched until May 2015. The methodological quality of the trials was assessed according to the Cochrane Handbook. Review Manager 5.3 and Stata 12.0 software were applied for data analysis.RESULTS: Thirty RCTs involving 2038 participants were included. The methodological quality of the trials was generally passable. The combined use of Shenmai injection and conventional medicine was significantly more effective at managing shock compared to conventional medicine alone in the outcomes of total effective rate [risk ratio(RR 1.25,95% confidence interval(CI) 1.18 to 1.31] and mortality rate [risk difference(RD)-0.10, 95% CI-0.17 to-0.02]. Likewise, improvements were observed in other metrics. Three trials reported adverse events, but no trial reported serious adverse effects.CONCLUSION: Our results indicated the potential effectiveness of Shenmai injection combined with conventional medicine treatment for shock. However, further rigorously designed trials are needed to collect and weigh up all the evidence for the use of Shenmai injection.     

中西医结合治疗哮喘随机对照试验的系统评价

目的:评估中西医结合治疗支气管哮喘的临床疗效。方法:检索PubMed(1988-2008)、CBMdisc(1978-2008)、CNKI(1980-2008)、VIP(1989-2008),纳入治疗组采用中西医结合疗法,对照组采用西药对照防治支气管哮喘的随机对照试验。纳入试验的方法学质量由两位评价员独立评价,采用RevMan4.2.10软件作meta分析。结果:共纳入26篇随机对照试验,全部研究方法学质量都被评为C级。Meta分析显示,总有效率合并效应值(OR=4.62,CI95%[3.40,6.29],P0.00001),FEV1合并效应值(WMD=0.29,CI95%[0.22,0.35],P0.00001),FEV1%合并效应值(WMD=3.57,CI95%[2.84,4.30],P0.00001),FVC合并效应值(WMD=0.32,CI95%[0.21,0.43],P0.00001),没有发现严重不良反应报道。结论:中西医结合治疗支气管哮喘较单纯西医治疗有更好的疗效,由于纳入研究均存在偏倚的高度可能性,尚需要更多高质量的随机对照试验来证明。     

The effects of grape seed extract on glycemic control,serum lipoproteins,inflammation, and body weight: A systematic review and meta‐analysis of randomized controlled trials

The aim of this systematic review and meta‐analysis was to analyze the effects of grape seed extract (GSE) on glycemic control and serum lipoproteins, inflammation and body weight. Two independent authors systematically searched online databases including EMBASE, Scopus, PubMed, Cochrane Library, and Web of Science from inception until May 30, 2019. Cochrane Collaboration risk of bias tool was applied to assess the methodological quality of included trials. The heterogeneity among the included studies was assessed using Cochrane's Q test and I‐square (I²) statistic. Data were pooled using a random‐effects model and weighted mean difference (WMD) was considered as the overall effect size. Fifty trials were included in this meta‐analysis. Pooling effect sizes from studies demonstrated a significant decrease in fasting plasma glucose (FPG) (WMD): ?2.01; 95% confidence interval (CI): ?3.14, ?0.86), total cholesterol (TC; WMD: ?6.03; 95% CI: ?9.71, ?2.35), low‐density lipoprotein (LDL) cholesterol (WMD: ?4.97; 95% CI: ?8.37, ?1.57), triglycerides (WMD: ?6.55; 95% CI: ?9.28, ?3.83), and C‐reactive protein (CRP) concentrations (WMD: ?0.81; 95% CI: ?1.25, ?0.38) following GSE therapy. Grape seed did not influence HbA1c, HDL cholesterol levels, and anthropometric measurements. This meta‐analysis demonstrated that GSE intake significantly reduced FPG, TC, LDL cholesterol, triglycerides, and CRP levels.     

