活血化瘀方药联合地诺孕素治疗子宫内膜异位症有效性与安全性Meta分析  

Meta-analysis of Efficacy and Safety of Activating Blood and Dissipating Stasis Herbs Combined with Dienogest in the Treatment of Endometriosis

作　　者：田敏讷 刘利国 周英[2] TIAN Minne;LIU Liguo;ZHOU Ying(Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China)

机构地区：[1]广州中医药大学,广东广州510405 [2]广州中医药大学第一附属医院,广东广州510405

出　　处：《辽宁中医药大学学报》2023年第6期112-118,共7页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：广州市科技局市校(院)联合资助(登峰医院)基础研究项目(202102010400);广州中医药大学第一附属医院创新强院工程(二期)临床研究专项(2019IIT17)。

摘　　要：目的 系统评价活血化瘀方药联合地诺孕素治疗子宫内膜异位症的有效性与安全性。方法 计算机检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据知识服务平台、中文科技期刊数据库(VIP)、中国临床试验注册中心、PubMed、Web of science、Embase、Cochrane Library等关于活血化瘀方药联合地诺孕素治疗子宫内膜异位症的随机对照试验,检索时限为建库起至2022年11月。采用Cochrane协作网偏倚风险评估工具进行方法学质量评价,运用RevMan 5.4和Stata 16.0软件进行Meta分析。结果 共纳入9项研究,1078例患者,其中试验组539例,对照组539例。Meta分析结果显示,活血化瘀方药联合地诺孕素治疗在提高总有效率[RR=1.24,95%CI(1.17,1.30),P<0.000 01]、减小子宫内膜异位囊肿直径[MD=-1.01,95%CI(-1.63,-0.39),P=0.001]、降低疼痛视觉模拟评分(VAS)[MD=-1.68,95%CI(-2.67,-0.70),P<0.000 01]、降低糖类抗原125[MD=-17.05,95%CI(-23.44,-10.66),P<0.000 01]、降低雌二醇水平[MD=-22.91,95%CI(-25.34,-20.48),P<0.000 01]、降低孕酮水平[MD=-0.22,95%CI(-0.25,-0.19),P<0.000 01]、降低血清内皮生长因子[MD=-23.97,95%CI(-30.96,-16.99),P<0.000 01]、降低基质金属蛋白酶-2[MD=-42.29,95%CI(-45.68,-38.89),P<0.000 01]、降低基质金属蛋白酶-9[MD=-118.99,95%CI(-172.97,-65.02),P<0.000 01]、降低半乳糖凝集素-3[MD=-1.35,95%CI(-1.83,-0.87),P<0.000 01]、降低复发率[RR=0.28,95%CI(0.13,0.59),P=0.000 8]方面均优于单用地诺孕素治疗。总有效率漏斗图及Egger’s检验结果提示,不存在明显的发表偏倚。结论 活血化瘀方药联合地诺孕素治疗子宫内膜异位症疗效和安全性良好,但仍需要更多设计严谨的高质量随机对照试验提供证据。Objective To systematically evaluate the effectiveness and safety of activating blood and dissipating stasis herbs combined with dienogest in the treatment of endometriosis.Methods The authors searched the databases of CNKI,CBM,WanFang,VIP,China Clinical Trials Registry,PubMed,Web of science,Embase,Cochrane Library to screen randomized controlled trials of activating blood and dissipating stasis herbs in the treatment of endometriosis from inception to November 2022.The methodological quality was assessed using the Cochrane Risk of Bias Tool.Meta-analysis was performed using RevMan 5.4 and Stata 16.0.Results A total of 9 RCTs with 1078 patients were included,including 539 in the experiment group and 539 in the control group.Meta-analysis results showed that the total efficacy rate[RR=1.24,95%CI(1.17,1.30),P<0.00001],the lump diameter of endometriosis cysts[MD=-1.01,95%CI(-1.63,-0.39),P=0.001],the visual analogue scale[MD=-1.68,95%CI(-2.67,-0.70),P<0.00001],the carbohydrate antigen 125[MD=-17.05,95%CI(-23.44,-10.66),P<0.00001],the estradiol[MD=-22.91,95%CI(-25.34,-20.48),P<0.00001],the progesterone[MD=-0.22,95%CI(-0.25,-0.19),P<0.00001],the vascular endothelial growth factor[MD=-23.97,95%CI(-30.96,-16.99),P<0.00001],the matrix metalloproteinase-2[MD=-42.29,95%CI(-45.68,-38.89),P<0.00001],the matrix metalloproteinase-9[MD=-118.99,95%CI(-172.97,-65.02),P<0.00001],the galectin-3[MD=-1.35,95%CI(-1.83,-0.87),P<0.00001],the recurrence rate[RR=0.28,95%CI(0.13,0.59),P=0.0008]in the group of Chinese patent medicines for activating blood and dissipating stasis combined with dienogest were better than those in dienogest group.The funnel plot and Egger's test suggested that there was no significant publication bias in the results of the total efficacy rate.Conclusion Activating blood and dissipating stasis herbs combined with dienogest therapy has advantages in clinical efficacy and safety than dienogest therapy in the treatment of endometriosis.However,more high-quality clinical trials and real-world studies are needed to pr

关 键 词：子宫内膜异位症 活血化瘀方药 地诺孕素 血清因子 META分析 

分 类 号：R711.71[医药卫生—妇产科学]