Home | Current Issue | Past Issues | Search | CollectionsRSS | PDA Services | FAQ | SHCIM Online | Chinese Updated Saturday, October 20, 2018
 Services
Submit a manuscript
Subscribe
Individuals
Institutions
Response
Send response
Read responses
Reprint
Advance online publication
Sign up for e-alert
JCIM job opportunities
Contact JCIM
 Information For
Readers
Authors
Reviewers
Advertisers
 About JCIM
Journal description
Editorial policy
Privacy policy
Copy right
Editorial staff
 Language Polishing
Journal of Chinese Integrative Medicine: 2012; 10(11): 1211-1228
DOI: 10.3736/jcim20121104
Systematic review and meta-analysis of randomized controlled trials of integrative medicine therapy for treatment of chronic severe hepatitis
1. Hui-min Liu (Beijing University of Chinese Medicine, Beijing 100029, China )
2. Xian-bo Wang (Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China )
3. Yu-juan Chang (Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China )
4. Li-li Gu (Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China )
BACKGROUND: Chronic severe hepatitis is a critical disease with high mortality. Currently, effective drugs and therapy still lack. Comprehensive and supportive treatment, artificial liver and liver transplantation are the main therapies. A great number of studies on traditional Chinese medicine (TCM) in many ways combined with Western medicine treatment for chronic severe hepatitis have been reported, but the efficacy and safety still lack systematic evaluation.
OBJECTIVE: To evaluate the efficacy and safety of integrative medicine therapy for chronic severe hepatitis.
SEARCH STRATEGY: Literature was searched from PubMed, the Cochrane Library, the China National Knowledge Infrastructure Database, the Chongqing VIP Chinese Science and Technology Periodical Database, the Chinese Biomedical Literature Database and Wanfang Database. The time limitation ran from the commencement of each database to February 29, 2012.
INCLUSION CRITERIA: Randomized controlled trials (RCTs) testing Chinese herbal medicine (CHM) combined with Western medicine (comprehensive and supportive treatment or artificial liver plasma exchange) against Western medicine were included.
DATA EXTRACTION AND ANALYSIS: Two authors collected and extracted data independently. The methodological quality of literature was assessed by risk of bias table from Cochrane Collaboration and the data were analyzed by RevMan 5.1 software. Heterogeneity of the included studies was checked by Chi-square test. The efficacy measure was relative risk (RR) or mean difference with a 95% confidence interval (CI).
RESULTS: A total of 45 RCTs involving 4 449 patients with chronic severe hepatitis were included. Quality of all included trials was low. The oral CHM, enema and combined TCM with either Western medicine or plasma exchange were superior to Western medicine alone in improving total effective rate and reducing mortality with significant differences. In laboratory parameters, the integrative medicine treatment group was better than Western control group in reducing the total bilirubin and alanine aminotransferase, but two groups showed equal efficacy in lowering aspartate aminotransferase activity. The oral Chinese medicine combined with Western medicine or plasma exchange was better than Western medicine used alone in improving albumin synthesis and coagulation function, but Chinese medicine enema had no significant effect on the level of plasma albumin. The main side effects of the treatment group were abdominal pain, diarrhea and other intestinal symptoms after enema, while adverse reactions of the control group were mainly due to the plasma exchange.
CONCLUSION: Integrated Chinese and Western medicine can promote the recovery of liver function and coagulation function, and reduce the mortality rate of patients with chronic severe hepatitis. However, due to a lower quality of clinical trials published in Chinese journals, the evidence is insufficient to prove the superiority of integrative therapy. Further well-designed, multicenter, large-sample RCTs are still needed to evaluate the beneficial effects of CHM.
Welcome to JCIM! You are the number 10124 reader of this article!
Download Article:
[Full Text]      [PDF]      [Chinese]      [Previous]      [Next]      [This Issue]
Please cite this article as:
Liu HM, Wang XB, Chang YJ, Gu LL. Systematic review and meta-analysis of randomized controlled trials of integrative medicine therapy for treatment of chronic severe hepatitis. J Chin Integr Med / Zhong Xi Yi Jie He Xue Bao. 2012; 10(11): 1211-1228.