Effect of supplementing Qi and promoting blood circulation therapy on left ventricular remodeling: a systematic review and Meta-analysis

OBJECTIVE: To evaluate the effectiveness of an adjuvant therapy from Traditional Chinese Medicine for supplementing Qi and promoting blood circulation(CMSQPBC) on left ventricular remodeling in patients after myocardial infarction(MI).METHODS: Randomized controlled trials were identified in the Cochrane Library, Embase, Web of Science, PubMed, China National Knowledge Infrastructure Database, Chinese Biomedical Literature Database, China Science and Technology Journal Database, Wanfang databases, reviews, and reference lists of relevant articles. The weighted mean difference(WMD) was calculated for changes in the left ventricular ejection fraction(LVEF), LV end-diastolic volume(LVEDV) and LV end-systolic volume(LVESV) from baseline to follow-up( 3 months) by using random-effects Meta-analysis. The primary outcome was change in LVEF, and secondary outcomes were changes in LV dimensions including LVEDV and LVESV.RESULTS: A total of 10 trials(enrolling 854 participants, median follow-up six months) evaluated the association between CMSQPBC and changes in LV function and volume. Compared with the control group, CMSQPBC significantly improved LVEF(854 patients; WMD: 4.97%, 95% CI: 3.78-6.15; P 0.001)and attenuated the enlargement of LVEDV(607 patients;WMD:-7.89 mL, 95% CI:-11.54 to-4.24; P0.001) and LVESV(364 patients; WMD =-5.80 mL,95% CI,-9.60 to-2.01; P 0.01).CONCLUSION: CMSQPBC may reverse deleterious pathological remodeling after myocardial infarction. Higher quality and more rigorous randomized trials with larger sample sizes are needed to further confirm the findings.     

The effects of curcumin supplementation on endothelial function: A systematic review and meta‐analysis of randomized controlled trials

Impaired endothelial function is an important risk factor for cardiovascular disease (CVD). Curcumin supplementation might be an appropriate approach to decrease the complications of CVD. Randomized controlled trials assessing the effects of curcumin supplementation on endothelial function were included. Two independent authors systematically searched online database including EMBASE, Scopus, PubMed, Cochrane Library, and Web of Science with no time restriction. Cochrane Collaboration risk of bias tool was applied to assess the methodological quality of included trials. Between‐study heterogeneities were estimated using the Cochran's Q test and I‐square (I²) statistic. Data were pooled using a random‐effects model, and weighted mean differences (WMDs) were considered as the overall effect sizes. Ten studies with 11 effect sizes were included. We found a significant increase in flow‐mediated dilation (FMD) following curcumin supplementation (WMD: 1.49; 95% CI [0.16, 2.82]). There was no effect of curcumin supplement on pulse wave velocity (PWV; WMD: ?41.59; 95% CI [?86.59, 3.42]), augmentation index (Aix; WMD: 0.71; 95% CI [?1.37, 2.79]), endothelin‐1 (ET‐1; WMD: ?0.30; 95% CI [?0.96, 0.37]), and soluble intercellular adhesion molecule‐1 (sICAM‐1; WMD: ?10.11; 95% CI [?33.67, 13.46]). This meta‐analysis demonstrated the beneficial effects of curcumin supplementation on improving FMD, though it did not influence PWV, Aix, Et‐1, and sICAM‐1.     

Tonifying kidney therapy for stable chronic obstructive pulmonary disease: a systematic review

OBJECTIVE: To evaluate the efficacy and safety of tonifying kidney therapy(Bushen, TK) for stable chronic obstructive pulmonary disease(COPD).METHODS: Randomized controlled trials(RCTs) of TK use for treatment of stable COPD were searched in four databases including Pub Med, the Cochrane Library, Chinese Biomedical Literature Database,and China National Knowledge Infrastructure Database from inception to December 2017. Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies. Rev Man 5.3 software was used for the Meta-analysis.RESULTS: Eight RCTs involving 809 patients with stable COPD were included. Compared with the conventional Western Medicine(CWM) group, the TK group(TK combined with CWM) showed significant improvements in the effectiveness rates(RR =1.37, 95% CI 1.22 to 1.53, P 0.000 01) and 6-min walk distance in meters(MD 11.92, 95% CI 3.52 to20.32, P = 0.005), this study also showed that the TK group can decrease The Traditional Chinese Medicine Syndrome Score(MD-8.01, 95% CI-12.89 to-3.13, P = 0.001). The lung function [forced expiratory volume in one second%(FEV1%), FEV1/forced vital capacity] showed no difference between the TK and control groups.CONCLUSION: For patients with stable COPD, TK can improve the clinical effectiveness and exercise capacity but fail to improve the patient's symptoms. Because of the low methodological quality of the included trials, additional high-quality and large-scale RCTs are required.     

