Cochrane Systematic Reviews of Chinese Herbal Medicines: An Overview

ObjectivesOur study had two objectives: a) to systematically identify all existing systematic reviews of Chinese herbal medicines (CHM) published in Cochrane Library; b) to assess the methodological quality of included reviews. Methodology/Principal FindingsWe performed a systematic search of the Cochrane Database of Systematic Reviews (CDSR, Issue 5, 2010) to identify all reviews of CHM. A total of fifty-eight reviews were eligible for our study. Twenty-one of the included reviews had at least one Traditional Chinese Medicine (TCM) practitioner as its co-author. 7 reviews didn't include any primary study, the remaining reviews (n = 51) included a median of 9 studies and 936 participants. 50% of reviews were last assessed as up-to-date prior to 2008. The questions addressed by 39 reviews were broad in scope, in which 9 reviews combined studies with different herbal medicines. For OQAQ, the mean of overall quality score (item 10) was 5.05 (95% CI; 4.58-5.52). All reviews assessed the methodological quality of primary studies, 16% of included primary studies used adequate sequence generation and 7% used adequate allocation concealment. Of the 51 nonempty reviews, 23 reviews were reported as being inconclusive, while 27 concluded that there might be benefit of CHM, which was limited by the poor quality or inadequate quantity of included studies. 58 reviews reported searching a median of seven electronic databases, while 10 reviews did not search any Chinese database. ConclusionsNow CDSR has included large numbers of CHM reviews, our study identified some areas which could be improved, such as almost half of included reviews did not have the participation of TCM practitioners and were not up-to-date according to Cochrane criteria, some reviews pooled the results of different herbal medicines and ignored the searching of Chinese databases.

研究目标 本研究包含两项目标：a）系统识别《科克伦图书馆》（Cochrane Library）中已发表的所有中医药（Chinese herbal medicines, CHM）相关系统评价；b）评估纳入的系统评价的方法学质量。

方法学与主要研究结果 我们对2010年第5期《科克伦系统评价数据库》（Cochrane Database of Systematic Reviews, CDSR）开展系统检索，以筛选所有中医药相关系统评价。最终共有58篇系统评价符合本研究纳入标准。其中21篇纳入评价至少有1名中医（Traditional Chinese Medicine, TCM）从业者作为共同作者。7篇评价未纳入任何原始研究，剩余51篇评价的纳入原始研究中位数为9项，参与者中位数为936名。50%的评价最后一次更新评估的时间早于2008年。39篇评价所探讨的问题范围较广，其中9篇评价合并了不同草药类药物的研究数据。

就OQAQ量表而言，其整体质量评分（第10条目）的均值为5.05（95%置信区间：4.58~5.52）。所有评价均对原始研究的方法学质量进行了评估，其中16%的纳入原始研究采用了恰当的序列生成方法，7%采用了恰当的分配隐藏方法。在51篇包含原始研究的评价中，23篇的研究结论为不确定性，27篇认为中医药可能存在获益，但该结论受限于纳入研究的质量较差或样本量不足。58篇评价的检索电子数据库中位数为7个，其中10篇评价未检索任何中文数据库。

研究结论 目前《科克伦系统评价数据库》已收录大量中医药相关系统评价，本研究识别出若干可改进的方向：近半数纳入评价无中医从业者参与，且不符合科克伦协会的最新标准；部分评价合并了不同草药类药物的研究数据，且未对中文数据库进行检索。