References:
1Lu FM, Zhuang H. Management of hepatitis B in China[J].Chin Med J (Engl), 2009, 122(1): 3-4.  .
2Wang YJ. Plasmapheresis: intermediate artificial liver[J].Zhonghua Gan Zang Bing Za Zhi, 2003, 11(1): 41. Chinese.
3Han DW. Study on pathogenesis of liver failure: the hypothesis of intestinal endotoxin[J].Gan Zang Bing Za Zhi, 1995, 3(3): 134-137. Chinese.
4Chen HL, Wu XZ, Guan FL, Pei DK. Protective effects of Tongli Gongxia herbs on gut barrier in rat with multiple organ dysfunction syndrome[J].Zhongguo Zhong Xi Yi Jie He Za Zhi, 2000, 20(2): 120-122. Chinese with abstract in English.
5Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. West Sussex: John Wiley & Sons Ltd. 2008.
6Gu CL, Fu YX, Shang XW, Xie DL, Zhang P. Clinical observation on treatment for chronic severe hepatitis with integrated Chinese and Western medicine[J].Zhong Yi Yao Xue Kan, 2006, 24(2): 377-378. Chinese.
7Wang JP. Application of oral administration of Jaundice-dispeling and Liver-clearing Decoction in the treatment of chronic severe hepatitis[J].Zhongguo Shi Yong Yi Yao, 2009, 4(32): 111-112. Chinese.
8Qiu H, Mao DW, Huang B, Long FL, Chen YQ, Wang L, Wu JH. A clinical trial to evaluate the effects of detoxification and dissipation blood stasis granule on the prognosis of patient with chronic severe hepatitis[J].Zhong Xi Yi Jie He Gan Bing Za Zhi, 2007, 17(5): 259-260, 263. Chinese with abstract in English.
9Li J, Wang LF, Li FY, Zhang MX, Cao WK, Li Q, Wen XM, Mao DW, Sun KW, Zhou XZ, Tian DY, Guo JC, Yang DG, Li XH, Yang HZ, Wang XB, Zhuo YH, Zhang Q, Li HM, Hu XY, Zhao W, Zhang FC, He LY. The study of the integrated Chinese and Western medicine for chronic severe hepatitis. Paper Compilation of the 20th National Academic Conference on Integrative Medicine for Treatment of Liver Diseases. 2011: 27-29. Chinese.
10Gao JR. Integrative medicine treatment for chronic severe hepatitis merger peritonitis: a clinical report of 26 cases[J].Zhong Xi Yi Jie He Gan Bing Za Zhi, 1999, 9(4): 4. Chinese.
11Li JY, Guo JC, Yao P, Tian YM, Gou CY, Zhang JY, Li XH. Clinical analysis on treating chronic severe hepatitis B by supplementing qi and nourishing yin[J].Zhonghua Zhong Yi Yao Za Zhi, 2011, 26(6): 1300-1302. Chinese with abstract in English.
12Hu XY, Wu J, Li YD, Zhong S, Liu GW. Improvement of multiple organ functions in chronic severe hepatitis with Qingan Jiedu method and its prognosis assessment by MELD score. Paper Compilation of the 13th Academic Conference on Internal Medicine Hepatology Sponsored by China Association of Chinese Medicine. 2008: 227-231. Chinese with abstract in English.
13Li ZZ. Effect of Sanjun Tuihuang Decoction on patients with severe chronic hepatitis[J].Zhongguo Bing Yuan Sheng Wu Xue Za Zhi, 2009, 4(10): 779-781. Chinese with abstract in English.
14Li Q, Li D, Zhang LH. Effects of Zhonggan mixture in improving liver function of patients with chronic severe hepatitis[J].Zhong Yi Yao Lin Chuang Za Zhi, 2006, 18(4): 387-388. Chinese.