Efficacy and safety of external application of Traditional Chinese Medicine for the treatment of acute gouty arthritis: a systematic review and Meta-analysis

OBJECTIVE:To evaluate the clinical efficacy and safety of external application of Traditional Chinese Medicine(EATCM)on acute gouty arthritis(AGA).METHODS:Six electronic data bases were retrieved from their inception to march 2017.15 randomized controlled clinical trials(RCTs)were included.The quality of the literatures was assessed according to Cochrane review criteria by using RevMan5.3 software;and related data was counted using Stata14.0 software.RESULTS:There was no significant difference in C-reactiveprotein(CRP)between experimental intervention group and control group[(WMD= 1.093,95% CI(-2.514,4.701);P=0.553)].In terms of overall efficacy,the EATCM's treatment group was significantly superior to control group[(OR = 3.692; 95% CI(2.408,5.661); P0.001)].The EATCM was better than western medicine treatments or other interventions in reducing the adverse reactions[(OR = 0.135; 95% CI(0.067,0.274); P0.001)].All these funnel plots showed unlikelihood of publishing bias.But due to excessive heterogeneity,the statistical results of serum uric acid and visual analogue scale and CRP between the two groups became uncertain.CONCLUSION:The results indicate that EATCM may have greater overall efficacy with fewer adverse drug reactions,although the evidence is weak owing to the low methodological quality and the small number of the included trials.     

Safety and efficacy of Danqipiantan capsule for treatment of stroke: a systematic review

Objective

To evaluate the efficacy and safety of Danqipiantan capsule (DPC) for the treatment of stroke.

Methods

PubMed, China Science And Technology Journal Database, Wanfang Database, Chinese periodicals in the China National Knowledge Infrastructure, and the General Hospital of Tianjin Medical University's Library were searched until July 2012. Randomized controlled trials (RCTs) and observational studies that reported the use of DPC for treatment of stroke were selected.

Results

Eleven articles that included 12 RCTs, and 2 articles that included 3 observational studies were identified. A total of 2590 patients participated in the studies. We found that there was a significant statistical difference between DPC treatment groups and the control groups in terms of the effective rate [risk ratio (RR), 1.14; 95% confidence intervals (CI), 1.04, 1.25; P=0.01], Fugl-Meyer Assessment Scale [weighted mean difference (WMD), 9.77; 95% CI (4.84, 14.70); P=0.00], Barthel Index [WMD=6.40; 95% CI (3.15, 9.65)], and mean flow velocity [WMD= 5.79; 95% CI (1.64, 9.94)]. There were no significant differences for The National Institutes of Health Stroke Scale [WMD=0.60; 95% CI (− 1.09, 2.29)], visual field defects [left visual field: WMD= − 203.10; 95% CI (− 424.41, 18.21); right visual field: WMD= − 172.60; 95% CI (− 409.29, 64.09)] or the functional independence measure [WMD= − 7.90; 95% CI (− 16.64, 0.84)]. Seven articles that included eight RCTs reported the safety of DPC treatment. Two articles that included three observational studies also reported beneficial effects for DPC. Because the Chinese studies were of poor methodological quality, and most of the sample sizes were small, our analysis was likely affected by bias.

Conclusion

DPC has a beneficial effect and is relatively safe when used for the treatment of stroke.     

The effects of spirulina on glycemic control and serum lipoproteins in patients with metabolic syndrome and related disorders: A systematic review and meta‐analysis of randomized controlled trials

