补肾活血法治疗抗心磷脂抗体阳性复发性流产的Meta分析

Meta Analysis of Treating Positive-ACA Recurrent Spontaneous Abortion by the Method of Invigorating-kidney and Promoting Blood-circulation

目的:运用循证医学的方法系统评价补肾活血法治疗抗心磷脂抗体(ACA)阳性复发性流产的疗效与安全性,为临床提供循证参考。方法:计算机检索国内外数据库及手动检索国内核心期刊(检索期限为1990年1月至2018年4月),纳入以补肾活血法为组方依据治疗抗心磷脂抗体阳性复发性流产的临床随机对照试验,提取资料,用Cochrane系统评价的方法对文献质量进行评分,采用RevMan5.3统计软件对纳入研究的结果进行Meta分析。结果:13篇相关研究文献被纳入本研究,Meta分析显示,与对照组相比,治疗组疗效总有效率增加,差异具有统计学意义[OR=3.77,95%CI(2.42,5.90)];治疗组中医证候积分明显高于对照组,差异具有统计学意义[MD=-5.45,95%CI(-5.92,-4.99)];治疗组ACA转阴率明显高于对照组,差异具有统计学意义[OR=3.71,95%CI(2.54,5.43)];治疗组ACA水平明显低于对照组,差异具有统计学意义[MD=-1.99,95%CI(-2.31,-1.66)];治疗组保胎至12周成功率明显高于对照组,差异具有统计学意义[OR=3.36,95%CI(2.14,5.28)];治疗组血清人绒毛膜促性腺激素(β-HCG)明显高于对照组,差异具有统计学意义[MD=35.96,95%CI(33.20,38.71)]。结论:现有临床文献所评价补肾活血法治疗抗心磷脂抗体阳性复发性流产较西医有显著优势,是一种很有前景的治疗手段。

Objective:To provide evidence-based reference for clinical work by assessing clinical effects and the safety of invigorating-kidney and promoting blood-circulation method in the treatment for positive anticardiolipin antibody(ACA)recurrent spontaneous abortion(RSA)using the method of evidence-based medicine.Methods:Clinical randomized control test for the recipe based on the method of invigorating-kidney and promoting blood-circulation in the treatment for positive-ACA RSA were searched in domestic and foreign databases by computer and domestic core journals manually(retrieval period from January,1990 to April,2018)to extract the data,the quality of the papers were scored using Cochrane system evaluation method,the results of the included studies were performed Meta analysis using statistical software RevMan 5.3.Results:All 13 papers about the related studies were included in the study.Meta analysis showed that,compared with the control group,total effective rate of clinical effects in the treatment group raised,and the difference had statistical meaning[OR=3.77,95%CI(2.42,5.90)];the treatment group was higher than the control group in TCM syndrome scores obviously,and the difference showed statistical meaning[MD=-5.45,95%CI(-5.92,-4.99)];the treatment group was notably higher than the control group in ACA negative-conversion rate,and there was a significant difference[OR=3.71,95%CI(2.54,5.43)];the treatment group was lower than the control group in the levels of ACA obviously,and the difference was statistically significant[MD=1.99,95%CI(-2.31,-1.66)];the treatment group was higher than the control group in the success rate of protecting the fetus to 12th week,and the difference had statistical meaning[OR=3.36,95%CI(2.14,5.28)];the treatment group was notably higher than the control group inβ-HCG,and the difference had statistical meaning[MD=35.96,95%CI(33.20,38.71)].Conclusion:The method of invigorating-kidney and promoting blood-circulation in the treatment for positive ACA RSA shows the distinct advantages compared with Western medicine assessed by the existing clinical literature,and it′s a promising therapeutic measure.