Liang Li-Xin, Liu Zi-Hao, Long De-Huai, Liu Hong-Xu
Beijing Hospital of Traditional Chinese Medicine, Capital Medical University Beijing 100010, China Shunyi Branch, Beijing Hospital of Traditional Chinese Medicine Beijing 101300, China.
Beijing Hospital of Traditional Chinese Medicine, Capital Medical University Beijing 100010, China.
Zhongguo Zhong Yao Za Zhi. 2022 Sep;47(18):5088-5096. doi: 10.19540/j.cnki.cjcmm.20220529.503.
This study aims to analyze the outcome indicators of randomized controlled trial(RCT) on traditional Chinese medicine(TCM) intervention of sepsis-induced myocardial injury(SIMI) in recent five years, which is expected to lay a basis for the construction of core outcome set(COS) for this disease treated by TCM. To be specific, RCT on the treatment of SIMI with TCM was retrieved from 4 Chinese databases, 3 English databases, and 2 clinical trial protocol registries. The quality of the included studies was evaluated with Cochrane risk-of-bias(ROB) tool, and the outcome indicators were analyzed. Finally, 42 RCTs were included, of which 2 were clinical trial registration schemes. The study found that 42 RCTs had a high risk of bias, and reported a total of 86 indicators in "clinical effective rate, disease severity, TCM syndrome score, inflammation, myocardium, cardiac structure and hemodynamics, electrocardiogram, immunology, metabolism and liver and kidney function, and safety". Outcome indicators on myocardium had the highest emergence frequency, followed by indicators on the cardiac structure and hemodynamics. A total of 8 RCTs reported TCM syndrome scores. Further analysis suggested the following problems in the selection of outcome indicators in the RCTs on TCM intervention of SIMI: no classification of primary and secondary indicators, disregard of endpoint indicators, irrational selection of alternative indicators, neglection of TCM characteristics, no assessment of patients' immune status, and no emphasis on economic indicators and safety indicators. Therefore, according to the recommendations of the core outcome measures in effectiveness trials(COMET) working group, a COS for TCM intervention of TCM for SIMI should be developed, so as to facilitate clinical researchers to select appropriate outcome indicators, the combination of conclusions of similar clinical studies, and the promotion of TCM interventions.
本研究旨在分析近五年中医药干预脓毒症诱导的心肌损伤(SIMI)的随机对照试验(RCT)的结局指标,以期为该病中医药治疗核心结局集(COS)的构建奠定基础。具体而言,从4个中文数据库、3个英文数据库及2个临床试验注册登记处检索中医药治疗SIMI的RCT。采用Cochrane偏倚风险(ROB)工具评估纳入研究的质量,并分析结局指标。最终纳入42项RCT,其中2项为临床试验注册方案。研究发现,42项RCT存在较高偏倚风险,共报告了“临床有效率、疾病严重程度、中医证候评分、炎症、心肌、心脏结构与血流动力学、心电图、免疫学、代谢及肝肾功能、安全性”等86项指标。心肌相关结局指标出现频率最高,其次是心脏结构与血流动力学相关指标。共有8项RCT报告了中医证候评分。进一步分析提示,中医药干预SIMI的RCT在结局指标选择方面存在以下问题:未区分主次指标、忽视终点指标、替代指标选择不合理、忽视中医特色、未评估患者免疫状态、未重视经济指标及安全性指标。因此,应根据有效性试验核心结局指标(COMET)工作组的建议,制定中医药干预SIMI的COS,以方便临床研究人员选择合适的结局指标,综合类似临床研究结论,推广中医药干预措施。