补肾健脾法联合淋巴细胞主动免疫治疗封闭抗体不足型复发性流产的Meta分析

Meta-analysis on Combination Therapy with Lymphocyte Immuno-therapy and Method of Reinforcing the Kidney and Spleen in Closed Antibody Deficiency Type Recurrent Spontaneous Abortion

目的:利用循证医学的方法系统评价补肾健脾法联合淋巴细胞主动免疫治疗封闭抗体不足型复发性流产(RSA)的有效性和安全性,为临床治疗提供循证医学证据。方法:通过计算机和手工检索补肾健脾法联合淋巴细胞主动免疫治疗封闭抗体不足型复发性流产的临床文献,检索年限:建库至2016年10月24日,采用Cochrane Handbook5.1.0推荐的偏倚风险评估工具,结合《循证针灸临床实践指南》文献质量评价标准描述的RCT质量评价说明,评价纳入文献的质量,并应用Rev Man5.2进行Meta分析。结果:6篇相关研究文献纳入本研究。补肾健脾法联合主动免疫治疗有明显优势,可使封闭抗体转阳率增加(OR=3.25,95%CI[1.78,5.93],Z=3.85(P=0.0001))、妊娠率成功率增高(OR=3.34,95%CI[1.64,6.80],Z=3.32(P=0.0009))。结论:现有临床文献评价补肾健脾法联合淋巴细胞主动免疫治疗封闭抗体不足型复发性流产较单纯淋巴细胞主动免疫治疗优势明显,颇具前景,但纳入的文献数目有限,质量较低,并且存在潜在的发表偏倚,故本系统评价尚不能对补肾健脾法联合淋巴细胞主动免疫治疗封闭抗体不足型复发性流产的临床有效性和安全性做出肯定结论。

Objective： To evaluate the efficiency and safety of combination therapy with lymphocyte immunotherapy and method of reinforcing the kidney and spleen in closed antibody deficiency type recurrent spontaneous abortion（RSA） by using the method of evidence-based medicine system, provides evidence-based medical evidence for clinical treatment. Methods： By the method of computer and manual retrieval to find out the clinical literature about combination therapy with lymphocyte immunotherapy and method of reinforcing the kidney and spleen in closed antibody deficiency type recurrent spontaneous abortion, retrieval of building library-October 24, 2016; employing the bias risk assessment tools which are recommended by the Cochrane Handbook5.1.0; combining with the description which evaluates the literature quality according to the quality evaluation explanation of RCT by the＂ evidence-based acupuncture clinical practice guidelines＂ literature quality evaluation standard, and applying RevMan5.2 Meta analysis.Results： Six related papers are included in this study. There are many obvious advantages of connecting the invigorating the kidney and the spleen prescription and the active immunotherapy, which increases the rates of blocking antibody positive conversion（OR=3.25, 95% CI（1.78, 5.93], Z=3.85）（P=0.0001）and success of the pregnancy rate（OR=3.34,95% CI（1.64, 6.80], Z=3.32（P=0.0009））.Conclusion： The evaluation which is made by current clinical literature about combination therapy with lymphocyte immunotherapy and method of reinforcing the kidney and spleen in closed antibody deficiency type recurrent spontaneous abortion is more obviously superior than the simplistic lymphocyte active immunotherapy. So this method is a kind of very promising treatments, but because of the limited number of inclusive literature, the low quality and the potential publication bias, the system evaluation can not make an affirmative conclusion about the clinical efficiency and safety of the combination therapy with lymphocyte immunotherapy and method of reinforcing the kidney and spleen in closed antibody deficiency type recurrent spontaneous abortion.