中医辨证治疗功能失调性子宫出血疗效的网状Meta分析

Network Meta Analysis on The Efficacy of TCM Syndrome Differentiation in The Treatment of Dysfunctional Uterine Bleeding

目的基于8种不同中医辩证干预措施对功能失调性子宫出血疗效进行网状Meta分析,探讨对比不同中医辨证干预措施的治疗效果。方法计算机检索PubMed、CBM、CNKI、WanFang Data、VIP、The Cochrane Li-brary以及EMbase数据库有关中医辨证治疗治疗功能失调性子宫出血的随机对照试验,检索年限均自建库起至2020年2月3日。筛选出符合纳入标准的研究,按照Cochrane5.1手册标准对纳入研究进行文献质量评价与偏倚风险评估,用R软件进行网状Meta分析与概率排序。结果共纳入43个研究,共包含功能失调性子宫出血患者4606名。网状Meta分析结果提示,各中医辨证干预措施组疗效均优于西药干预组,其中养肝补肾组[OR=6.9,95%CI(3.5,14.0)]对功能失调性子宫出血患者疗效最佳,其次分别为清热凉血组[OR=6.1,95%CI(3.1,14.0)]、养血补气组[OR=5.5,95%CI(2.6,13.0)]、健脾组[OR=3.7,95%CI(1.7,9.0)]、补气组[OR=2.9,95%CI(1.3,6.8)]、补肾组[OR=2.7,95%CI(1.7,4.4)]、活血化瘀组[OR=2.6,95%CI(1.5,4.7)]和健脾补肾组[OR=2.4,95%CI(1.5,3.8)]。结论不同中医辨证干预措施治疗功能失调性子宫出血疗效均优于西药干预措施,其中又以养肝补肾法疗效最优。由于受所纳入文献的数量及质量限制,上述结论仍需更多大样本、高水平的随机对照试验进行更高质量验证。

Objective:To explore and compare the therapeutic effects of 8 different TCM differentiated interventions on dysfunctional uterine bleeding.Methods:PubMed,CBM,CNKI,Wanfang Data,VIP,the Cochrane Library and EMBASE databases were searched for randomized controlled trials on TCM syndrome differentiation and treatment of dys-functional uterine bleeding.The retrieval period was from the establishment of the database to February 3,2020.Accord-ing to Cochrane 5.1 manual standard,the included studies were evaluated for literature quality and bias risk,and R software was used for network meta-analysis and probability ranking.Results:A total of 43 studies involving 4606 patients with dysfunctional uterine bleeding were included.The results of network meta-analysis showed that the curative effect of each TCM intervention group was better than that of Western medicine intervention group,among which the liver and kid-ney nourishing Group[OR=6.9,95%CI(3.5,14.0)]was the best,followed by the heat clearing and blood cooling group[OR=6.1,95%CI(3.1,14.0)],The group of nourishing blood and Qi[OR=5.5,95%CI(2.6,13.0)],Jianpi group[OR=3.7,95%CI(1.7,9.0)],Buqi group[OR=2.9,95%CI(1.3,6.8)],kidney tonifying group[OR=2.7,95%CI(1.7,4.4)],blood activating and blood stasis resolving group[OR=2.6,95%CI(1.5,4.7)],and nourishing spleen and kidney Group[OR=2.4,95%CI(1.5,3.8)].Conclusion:The therapeutic effects of different TCM syndrome differentiation intervention measures on dysfunctional uterine bleeding is better than that of Western medicine intervention measures,and Yanggan Bushen method has the best effect.Due to the limitation of the quantity and quality of the included literature,more large sample and high-level randomized controlled trials are needed to verify the above conclusions.