The aim of this systematic review and meta‐analysis was to evaluate the effects of spirulina on glycemic control and serum lipoproteins in patients with metabolic syndrome (MetS) and related disorders. Two independent authors systematically searched online database including EMBASE, Scopus, PubMed, Cochrane Library, and Web of Science from inception until April 30, 2019. The Cochrane Collaboration's risk of bias tool was applied to assess the methodological quality of included trials. The heterogeneity among the included studies was assessed using Cochrane's Q test and I‐square (I²) statistic. Pooling effect sizes from studies showed a significant reduction in fasting plasma glucose (FPG; weighted mean difference [WMD]: ?10.31; 95% confidence interval, CI [?16.21, ?4.42]) and insulin concentrations (WMD: ?0.53; 95% CI [?0.62, ?0.44]) following the administration of spirulina. Pooled analysis showed also a significant reduction in total cholesterol (WMD: ?20.50; 95% CI [?38.25, ?2.74]), low‐density lipoprotein cholesterol (LDL‐C; WMD: ?19.02; 95% CI [?36.27, ?1.78]), and very low‐density lipoprotein cholesterol (VLDL‐C) concentrations (WMD: ?6.72; 95% CI [?9.19, ?4.26]) and a significant increase in high‐density lipoprotein cholesterol (HDL‐C) levels (WMD: 1.42; 95% CI [0.16, 2.68]) following spirulina therapy. This meta‐analysis demonstrated the beneficial effects of spirulina supplementation on improving FPG, insulin, total cholesterol, LDL‐C, VLDL‐C, and HDL‐C levels in patients with MetS and related disorders.     

The impact of argan oil on plasma lipids in humans: Systematic review and meta‐analysis of randomized controlled trials

The study aims to investigate the effect of argan oil on plasma lipid concentrations through a systematic review of the literature and a meta‐analysis of available randomized controlled trials. Randomized controlled trials that investigated the impact of at least 2 weeks of supplementation with argan oil on plasma/serum concentrations of at least 1 of the main lipid parameters were eligible for inclusion. Effect size was expressed as the weighted mean difference (WMD) and 95% confidence interval (95% CI). Meta‐analysis of data from 5 eligible trials with 292 participants showed a significant reduction in plasma concentrations of total cholesterol (WMD: ?16.85 mg/dl, 95% CI [?25.10, ?8.60], p < .001), low‐density lipoprotein cholesterol (WMD: ?11.67 mg/dl, 95% CI [?17.32, ?6.01], p < .001), and triglycerides (WMD: ?13.69 mg/dl, 95% CI [?25.80, ?1.58], p = .027) after supplementation with argan oil compared with control treatment, and plasma concentrations of high‐density lipoprotein cholesterol (WMD: 4.14 mg/dl, 95% CI [0.86, 7.41], p = .013) were found to be increased. Argan oil supplementation reduces total cholesterol, low‐density lipoprotein cholesterol, and triglycerides and increases high‐density lipoprotein cholesterol levels. Additionally, larger clinical trials are needed to assess the impact of argan oil supplementation on other indices of cardiometabolic risk and on the risk of cardiovascular outcomes.     

Traditional Chinese Herbal Medicine for Perimenopausal Depression of Chinese Women: A Meta‑analysis

Objective: The objective of this study is to evaluate the effectiveness and safety of traditional Chinese herbal medicine (TCHM) in treatment of perimenopausal depression (PD) in China. Methods: To identify randomized controlled trials, an electronic search has been conducted through databases as follows: PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese Biological Medicine Database, China National Knowledge Infrastructure Database, Chinese Scientific Journal Database, and WanFang Digital Periodicals Database. Methodological quality was evaluated by Cochrane Collaboration’s tool which is able to assess the risk of bias in Review Manager Software. What’s more, meta?analysis was performed by using Cochrane Collaboration’s RevMan 5.2 software, (Nordic Cochrane Centre, Cochrane Collaboration, Copenhagen, and Denmark). Dichotomous data were analyzed by using relative risk (RR) and 95% confidence interval (CI). Continuous variables were analyzed using weighted mean differences (WMDs) and 95% CI. Subgroup analysis was performed by the type of medicine which was used in the experimental group. Results: This meta?analysis includes 11 randomized control trials with 818 patients. Compared to the control group (RR: 1.14, 95% CI: [1.03, 1.26], P = 0.009 and WMD: ?2.09, 95% CI: [ ?3.58, ?0.18]), the experimental group had a significant higher clinical efficacy rate and relatively lower Hamilton Depression Rating Scale (HAM?D) score. For clinical efficacy rate, the results varied depending on the detail treatment measures of the experimental group. In the experimental group with TCHM, no significant difference was observed (RR: 1.14, 95% CI: [0.97, 1.33]), while in the experimental group combined with western medicine, a significant difference in the clinical efficacy rate between the experimental group and control group showed up (RR: 1.15, 95% CI: [1.01, 1.32], P = 0.04). For the HAM?D score, subgroup analyses revealed that the pure TCHM therapy was not associated with significant HAM?D score reduction compared to the control group (WMD: ?2.48, 95% CI: [?6.00, 1.03], P = 0.17). However, in the experimental group where western medicine was added to, the HAM?D score decreased statistically compared to the control group (WMD: ?1.88, 95% CI: [?3.58, ?0.18], P = 0.03). There is no serious adverse event in both groups. Conclusions: Combination therapy of TCHM and western medicine is more effective in treating PD in terms of clinical efficacy rate. However, the results should be interpreted with caution due to the mediocre methodological quality of the included trials.     

