中药+枸橼酸氯米芬治疗排卵障碍性不孕的系统评价

Systematic review of Chinese medicine and clomiphene citrate for dysfunctional ovulatory acyesis

目的评价中药+枸橼酸氯米芬(CC)治疗排卵障碍性不孕的有效性。方法计算机检索PubMed、荷兰医学文摘数据库、Cochrane library、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊数据库,用Google scholar和Medical martix搜索引擎在互联网上查找相关文献,收集中药+CC治疗排卵障碍性不孕的随机和半随机对照试验。由2名研究者独立依据Gochranereviewer's handbook 4.2.6推荐的方法评价纳入研究的文献质量,对符合纳入标准的研究采用Cochranecollaboration's RevMan 4.2.10进行Meta分析。结果纳入3个随机对照试验和10个半随机对照试验,1555例排卵障碍性不孕患者。与单纯应用CC比较,中药+CC治疗排卵障碍性不孕妊娠可提高妊娠率,相对危险度(RR)为1.68,95%可信区间(CI)为(1.50,1.89),P<0.00001;提高排卵率,RR为1.19,95%CI为(1.12,1.26),P<0.00001;提高基础体温,RR为1.27,95%CI为(1.09,1.46),P<0.0001;增加子宫内膜厚度,RR为1.71,95%CI为(1.38,2.12),P<0.000 01。结论中药+CC治疗排卵障碍性不孕优于单纯CC,但目前的研究质量较低,尚需开展高质量临床试验。

Objective To assess the effectiveness of Chinese medicine with clomiphene citrate （CC） for dysfunctional ovulatory acyesis. Methods PubMed, EMBASE, Coehrane library, Chinese biomedical literature database, China journal fulltext database, Chinese scientific journals fulltext database, conference information and Internet information were searched for relevant information and randomly controlled trials of Chinese medicine with CC versus CC for dysfunctional ovulatory acyesis were included. The quality of the included studies was evaluated by Cochrane reviewer＇s handbook 4.2.6 recommended standard and the data were analyzed by Cochrane eollaboration＇s RevMan 4.2.10. Results Three randomly controlled trial and ten quasirandomly controlled trial （1555 patients） were included. Three trials were graded B and ten trials were graded C. There was difference in the rate of gestation risk ratio （RR）： 1.68, 95% confidence interval （CI）： （1.50, 1.89）, P 〈0.00001; the ovulation rate RR： 1.19, 95% CI： （1.12, 1.26）, P 〈0.00001; the basal animal heat RR： 1.27, 95% CI： （1.09, 1.46）, P 〈0.0001; the cervicle mucus RR： 1.71, 95% CI ： （1.38, 2.12）, P 〈0.00001. Conclusion Available evidence shows that Chinese traditional medicine with CC is more effective than CC. More large-scaled randomized trials will be needed to investigate the role of relaxation training for myocardial infarction.