黑升麻提取物可改善子宫内膜异位症患者术后治疗的低雌激素状态

Efficacy of black cohosh extracts for improving low estrogen status induced by postoperative GnRHa treatment in patients with endometriosis:a systematic review

目的:系统评价黑升麻提取物改善子宫内膜异位症患者术后促性腺激素释放激素激动剂(GnRHa)治疗导致低雌激素状态的有效性。方法:计算机检索至2020年1月,在Medline、PubMed、Cochrane Library、中国期刊全文数据库(CNKI)、中国生物医学文献数据库、万方数据和维普中国科技期刊数据库中,检索子宫内膜异位症患者腹腔镜手术后GnRHa疗程中加入黑升麻提取物辅助治疗以缓解GnRHa造成的低雌激素状态的临床随机对照试验,对符合纳入标准的文献进行质量评价,使用Revman 5.3软件对数据进行meta分析。结果:最终纳入7篇随机对照研究,总计745例患者。meta分析结果显示,与对照组比较,黑升麻提取物的加入不会影响患者体内激素水平,包括血清雌二醇水平(MD=1.24,95%CI:-4.58~7.08,P>0.05)和促黄体激素水平(MD=-0.02,95%CI:-0.15~0.11,P>0.05)。黑升麻提取物可以有效改善由于GnRHa造成患者体内低雌激素所产生的围绝经期症状:改善患者潮热出汗(OR=0.1,95%CI:0.02~0.47,P<0.01),减少失眠症状的发生(OR=0.23,95%CI:0.13~0.39,P<0.01),改善乏力(OR=0.09,95%CI:0.04~0.20,P<0.01),减少阴道干燥的发生(OR=0.04,95%CI:0.01~0.30,P<0.01)。黑升麻提取物的加入会影响手术12周后患者Kupperman绝经指数(KMI)评分(MD=-11.50,95%CI:-20.09^-2.90,P<0.01)及24周后KMI评分(MD=-23.68,95%CI:-39.66^-7.69,P<0.01)。结论:目前有限的证据表明,黑升麻提取物能够有效地改善子宫内膜异位症患者术后GnRHa治疗造成体内雌激素含量降低所引起的围绝经期症状,且不会影响体内激素水平。

Objective:To evaluate the efficacy of black cohosh extracts(BCE)in improving the low estrogen status induced by postoperative gonadotropin-releasing hormone agonist(GnRHa)in patients with endometriosis.Methods:Randomized clinical controlled trial about the improvement of low estrogen status caused by GnRHa with the treatment of BCE in patients with endometriosis after laparoscopic surgery were retrieved from Medline(Ovid),PubMed,Cochrane Library,CNKI,CBMdisc,Wanfang and VIP databases before January 2020,and meta-analysis of included studies was performed by Revman 5.3 software.Results:Seven randomized controlled trials involving 745 patients were included in this study.Meta-analysis results showed that the addition of BCE did not alter hormone levels of patients,including serum estradiol levels[MD=1.24,95%CI(-4.58,7.08),P>0.05]and luteinizing hormone levels[MD=-0.02,95%CI(-0.15,0.11),P>0.05].BCE effectively improved the perimenopausal symptoms induced by low estrogen status:improving hectic fever and sweating[OR=0.1,95%CI(0.02,0.47),P<0.01],reducing the occurrence of insomnia symptoms[OR=0.23,95%CI(0.13,0.39),P<0.01],improving fatigue[OR=0.09,95%CI(0.04,0.20),P<0.01],reducing the occurrence of vaginal dryness[OR=0.04,95%CI(0.01,0.30),P<0.01].BCE affected Kupperman s menopausal index(KMI)score 12 weeks after the surgery[MD=-11.50,95%CI(-20.09,-2.90),P<0.01]and KMI score 24 weeks after the surgery[MD=-23.68,95%CI(-39.66,-7.69),P<0.01].Conclusion:The limited evidence so far indicates that BCE could efficiently improve perimenopausal symptoms cause by low estrogen status of the patients recieved GnRHa treatment after surgery for endometriosis,but does not alter hormone levels of patients.