热毒宁注射液治疗社区获得性肺炎疗效的Meta分析

目的:评价热毒宁注射液治疗社区获得性肺炎( community-acquired pneumonia,CAP)的疗效和安全性.方法:广泛收集热毒宁注射液治疗CAP随机对照试验文献,用Jadad评分表评价纳入文献的质量.对纳入的试验作系统评价.结果:符合纳入标准的文献共7篇.Meta分析结果显示,热毒宁与抗生素联合治疗组与抗生素治疗组相比,治愈率相对危险度(relative risk,RR)为1.34,95％可信区间(confidence interval,CI)[1.19,1.51];总有效率RR为1.10,95％ CI[ 1.06,1.15].退热时间均数差(mean difference,MD)为- 1.42,95％CI[ -2.58,-0.26];咳嗽好转时间MD -2.36,95％ CI[ -3.41,-1.31];肺部啰音改善时间MD -2.30,95％CI[ -2.61,-2.00];胸部X线阴影吸收好转率MD为-2.36,95％CI[ -2.52,-2.20].2组上述各指标比较,差异均有统计学意义.未报道热毒宁注射液临床应用相关的严重不良反应.结论:当前证据表明在有效抗生素及常规对症治疗的基础上联合热毒宁注射液治疗CAP可以提高临床疗效,减轻咳嗽咳痰的症状,缩短发热时间,加速胸片阴影的吸收,且未见明显不良反应.但是由于纳入的研究质量所限,尚需要进行更多高质量的研究做进一步分析.     

Chinese herbal medicine therapy for coronary heart disease complicated with anxiety: a systematic review of randomized controlled trials

OBJECTIVE: To evaluated the effectiveness and safety of Chinese herbal medicines(CHMs) for coronary heart disease(CHD) complicated with anxiety.METHODS: Randomized controlled clinical trials(RCTs) with parallel-groups were included after searching through electric-databases from inception to May, 2017. Meta-analysis was undertaken with Rev Man 5.3 software.RESULTS: Twenty-three RCTs enrolling 1654 patients were included in this systematic review. The combination therapy(CHMs combined with anxiolytic) appeared to be superior to anxiolytic in terms of reducing the score of Zung Self-rating Anxiety scale(SAS)(mean Difference(MD),-12.25; 95%confidence interval(CI),-14.01 to-10.48, eliminating method; MD,-3.92; 95% CI,-5.48 to-2.35,tranquilizing method), improving the total effect rate(relative risk(RR), 1.26; 95% CI, 1.08 to 1.46,eliminating method) and reducing the TCM symptoms scores(MD,-2.24; 95% CI,-4.25 to-0.23,tranquilizing method) with a lower incidence of adverse events(RR, 0.46; 95% CI, 0.25 to 0.85, tonifying method). CHMs demonstrated benefits in lowering the score of Hamilton Anxiety Rating scale(MD,-6.77; 95% CI,-8.16 to-5.37, tonifying method),lowering the score of SAS(MD,-10.1;95% CI,-13.73 to-6.30, tonifying method) and reducing the TCM symptoms scores(MD,-2.18;95% CI,-3.12 to-1.24, tranquilizing method).CONCLUSION: We got a low evidence that CHMs,which had less side effects, showed potentially benefits to patients with CHD complicated with anxiety. While the results should be interpreted with caution. Trails with higher quality are required to verify the effectiveness and safety of CHMs for CHD complicated with anxiety.     