15Deng X, Yang DG, Wu QK, Tao YY, Nie G. A short-term clinical observation on chronic severe hepatitis B treated by Chishao Chengqi Decoction[J].Zhong Xi Yi Jie He Gan Bing Za Zhi, 2004, 14(2): 67-69. Chinese with abstract in English.
16Zhu QJ, Liang HM. Clinical observation on the treatment of chronic severe hepatitis B with Danhuangfang[J].Zhong Xi Yi Jie He Gan Bing Za Zhi, 2009, 19(5): 263-265. Chinese with abstract in English.
17An TJ. Evaluation of therapeutic efficiency of the Shaodan Chengqi Decoction on chronic severe hepatitis merge with intestinal endotoxemia[J].Yanbian Da Xue Yi Xue Xue Bao, 2005, 28(2): 129-130. Chinese with abstract in English.
18Huang JQ, Huang TJ, Zhang JJ, Yu HJ, Zhang ZG, Xing MY, Xiao F, Ning Q, Tian DY. Clinical effect on severe hepatitis treated by compound anti-fulminant hepatitis[J].Zhong Xi Yi Jie He Gan Bing Za Zhi, 2006, 16(6): 331-333, 337. Chinese with abstract in English.
19Ma RH. Clinical observation on treating 20 patients with chronic hepatitis by TCM syndrome differentiation plus fresh plasma[J].Zhong Yi Lin Chuang Yan Jiu, 2010, 2(2): 49-51. Chinese.
20Song AJ, Yu PL. Effect observation of integrative medicine treatment of chronic severe hepatitis[J].Zhonghua Zhong Yi Yao Xue Kan, 2010, 28(12): 2608-2610. Chinese with abstract in English.
21Fu HL, Pei L, Wei PK. Clinical observation on integrative medicine for treating patients with chronic severe hepatitis in convalescence stage[J].Xian Dai Zhong Xi Yi Jie He Za Zhi, 2004, 13(5): 567. Chinese.
22Luo XL. Integrative medicine treatment for chronic severe hepatitis of damp-heat syndrome: a report of 35 cases[J].Zhong Xi Yi Jie He Gan Bing Za Zhi, 2001, 11(3): 178-179. Chinese.
23Li F, Yin SQ, Deng WQ. Observation on Chinese herbal treatment for chronic severe hepatitis[J].Liaoning Zhong Yi Za Zhi, 2006, 33(7): 845-846. Chinese.
24Zeng DX, Zhang XL. Observation of curative effect on chronic severe hepatitis in early stage with Dahuang and Kaishi Injection: a report of 32 cases[J].Hunan Zhong Yi Yao Dao Bao, 2004, 10(10): 11-12. Chinese.
25Zhang WW, Qin MH. Corydalis saxicola combined with Breviscapine Injection for treatment of chronic severe hepatitis: a report of 43 cases[J].Shaanxi Zhong Yi, 2006, 27(1): 21-23. Chinese.
26Sun KW, Chen B, Huang YH, Wu YN, Zhou XQ. Clinical observation on chronic severe hepatitis B treated by principles of cooling-blood and detoxicating combined with clearing-heat and resolving-dampness or combined with strengthening-spleen and warming-yang[J].Zhongguo Zhong Xi Yi Jie He Za Zhi, 2006, 26(11): 981-983. Chinese with abstract in English.
27Xu QY, Zhang SB. Clinical observation on patients with chronic severe hepatitis treated by Chinese medicine retention enema[J].Zhongguo Dang Dai Yi Yao, 2011, 18(7): 105-106. Chinese.
28Xing JS. Observation on Chinese medicine retention enema in the treatment of chronic severe hepatitis[J].Liaoning Zhong Yi Za Zhi, 2006, 33(10): 1284-1285. Chinese.
