补肾中药联合克罗米芬改善PCOS子宫内膜容受性的Meta分析

A Meta-analysis on the Improvement of Endometrial Receptivity of PCOS by Bushen Recipe Combined with Clomiphene

目的:系统评价补肾中药联合克罗米芬对比克罗米芬改善多囊卵巢综合征子宫内膜容受性的疗效及安全性。方法:计算机检索知网数据库、维普网、万方数据知识服务平台、中国生物医学文献服务系统、考克兰数据库、Web of Science数据库、PubMed数据库、Embase数据库,时间限定为从建库至2020年1月2日,检索补肾中药联合克罗米芬与克罗米芬对比改善多囊卵巢综合征子宫内膜容受性的RCT,采用RevMan5.3软件进行Meta分析。结果:共有13项RCT符合纳入要求,合计797例PCOS患者。本次Meta分析结果显示:补肾中药联合克罗米芬组与克罗米芬组在改善子宫内膜厚度[WMD=1.62,95%CI(1.22,2.01),P<0.00001]、子宫内膜类型[RR=1.51,95%CI(1.28,1.78),P<0.00001]、子宫动脉搏动指数(PI)[WMD=-0.18,95%CI(-0.27,-0.09),P<0.0001]、子宫动脉阻力指数(RI)[WMD=-0.08,95%CI(-0.11,-0.05),P<0.00001]、妊娠率[RR=2.18,95%CI(1.55,3.05),P<0.00001]、中医证候评分[WMD=-6.97,95%CI(-8.97,-4.97),P<0.00001]、有效率[RR=1.25,95%CI(1.13,1.37),P<0.00001]方面,差异有统计学意义。结论:对比单纯使用克罗米芬,补肾中药联合克罗米芬能有效促进PCOS患者的子宫内膜增长,并改善其子宫内膜类型,促进子宫内膜血流灌注,提高妊娠率,同时改善临床症状,降低中医证候评分,提高治疗总有效率,有望进一步临床推广应用。

Objective:To systematically evaluate the efficacy and safety of Bushen recipe combined with clomiphene compared with clomiphene in improving endometrial receptivity of polycystic ovary syndrome.Methods:Researches were reviewed by searching the China National Knowledge Infrastructure(CNKI),VIP network,Wanfang database,SinoMed,Cochrane Library,Web of Science,PubMed and Embase up to January 2,2020.We retrieved the RCT of Bushen recipe combined with clomiphene and clomiphene to improve the endometrial receptivity of polycystic ovary syndrome and applied Revman5.3 software for meta analysis.”Results:A total of 13 RCTs were included,with a total of 797 PCOS patients.The results of this meta-analysis showed that there were statistically significant differences in the improvement of endometrial thickness[WMD=1.62,95%CI(1.22,2.01),P<0.00001],endometrial type[RR=1.51,95%CI(1.28,1.78),P<0.00001],uterine artery pulse index(PI)[WMD=-0.18,95%CI(-0.27,-0.09),P<0.0001],uterine artery resistance index(RI)[WMD=-0.08,95%CI(-0.11,-0.05),P<0.00001],pregnancy rate[RR=2.18,95%CI(1.55,3.05),P<0.00001],TCM syndrome score[WMD=-6.97,95%CI(-8.97,-4.97),P<0.00001],effective rate[RR=1.25,95%CI(1.13,1.37),P<0.00001].Conclusion:Compared with using clomiphene alone,Bushen recipe combined with clomiphene can effectively increase the thickness of endometrium and improve the type of endometrium,promote the blood perfusion of endometrium,improve the pregnancy rate,improve the clinical symptoms,reduce the TCM syndrome score,and improve the total efficiency of treatment with high clinical application value.