GR ADE SYSTEM-BASED SYSTEMATIC REVIEW OF AURICULAR ACUPUNCTURE FOR PRIMARY INSOMNIA

Objective: To assess the clinical therapeutic effectiveness and security of auricular acupuncture(AA) for primary insomnia.Methods: Large medical databases at home and abroad were used to conduct strict screening according to inclusive/exclusive criteria.We used bias risk assessment recommended by the Cochrane Handbook 5.1 to assess the bias risk of the included literature.We analyzed the data statistically with an analysis software RevMan 5.2, and evaluated the quality of the evidence with a software GRADE profiler 3.6.Results: Eight RCTs were included, involving 894 patients.Bias risk mainly existed in allocation concealment, performance bias and blinding method.In comparison of the AA group and the sham AA group or the no treatment group, there were significant differences in PSQI [WMD=-3.48, 95% CI(-3.96,-3.00)], sleep onset latency [WMD=-10.14, 95% CI(-17.16,-3.12)], and in number of awakening [WMD=-9.98, 95% CI(-1.10,-0.48)].Comparing the AA group with the Western drug group, significant difference existed in PSQI [WMD=-3.62, 95% CI(-4.59,-2.65)].The evidence quality of outcomes between the AA group and the sham AA group in PSQI was moderate, and sleep onset time and number of awakening were very low; the evidence quality of outcomes between the AA group and the Western drug group in PSQI was very low.There was no report of adverse event.Conclusion: AA therapy may be effective and safe in improving primary insomnia.However, due to the low quality of evidence and small number of RCTs, cautious attitude should be taken on this conclusion, and further research is needed to confirm the conclusion.     

Adjuvant Treatment with Yupingfeng Formula for Recurrent Respiratory Tract Infections in Children: A Meta‐analysis of Randomized Controlled Trials

This meta‐analysis aimed to evaluate the immunomodulating function of Yupingfeng Formula (YPFF) in children with recurrent respiratory tract infections (RRTIs). The PubMed, EMBASE, Cochrane Library, CNKI and WanFang databases were searched for randomized controlled trials comparing with and without YPFF for RRTIs in children. Twelve trials with 1236 patients were identified. Adjuvant treatment with YPFF significantly increased serum levels of IgA (weighted mean difference [WMD] 0.33 mg/mL; 95% confidence interval [CI] 0.20 to 0.45), IgG (WMD 1.36 mg/mL; 95% CI 1.06 to 1.65), IgM (WMD 0.16 mg/mL; 95% CI 0.02 to 0.31), and CD3⁺ T‐lymphocytes (WMD 10.16%; 95% CI 4.62 to 15.69) but not CD4⁺ T‐lymphocytes (WMD 3.16%; 95% CI ?0.27 to 6.59) and CD8⁺ T‐lymphocytes (WMD ?0.84%; 95% CI ?2.50 to 0.81). YPFF also reduced the frequency of RRTIs (WMD ?3.80 times; 95% CI ?4.86 to ?2.74) and increased total effective rates of symptom improvement (risk ratio: 1.44; 95% CI 1.19 to 1.75). Adjuvant treatment with YPFF could improve total clinical effective rate and decrease the frequency of respiratory tract infections in children with RRTIs. The beneficial effects of YPFF may be correlated to its immunomodulating action. More well‐designed trials with larger sample sizes are needed to evaluate its efficacy and safety. Copyright © 2016 John Wiley & Sons, Ltd.     