29Guo JC, Shi JP, Chen QW, Xun YH, Shi WZ, Liu Y, Shen ZX, Lou GQ. The study on the effects of colon herbal dialysis in patients with chronic severe hepatitis B[J].Zhong Yi Yao Xue Kan, 2006, 24(7): 1254-1256. Chinese with abstract in English.
30Li WY, Qian YD, Qiu SQ, Wang SP, Peng QP, Zhang ZG, Tian DY. Evaluation of traditional Chinese medicine retention-enema after colon dialysis for patients with intestine-originated endotoxemia in severe chronic hepatitis[J].Shi Yong Gan Zang Bing Za Zhi, 2009, 12(2): 133-135. Chinese.
31Shi WZ, Wang YF, Guo JC, Shi JP, Liu Y, Chen QW, Xun YH. Effects of colon dialysis with the traditional Chinese medicine on endotoxin, TNF-α, IL-6 and IL-2 in patients with severe chronic hepatitis[J].Yi Yao Dao Bao, 2008, 27(8): 935-937. Chinese with abstract in English.
32Wu QK, Xu XJ, Zheng YQ, Wang P, Liu XH. Effects of colon dialysis by traditional Chinese medicine on chronic severe hepatitis B patients[J].Zhong Xi Yi Jie He Gan Bing Za Zhi, 2009, 19(5): 269-270, 319. Chinese with abstract in English.
33Feng HL, Li Q, Tang KC. Yang JM, Wang BM. Efficacy of sequential colon dialysis in combination with artificial liver support system in treating chronic severe hepatitis: a report of 25 cases[J].Shi Jie Hua Ren Xiao Hua Za Zhi, 2009, 17(35): 3657-3660. Chinese with abstract in English.
34Wang LD. Clinical observation on 45 cases of chronic severe hepatitis treated by clyster of rhubarb decoction[J].Zhongguo Zhong Yi Yao Xin Xi Za Zhi, 2000, 7(10): 46. Chinese.
35Li Z, Fan HB, Xu LT, Zhou H, Tian ZF. Observation of effect of colon herbal dialysis therapy on chronic severe hepatitis[J].Xian Dai Zhong Xi Yi Jie He Za Zhi, 2011, 20(34): 4333-4334. Chinese with abstract in English.
36Zhang NN, Wang J, Liu P, Zhang ZX. Clinical study on patients with chronic severe hepatitis B treated by traditional Chinese medicine in multichannel[J].Liaoning Zhong Yi Yao Za Zhi, 2009, 36(7): 1137-1139. Chinese with abstract in English.
37Liu P, Zhang NN, Yang HX, Wei M. Clinical study on Chinese medicine treatment of blood-cooling, toxin-elimination and stasis-dissolving for 42 cases of chronic severe hepatitis with multiple drug administration[J].Jiangsu Zhong Yi Yao, 2009, 41(7): 28-30. Chinese.
38Hu JH, Qian Y, Yao NL, Nie G, Wu QK, Li XD, Gou CY, Yang HS, Li XH. Treatment of chronic severe hepatitis B by Jieduan Niwan method[J].Zhong Xi Yi Jie He Gan Bing Za Zhi, 2010, 20(4): 200-203. Chinese with abstract in English.
39Gong GY, Liu X, Ma JH. Clinical observation of 43 cases of chronic severe hepatitis B treated by integrated Chinese and Western medicine[J].Shi Jie Zhong Yi Yao, 2009, 4(4): 194-195. Chinese with abstract in English.
40Zhou T, Liu CH, Gu YL, Yu XM, Zhou XZ, Liu ZL. Effects of Kaiqiao Chengqi enema on hepatic encephalopathy due to chronic severe hepatitis B[J].Zhongguo Zhong Xi Yi Jie He Xiao Hua Za Zhi, 2006, 14(5): 305-307. Chinese with abstract in English.
41Wang H, Zhang WP, Liao H. Clinical study on the treatment of chronic severe hepatitis B with Ganshen Qingdu Yin and Chinese medicine retention enema[J].Liaoning Zhong Yi Za Zhi, 2010, 37(11): 2198-2200. Chinese with abstract in English.
