口服补肾类中成药联合左卡尼汀治疗少弱精子症的网状meta分析

Network Meta-analysis of Oral Kidney-tonifying Chinese Patent Medicine Combined with L-carnitine in the Treatment of Oligoasthenozoospermia

目的采用网状meta分析方法评价补肾类中成药联合左卡尼汀(L-carnitine,LC)治疗男性少弱精子症的有效性及安全性。方法运用计算机检索Web of Science、Cochrane Library、EMbase、PubMed、维普、万方、中国知网、中国生物医学文献数据库,搜寻有关补肾类中成药联合LC治疗少弱精子症的随机对照试验(randomized controlled trials,RCTs),检索时间为建库至2022年2月,对符合质量标准的研究采用Stata 16.0和Review Manager 5.4软件进行分析。结果共检索出2820篇文献,最终纳入33个RCTs,包括8种中成药和3896例患者。网状meta分析结果表明,8种中成药与LC联用在改善各指标方面均优于单独使用。在改善总有效率、精子活力a级和精子活力a+b级方面,麒麟丸+LC具有最好的疗效(SUCRA=90.9%,90.4%以及98.0%)。而复方玄驹胶囊+LC改善精子浓度和精子存活率的效果最好(SUCRA=91.0%,98.0%)。安全性方面,仅3篇文献报道了不良反应的具体发生情况,均未因不良反应事件而停药。结论8种中成药联合LC治疗少弱精子症皆具有较好的临床疗效,其中麒麟丸+LC与复方玄驹胶囊+LC在所有疗效指标中排名靠前且稳定,具有良好的临床应用价值。由于报道不良反应的文献较少,其安全性仍待进一步验证。

OBJECTIVE To evaluate the efficacy and safety of different kidney-tonifying Chinese patent medicines combined with L-carnitine(LC)in the treatment of oligoasthenozoospermia by network meta-analysis.METHODS Web of Science,Cochrane Library,EMbase,VIP,Wanfang,CNKI and Chinese Biomedical Literature Database were searched by computer for randomized controlled trials(RCTs)on related kidney-tonifying Chinese patent medicines combined with LC in the treatment of oligoasthenozoospermia.The retrieval time was from the establishment of the database to February 2022.Studies that met the quality criteria were analyzed using Stata 16.0 software and Review Manager 5.4.RESULTS A total of 2820 articles were retrieved and finally 33 RCTs involving 8 Chinese patent medicines and 3896 patients were included.The results of network meta-analysis showed that:eight Chinese patent medicines combined with LC were better than single use in improving each index.In terms of improving the total effective rate and sperm motility a%and(a+b)%,Qilin pill+LC had the best efficacy(SUCRA=90.9%,90.4%and 98.0%).Fufang Xuanju capsule+LC had the best effect on improving sperm concentration and sperm survival rate(SUCRA=91.0%,98.0%).In terms of safety,only 3 literatures reported the specific occurrence of adverse reactions,and no drug was discontinued due to adverse reactions.CONCLUSION Eight Chinese patent medicines combined with LC have good clinical efficacy in the treatment of oligoasthenozoospermia.Among them,Qilin pill+LC and Fufang Xuanju capsule+LC rank high and stable in all efficacy indicators,and have good clinical application value.Due to the lack of literature reporting adverse reactions,their safety remain to be further verified.