温针灸与电针治疗膝关节骨性关节炎疗效比较Meta分析

目的 :评价比较温针灸与电针治疗膝关节骨性关节炎(KOA)的疗效。方法 :检索数据库,收集以电针为对照组的温针灸治疗KOA的临床随机对照试验,提取资料并进行方法学质量评估。采用Revman 5.3对纳入结果进行Meta分析。结果:11篇文献纳入研究,共772例患者。其治愈率合并汇总OR值为1.12,95%CI[0.76,1.65],其总有效率汇总OR值为1.21,95%CI[0.81,1.80],以上差异无统计学意义(P0.05),说明温针灸组与电针治疗KOA在治愈率和总有效率方面差异均无统计学意义。其中4篇使用骨性关节炎指数WOMAC的样本量为279,标准化均数差(SMD)的合并效应量为0.08,95%CI[-0.15,0.32];5篇以VAS为疼痛指标的样本量为339,SMD的合并效应量为0.25,95%CI[-0.11,0.61],以上差异均无统计学意义(P0.05),说明在以WOMAC评分为结局指标和使用VAS评分作为疗效指标时,温针灸与电针治疗KOA疗效比较差异无统计学意义。结论:温针灸治疗KOA疗效不优于电针。     

针灸改善脑卒中后抑郁患者抑郁状态及日常生活能力的Meta分析

目的系统评价针灸对脑卒中后抑郁患者抑郁状态及日常生活能力的改善作用。方法计算机检索中国知网(CNKI)、维普中文期刊服务平台(VIP)、万方数据知识服务平台(WanFang Data)、中国生物医学文献服务平台(CBM)以及PubMed、Cochrane等数据库,收集针灸治疗脑卒中后抑郁的临床随机对照试验,文献发表时间为2009年8月27日至2019年8月27日。采用Cochrane风险偏倚评估工具评价文献质量,运用RevMan 5.3软件进行Meta分析。结果共纳入14篇文献,涉及患者1 120例。Meta分析结果显示:与抗抑郁剂相比,针灸疗法有较好的抗抑郁疗效[RR=1.15,95%CI(1.09,1.21),P0.000 01],能更好地改善患者的抑郁状态[SMD=-0.58,95%CI(-0.74,-0.43),P0.000 01],提高日常生活能力[SMD=0.71,95%CI(0.40,1.02),P0.000 01]。结论针灸在改善脑卒中后抑郁患者的抑郁状态、提高日常生活能力方面均优于抗抑郁剂;纳入分析的文献多数存在方法学缺陷,证据级别不高,故结论有待进一步验证。     

热毒宁注射液治疗手足口病的系统评价

目的:系统评价热毒宁注射液治疗手足口病的临床疗效及安全性,为临床治疗提供循证参考。方法:采用Cochrane系统评价方法,全面检索Cochrane Library,CBM,CNKI,Wanfang等数据库,查找热毒宁注射液治疗手足口病相关的随机对照试验(RCT),采用Rev Man 5.2软件进行Meta分析。结果:共24项随机对照研究符合纳入标准,其中热毒宁VS利巴韦林17项,合计2 412例患者,热毒宁联合利巴韦林VS利巴韦林7项,合计891例患者。Meta分析结果显示,与利巴韦林相比,热毒宁治疗手足口病的临床总有效率更高[OR=4.71,95%CI(3.46,6.42),P0.000 01],退热时间[WMD=-1.20,95%CI(-1.44,-0.95),P0.000 01],皮疹消退时间[WMD=-1.51,95%CI(-1.95,-1.07),P0.000 01],口腔疱疹或溃疡消退时间[WMD=-1.36,95%CI(-1.76,-0.97),P0.000 01],平均住院时间[WMD=-2.81,95%CI(-3.79,-1.82),P0.000 01]均短于利巴韦林,差异均具有统计学意义。与利巴韦林单药治疗相比,热毒宁与利巴韦林联合用药在临床总有效率[OR=5.48,95%CI(3.06,9.80),P0.000 01],退热时间[WMD=-1.70,95%CI(-2.05,-1.35),P0.000 01],皮疹消退时间[WMD=-1.91,95%CI(-2.99,-0.83),P0.000 01],口腔疱疹或溃疡消退时间[WMD=-1.81,95%CI(-2.09,-1.53),P0.000 01],平均住院时间[WMD=-2.32,95%CI(-3.59,-1.05),P=0.000 3]更有优势,差异均具有统计学意义。纳入的24项研究中热毒宁的不良反应较利巴韦林表现轻微,使用更为安全。结论:当前证据表明热毒宁联用利巴韦林与单用热毒宁治疗手足口病的疗效优于单用利巴韦林,且安全性良好。但由于纳入的研究质量有限,尚需设计更多大样本、高质量的临床试验进一步验证。