中药与促性腺激素释放激素激动剂抑制子宫内膜异位症术后复发的 网状meta分析

Network meta-analysis of Chinese herbal treatment and GnRH-a to prevent the post-operative recurrence of pelvic endometriosis

目的 采用网状meta分析的方法 ,比较中药与促性腺激素释放激素激动剂（gonadotropin releasing hormone angonist,GnRH-a）抑制子宫内膜异位症术后复发的疗效.方法 检索PubMed、EMBASE、Cochrane Library、中国期刊全文数据库（CNKI）、中国生物医学文献数据库（SinoMed）、维普数据库（VIP）、万方数据等有关中药、GnRH-a抑制子宫内膜异位症保守术后复发的文献,评价纳入随机对照试验的质量,采用STATA V.13.1软件进行统计分析.结果 共纳入41项研究,涉及4122例子宫内膜异位症患者,33项研究共计2912例纳入了子宫内膜异位症术后复发率结局指标的数据分析.与单纯手术比较,GnRH类药物和活血化瘀类药物、理气活血类药物、补肾活血类药物均可降低患者的复发率[OR（95%CI）分别为0.35（0.24,0.50）、0.33（0.21,0.52）、0.18（0.09,0.36）、0.23（0.12,0.43）,P〈0.05].结论 GnRH-a类药物和活血化瘀类药物、理气活血类药物、补肾活血类药物在抑制子宫内膜异位症术后复发方面的疗效相当.

Objective To assess the clinical effects and safety of Chinese herbal treatment compared with GnRH-a for preventing the post-operative recurrence of pelvic endometriosis.Methods The relative randomized controlled trials （RCTs） of Chinese herbal treatment, GnRH-a and control groups were searched from PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wan-Fang Data, and the related references and website were also traced. The RCTs were screened according to the predefined inclusion and exclusion criteria. The related items were used to assess the quality of RCTs. Data were analyzed by STATA V.13.1 software.Results A total of 41 RCTs were included with 4122 patients with pelvic endometriosis, while only 33 studies with 2912 patients were analyzed of post-operative recurrence. Compared with the only surgery groups, GnRH-a and three kinds of Chinese herbal treatment （the medicine for activating blood circulation, the medicine for regulating the circulation of qi and blood, the medicine for strengthening kidney and promoting blood circulation） could significantly decrease the recurrence rate after operation, theOR（95%CI） were 0.35（0.24,0.50）, 0.33（0.21,0.52）, 0.18（0.09,0.36）, 0.23（0.12,0.43）,P〈0.05.Conclusions GnRH-a and three kinds of Chinese herbal treatment （the medicine for activating blood circulation, the medicine for regulating the circulation of qi and blood, the medicine for strengthening kidney and promoting blood circulation） could significantly decrease the recurrence rate after operation. There was no significant difference among all interventions.