中西药联合使用治疗复发性流产的Meta-分析
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摘要
目的系统评价中西药联合对比西药治疗复发性流产的综合疗效,为临床用药提供依据。方法通过计算机检索PubMed、Cochrane library、Embase、中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库建库—2017年5月中西药联合治疗复发性流产患者的随机对照研究(RCT),对纳入文献进行质量评价,并用Revman 5.3软件进行Meta-分析。结果最终纳入43篇文献共3 298名患者。Meta-分析结果显示,中西药联合组的有效率明显高于西药组[OR=3.57,95%CI(2.73,4.67),P=0.98];针对不同中医症型,亚组分析显示补肾组、补肾健脾组、补气补血组以及补肾活血组疗效均优于单独使用西药[OR=3.47,95%CI(2.60,4.63),P=0.97];中西药联合使用能提高中医症候疗效[OR=4.54,95%CI(2.95,6.99),P=1.00],显著降低症状积分[MD=-3.46,95%CI(-4.32,-2.60),P<0.000 1];中西药联合使用组和西药组在孕8周[SMD=-0.65,95%CI(-0.10,1.40),P<0.000 01]、孕10周[SMD=0.10,95%CI(-0.78,0.98),P<0.000 01]血清β-HCG、IL-10[SMD=0.14,95%CI(-0.87,1.15),P<0.000 01]没有显著差异。结论与单独使用西药治疗相比,中西药联用增加了治疗有效率,改善了再次妊娠时的流产症状;针对不同中医症型的患者,均能够取得更好的疗效。中西药联用在血清β-HCG以及血清IL-10因子方面没明显改善。
Objective To compare the comprehensive curative effect of Chinese and western medicine combined with western medicine alone in the treatment of patients with recurrent spontaneous abortion.Methods Clinical control trials of patients with recurrent spontaneous abortion were conducted through the computer search of PubMed,Cochrane library,Embase,CBM,CNKI and Wanfang Data from inception to May 1,2017.And then the quality of the included documents was evaluated,Revman 5.3software was used to perform Meta-analysis of the eligible studies.Results A total of 3 298 patients with recurrent spontaneous abortion were included in 43 literatures.Meta-analysis showed that the effective rate of the combination group was significantly higher than that of the western medicine group[OR=3.57,95%CI(2.73,4.67),P=0.98];For different TCM types,the kidney group,bushenjianpi group,qixuejunbu group and bushenhuoxue group were all better than medicine alone[OR=3.57,95%CI(2.73,4.67),P=0.98];At the same time,the combination of Chinese and western medicine can significantly improve the efficacy of TCM symptoms[OR=4.54,95%CI(2.95,6.99),P=1.00],significant reduced symptom scores[MD=-3.46,95%C(I-4.32,-2.60),P<0.000 1];However,there was no significant difference between the western medicine group and Chinese and western medicine for8 weeks[SMD=-0.65,95%C(I-0.10,1.40),P<0.000 01]and 10 weeks of[SMD=0.10,95%C(I-0.78,0.98),P<0.000 01]serumβ-HCG,serum IL-10[SMD=0.14,95%C(I-0.87,1.15),P<0.000 01].Conclusions Compared with the use of western medicine alone in the treatment of recurrent spontaneous abortion,the effective rate of combined use of Chinese and western medicines has increased significantly,which has improved the symptoms of miscarriage when recurrent miscarriage occurs during re-pregnancy;and for the recurrent abortions of different TCM syndrome types,combined Chinese medicine treatment can achieve better efficacy.Analysis of serumβ-HCG levels and serum IL-2 and IL-10 levels in the two groups showed no statistical significance.
