针灸结合中药治疗卵巢早衰的Meta分析

Acupuncture combined with traditional Chinese medicine in the treatment of premature ovarian failure:A meta-analysis

目的系统评价针灸结合中药治疗卵巢早衰的临床疗效及安全性。方法检索CNKI、VIP、Wangfang database、CBM、PubMed、Cochrane Library、EMBase等数据库中关于针灸结合中药治疗卵巢早衰临床疗效的随机对照研究的相关文献,检索时限截止至2019年10月,由2名研究员独立筛选文献,提取数据,参照Cochrane协作网的偏倚风险评估工具对纳入文献进行评价,利用Rev Man 5.3软件进行Meta分析。结果本研究共纳入14篇文献,879例患者。Meta分析结果显示,(1)针灸结合中药治疗卵巢早衰总有效率优于激素替代疗法(HRT)[OR=3.41,95%CI(2.38,4.89),P<0.05]。(2)实验室指标(E2、FSH、LH)改善情况针灸结合中药优于激素替代疗法,合并效应量SMD分别为0.86、-0.95、-0.82,差异有统计学意义(P<0.05)。(3)临床症状(Kupperman评分)改善的情况针灸结合中药优于激素替代疗法,合并效应量SMD为-0.99(P<0.05)。(4)不良反应主要以胃肠道不适和头晕恶心为主,针灸结合中药同激素替代疗法比较,差异没有统计学意义[OR=0.13,95%CI(0.01,1.17),P=0.07]。结论基于目前证据,针灸结合中药治疗卵巢早衰的临床疗效确切,优于激素替代治疗,但由于纳入文献质量不高,结论尚需临床高质量随机对照试验证据证明。

Objective To compare the efficacy and safety between acupuncture combined with traditional Chinese medicine and hormone replacement therapy for premature ovarian failure.Methods Articles up to October,2019 about the randomized controlled trails on the efficacy of treating the premature ovarian failure with acupuncture combined with herbal medicine were included in the electronic retrieval library,which were from China national knowledge infrastructure(CNKI),China Science and Technology Journal Database(VIP),WanFang Database,China Biology Medicine disc(CBM),Pubmed,Cochrane Library,and EMBase.Studies screening and data extraction were performed by two researchers separately.The quality evaluation and risk assessment of the inclusion were carried out by using the criteria provided by the Cochrane.Meta-analysis was conducted with RevMan 5.3.Results A total of 14 randomized controlled trials were included,involving 879 individuals.The meta-analysis showed that:1)The total effective rate for the treatment of premature ovarian failure was higher in acupuncture combined with traditional Chinese medicine than in the hormone replacement therapy[OR=3.41,95%CI(2.38,4.89),P<0.05];2)The improvement of laboratory indexes(E2,FSH,LH)in patients who received treatment of acupuncture combined with traditional Chinese medicine were superior to those with hormone replacement therapy(SMD=0.86,-0.95,-0.82,P<0.05);3)The improvement of the Kupperman score in patients with acupuncture combined with traditional Chinese medicine was superior to those with hormone replacement therapy(SMD=-0.99,P<0.05);4)The main adverse reactions reported were gastrointestinal symptoms,dizziness and nausea.The adverse effects rate were similar in both oacupuncture combined with traditional Chinese medicine group and hormone replacement therapy group[OR=0.13,95%CI(0.01,1.17),P=0.07].Conclusions Our analysis found that acupuncture combined with traditional Chinese medicine showed better efficacy than hormone replacement therapy in the treatment of premature ovarian failure.However,the quality of the enrolled studies is low.Consequently,more high-quality randomized controlled trials would be needed in future.