治未病理论下中药联合健康指导治疗多囊卵巢综合征的系统评价

Systematic Review on the Effect of Chinese Herbal Medicine Combined with Health Guidance on Polycystic Ovary Syndrome on the Basis of Theroy of Preventive Treatment of Disease

目的 系统评价“治未病”思想下中药联合健康指导治疗多囊卵巢综合征(PCOS)的疗效,以提供更好的临床治疗方案和循证依据。方法计算机检索中国知网(CNKI)、万方学术期刊数据库(WanFang)、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、Web of Science、Clinicalkey和Embase数据库,搜索与中药联合健康指导治疗PCOS相关的文献,进行严格筛选和数据提取后,使用RevMan5.3软件实现Meta分析。结果 共纳入17篇文献1175例患者,Meta分析结果显示,中药联合健康指导相较于对照组能够有效提高PCOS临床疗效(RR=1.28,95%CI[1.09,1.52],P=0.003);增加BBT双相率(RR=1.33,95%CI[1.12,1.57],P=0.001)和妊娠率(RR=1.94,95%CI[1.02,3.70],P=0.04);显著降低身体质量指数(BMI)(MD=-1.19,95%CI[-1.69,-0.69],P<0.00001);调节性激素中睾酮(T)(SMD=-0.51,95%CI[-0.64,-0.38],P<0.00001)和黄体生成素水平(LH)(SMD=-0.90,95%CI[-1.39,-0.41],P=0.0003);但两组在改善卵泡雌激素水平(FSH)方面差异无统计学意义(SMD=-0.16,95%CI[-0.68,0.35],P=0.54)。进一步通过Meta回归和亚组分析,得知指标FSH的异质性来源可能与年龄相关;联合治疗能够明显降低<28岁和痰湿型的PCOS患者BMI水平,并且能够普遍改善PCOS患者LH水平。对临床疗效进行敏感性分析,结果相对稳定。结论 中药联合健康指导对治疗PCOS具有较大优势,但仍需对结论进一步证实。

Objective Evaluate the effect of Chinese herbal medicine combined with health guidance on polycystic ovary syndrome(PCOS) systematically in order to provide schemes of treatment and evidence of medicine. Methods By searching CNKI, WanFang, Pubmed, Web of Science and so on, related literatures about treating PCOS by Chinese herbal medicine and health guidance were collected. After selecting and extracting data, the Meta analysis was finally perfomed by the software of RevMan 5.3. Results A total of 17 randomized controlled trials(RCTs), included in 1175 cases were involved. Meta-analysis showed that the effectivness of Chineses medicine associated with health guidance group was superior to control group(RR=1.28, 95% CI[1.09, 1.52], P=0.003). The experimental group could also improve the ratio of BBT presented typical double phase(RR=1.33, 95% CI[1.12, 1.57], P=0.001), pregnancy rate(RR=1.94, 95% CI[1.02, 3.70], P=0.04) and reduce androgen(T)(SMD=-0.51, 95% CI[-0.64,-0.38], P<0.00001),luteinizing hormone(LH)(SMD=-0.90, 95% CI[-1.39,-0.41], P=0.0003) as well as body mass index(BMI)(MD=-1.19,95% CI[-1.69,-0.69], P<0.00001). But there was no significant difference in regulating follicle stimulating hormone(FSH) between two groups(SMD=-0.16, 95% CI[-0.68, 0.35], P=0.54). Through meta regression and subgroup analysis,the heterogeneity of FSH was related to age. Combination therapy can contribute to reducing BMI of patients who had been confirmed diagnosed with phlegm-dampness PCOS and less than 28 yaers old. In addition, the therapy can improve the level of LH generally. Clinical efficacy was evaluated by sensitivity analysis which suggested relatively stability of outcomes. Conclusion The therapy of Chinese herbal medicine combined with health guidance in treatment of PCOS had a greater superiority, but this conclusion still needed more studies in high quality and large sample to confirm.