Objective To compare the comprehensive curative effect of Chinese and western medicine combined with western medicine alone in the treatment of patients with recurrent spontaneous abortion.Methods Clinical control trials of patients with recurrent spontaneous abortion were conducted through the computer search of PubMed,Cochrane library,Embase,CBM,CNKI and Wanfang Data from inception to May 1,2017.And then the quality of the included documents was evaluated,Revman 5.3software was used to perform Meta-analysis of the eligible studies.Results A total of 3 298 patients with recurrent spontaneous abortion were included in 43 literatures.Meta-analysis showed that the effective rate of the combination group was significantly higher than that of the western medicine group[OR=3.57,95%CI(2.73,4.67),P=0.98];For different TCM types,the kidney group,bushenjianpi group,qixuejunbu group and bushenhuoxue group were all better than medicine alone[OR=3.57,95%CI(2.73,4.67),P=0.98];At the same time,the combination of Chinese and western medicine can significantly improve the efficacy of TCM symptoms[OR=4.54,95%CI(2.95,6.99),P=1.00],significant reduced symptom scores[MD=-3.46,95%C(I-4.32,-2.60),P<0.000 1];However,there was no significant difference between the western medicine group and Chinese and western medicine for8 weeks[SMD=-0.65,95%C(I-0.10,1.40),P<0.000 01]and 10 weeks of[SMD=0.10,95%C(I-0.78,0.98),P<0.000 01]serumβ-HCG,serum IL-10[SMD=0.14,95%C(I-0.87,1.15),P<0.000 01].Conclusions Compared with the use of western medicine alone in the treatment of recurrent spontaneous abortion,the effective rate of combined use of Chinese and western medicines has increased significantly,which has improved the symptoms of miscarriage when recurrent miscarriage occurs during re-pregnancy;and for the recurrent abortions of different TCM syndrome types,combined Chinese medicine treatment can achieve better efficacy.Analysis of serumβ-HCG levels and serum IL-2 and IL-10 levels in the two groups showed no statistical significance.
引文
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[5]乐杰.妇产科学[M].第7版.北京:人民卫生出版社,2008.
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[8]陈蓉,刘杨春,王雪梅.清热固胎汤联合黄体酮治疗复发性流产(血热证)的临床研究[J].中医药导报,2016(16):83-86.
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[11]党慧敏,刘艳巧,刘润侠,等.补肾活血方联合地屈孕酮片对复发性自然流产患者血管内皮生长因子及其可溶性受体-1的影响[J].中医杂志,2014,55(20):1739-1744.
[12]郭方兰.温阳健脾方治疗脾肾阳虚型复发性流产的临床研究[D].昆明:云南中医学院,2016.
[13]侯海丽.加味丹寿汤合地屈孕酮片对原因不明复发性流产患者的疗效观察[D].郑州:河南中医药大学,2014.
[14]黄红梅,李群,彭瑶,等.中西医结合治疗反复性流产48例临床观察[J].中医药导报,2014(3):55-57.
[15]黄越,梁淑东,唐翠兰.安胎汤联合西药治疗复发性流产效果观察[J].现代医药卫生,2010,26(2):172-173.
[16]黄长盛,管雁丞,刘新玉.中西医结合治疗脾肾两虚复发性自然流产31例[J].江西中医药,2016(4):50-52.
[17]姜丽娟,郭方兰,吴生元.吴氏扶阳学术思想治疗脾肾阳虚型滑胎36例[J].中国中医药现代远程教育,2016,14(24):64-67.
[18]李平.中西医结合治疗习惯性流产60例临床观察[J].湖南中医杂志,2000(1):20-21.
[19]李亚,王俊玲,刘昱磊,等.活血化瘀法治疗血栓前状态所致复发性流产的临床观察[J].广州中医药大学学报,2015,32(6):1000-1004.
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[22]马艳芳,宋益庆.益气固肾汤化裁联合西药对复发性自然流产患者免疫功能及妊娠结局的影响[J].四川中医,2017(4):114-116.
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[27]邱美林.PCOS合并复发性流产的中西医结合临床研究[D].扬州:扬州大学,2016.
[28]饶育梅.补肾安胎方联合黄体酮治疗复发性流产39例[J].中国药业,2014,23(22):112-114.
[29]王春燕,张文红.中西医结合治疗黄体功能不全引起的复发性早期流产的临床研究[J].特别健康,2017(15):245.
[30]王革新,魏伟周,黄丙坤.中西医结合治疗原因不明复发性流产患者Th1/Th2细胞因子水平的影响[J].中华中医药学刊,2010(8):1701-1702.
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[32]谢英花,杨雪.寿胎丸合四物汤加地屈孕酮片治疗复发性流产临床疗效观察[J].新中医,2016(6):156-158.
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