42Qiu H, Mao DW, Hu ZB, Huang B, Zhou DH, Li DF, Long FL, Huang GY. A multi-central clinical trial of traditional Chinese medicine combined therapeutic regimen for chronic severe hepatitis[J].Zhong Xi Yi Jie He Gan Bing Za Zhi, 2008, 18(5): 260-262, 276. Chinese with abstract in English.
43Chen B, Sun KW, Peng J, Xiao DM, Jiao JP, Zhang QB, Zhang T, Zhu WF. Clinical observation on treatment of chronic severe hepatitis based on the dialectical mode of yang jaundice-yin and yang jaundice-yin jaundice[J].Zhongguo Zhong Yi Yao Ke Ji, 2012, 19(1): 57-58, 66. Chinese.
44Liu X, Hu J, Zheng HH, Ouyang Q. Clinical observation of 40 cases with chronic severe hepatitis treated by Zhonggan Mixture combined with plasma exchange[J].Jiangxi Zhong Yi Yao, 2010, 10(10): 26-27. Chinese.
45Ruan QF, Hong YQ, Zheng QS, Wu L, Zhao JF. Clinical study on therapeutic efficacy of traditional Chinese medicine combined with plasma exchange on chronic severe hepatitis[J].Guang Ming Zhong Yi, 2011, 26(12): 2439-2441. Chinese with abstract in English.
46Lin H, Li Q, Zhang JJ. Combination therapy of traditional Chinese medicine and plasma exchange in patients with chronic severe hepatitis[J].Chuan Ran Bing Xin Xi, 2009, 22(5): 305-307. Chinese with abstract in English.
47Ruan QF, Wu L, Zhao JF, Hong YQ, Zheng QS. Clinical research of Yinshao Guiqi Decoction for chronic severe hepatitis after plasma exchange[J].Zhongguo Zhong Yi Ji Zheng, 2011, 20(9): 1397-1398. Chinese.
48Zhao WX, Ma SP, Ye F, Liu JK. Clinical observation on 30 cases of chronic severe hepatitis treated by Yiqi Huoxue Granule along with single plasmapheresis[J].Henan Zhong Yi, 2011, 31(2): 141-143. Chinese with abstract in English.
49Huang XJ. Treatment of 26 cases of chronic severe hepatitis with modified Yinchen Zhufu Decoction[J].Guo Ji Zhong Yi Zhong Yao Za Zhi, 2008, 30(5): 350, 352. Chinese with abstract in English.
50Li Q, Lin H, Liu ZF, Chen LF, Pan C, Zhang JJ. Clinical study of combination therapy of artificial liver treatment and traditional Chinese medicine in patients with chronic severe hepatitis[J].Zhong Xi Yi Jie He Gan Bing Za Zhi, 2010, 20(1): 12-14. Chinese with abstract in English.
51Zheng XY. Clinical guideline for new drugs of traditional Chinese medicine (trial implementation)[M]. Beijing: China Medical Science Press, 2002. 361-390. Chinese.
52Zhang Y, Tan SZ. The research progress of etiology and pathogenesis in traditional Chinese medicine for chronic severe hepatitis and hepatic failure[J].Zhong Xi Yi Jie He Gan Bing Za Zhi, 2011, 21(6): 380-383. Chinese.
53Xu X, Li BP, Zhang HF. Advancement of the study on rhubarb[J].Shanghai Zhong Yi Yao Za Zhi, 2003, 37(4): 56-60. Chinese with abstract in English.
54Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials[J].Ann Intern Med, 2010, 152(11): 726-732.  .

 Home | Current Issue | Past Issues | Search | CollectionsRSS | PDA Services | FAQ | SHCIM Online | Chinese
Copyright © 2003-2012 by JCIM Press. All rights reserved. ISSN 1672-1977