补肾活血中药联合孕三烯酮用于子宫内膜异位症术后治疗的系统评价和Mate分析

Tonifying kidney and activating blood traditional Chinese drugs combined with gestrinone for postoperative treatment of endometriosis:a systematic review and meta-analysis

目的采用Meta分析方法系统评价补肾活血中药联合孕三烯酮用于子宫内膜异位症术后治疗的效果和安全性。方法计算机检索中国知网(CNKI)、万方数据、维普网、中国生物医学文献数据库(CBM)、PubMed、Embase和Web of Science等数据库从建库至2022年11月有关补肾活血中药联合孕三烯酮用于子宫内膜异位症术后治疗的临床随机对照试验(RCT),制定纳入和排除标准,筛选符合标准的文献。以给予补肾活血中药联合孕三烯酮治疗的患者作为试验组,单纯给予孕三烯酮治疗的患者作为对照组,提取相关资料运用RevMan 5.4.1软件进行Meta分析。结果共纳入7项RCT研究,涉及患者816例。Meta分析结果显示:与对照组相比,试验组的总有效率[比值比(OR)=2.35,95%CI(1.47,3.77),P=0.0004]、妊娠率[OR=2.34,95%CI(1.62,3.38),P<0.00001]显著增高,复发率[OR=0.38,95%CI(0.24,0.59),P<0.0001]、FSH水平[均数差(MD)=-1.53,95%CI(-1.87,-1.20),P<0.00001]、糖类抗原125(CA125)水平[MD=-13.53,95%CI(-16.78,-10.28),P<0.00001]及LH水平[MD=-1.64,95%CI(-1.86,-1.42),P<0.00001]显著降低;两组的不良反应发生率及E 2水平变化无显著性差异(P>0.05)。结论与单纯使用孕三烯酮比较,补肾活血中药联合孕三烯酮用于子宫内膜异位症术后治疗在提高治疗有效率及妊娠率、降低复发率等方面可能更有优势,但因为本研究纳入文献的数量及质量有限,后续仍需要更多高质量的RCT研究进一步验证。

Objective:To explore the efficacy and the safety of tonifying kidney and activating blood traditional Chinese drugs combined with gestrinone for postoperative treatment of endometriosis by using meta-analysis.Methods:CNKI,Wanfang,VIP,CBM,PubMed,Embase and Web of Science were searched for randomized controlled trials(RCTs)about postoperative treatment of endometriosis with tonifying kidney and activating blood Chinese drugs combined with gestrinone from establishment to November 2022.All included researches were assessed using the Cochrane Collaboration’s tool for assessing risk of bias and the modified Jadad Scale.The meta-analysis for all studies was conducted using RevMan 5.4.1.Results:Totally 7 RCTs were included,involving 816 patients.Results of the meta-analysis showed that the efficiency of treatment[OR=2.35,95%CI(1.47,3.77),P<0.0004]and the pregnancy rate[OR=2.34,95%CI(1.62,3.38),P<0.00001]of the treatment group were significantly higher than those of the control group.The recurrence rate[OR=0.38,95%CI(0.24,0.59),P<0.0001]as well as the levels of FSH[mean difference(MD)=-1.53,95%CI(-1.87,-1.20),P<0.00001],CA125[MD=-13.53,95%CI(-16.78,-10.28),P<0.00001]and LH[MD=-1.64,95%CI(-1.86,-1.42),P<0.00001]were significantly lower than those of the control group.But the rate of total adverse reactions and the level of estradiol showed no statistically significant differences between the two groups.Conclusions:Postoperative treatment of endometriosis with tonifying kidney and activating blood traditional Chinese drugs combined with gestrinone has better efficacy and higher pregnancy rate as well as lower recurrent rate.Higher quality RCTs are needed for the limitation of the number and quality of this study.