中医药治疗男性免疫性不育meta分析  

Treatment of male immune infertility by traditional Chinese medicine:A meta-analysis

作　　者：范春美 马斯棋 丁克凡 杨毅坚 文鑫邦 赵梓钦 陈淑慧 秦国政[2] FAN Chun-mei;MA Si-qi;DING Ke-fan;YANG Yi-jian;WEN Xin-bang;ZHAO Zi-qin;CHEN Shu-hui;QIN Guo-zheng(The First School of Clinical Medicine,Yunnan University of Chinese Medicine,Kunming,Yunnan 650021,China;Department of Andrology/Reproductive Medicine,Yunnan Provincial Hospital of Traditional Chinese Medicine,Kunming,Yunnan 650021,China)

机构地区：[1]云南中医药大学第一临床医学院,云南昆明650021 [2]云南省中医医院男科/生殖医学科,云南昆明650021

出　　处：《中华男科学杂志》2024年第6期547-563,共17页National Journal of Andrology

基　　金：国家自然科学基金地区科学基金项目(81860853);2023年国家中医药循证能力提升项目。

摘　　要：目的:运用meta分析方法系统评价中医药治疗男性免疫性不育的有效性和安全性。方法:检索万方数据库、中国生物医学文献数据库、Cochrane Library、维普数据库、PubMed数据库、CNKI(China National Knowledge Infrastructure)数据库,搜集中医药治疗男性免疫性不育的随机对照试验(RCT),并进行方法学质量评价,采用RevMan5.4软件进行统计分析与发表偏倚评估。结果:有25篇RCT文献纳入本项研究,总共纳入病例2563例,其中试验组1407例,对照组1155例。meta分析显示中医药治疗男性免疫性不育总有效率(OR=6.35,95%CI:4.96~8.13,P<0.00001)、精浆抗精子抗体转阴率(OR=4.52,95%CI:2.72~7.51,P<0.00001)、血清抗精子抗体转阴率(OR=2.98,95%CI:2.23~3.96,P<0.00001)、精液浓度(MD=15.56,95%CI:11.32~19.79,P<0.00001)、a级精子百分率(MD=3.85,95%CI:1.91~5.79,P=0.00001)、a+b级精子百分率(MD=13.77,95%CI:7.06~20.48,P<0.0001)、精子存活率(MD=10.32,95%CI:6.78~13.86,P<0.00001)、妊娠率(OR=3.53,95%CI:2.68~4.63,P<0.00001)、不良反应(OR=0.06,95%CI:0.01~0.23,P<0.00001)均显著优于单纯西药治疗。中医药治疗男性免疫性不育的精子畸形率与单纯使用西药组疗效差异不明显(MD=-7.53,95%CI:-15.50~0.44,P=0.06)。结论:中医药治疗男性免疫性不育疗效确切、安全性高,是治疗男性免疫性不育的有效方法。Objective:To evaluate the efficacy and safety of traditional Chinese medicine(TCM)in the treatment of male immune infertility(MII)by meta-analysis.Methods:We retrieved randomized controlled trial(RCT)on the treatment of male immune infertility with traditional Chinese medicine from the databases of WanFang,Chinese Biomedical Literature,Cochrane Library,Weipu,PubMed and CNKI,and performed methodological quality assessment of the RCTs identified and statistical analysis and evaluation of the publication bias using the RevMan5.4 software.Results:Totally,25 RCTs(2563 cases)were included in this study.Compared with Western medicine alone in the treatment of MII,TCM achieved a significantly higher total effectiveness rate(OR=6.35,95%CI:4.96-8.13,P<0.00001),negative conversion rate of seminal plasma anti-sperm antibodies(OR=4.52,95%CI:2.72-7.51,P<0.00001),negative rate of serum anti-sperm antibodies(OR=2.98,95%CI:2.23-3.96,P<0.00001),sperm concentration(MD=15.56,95%CI:11.32-19.79,P<0.00001),grade a sperm motility(MD=3.85,95%CI:1.91-5.79,P=0.00001),grade a+b sperm motility(MD=13.77,95%CI:7.06-20.48,P<0.0001),sperm viability(MD=10.32,95%CI:6.78-13.86,P<0.00001)and pregnancy rate(OR=3.53,95%CI:2.68-4.63,P<0.00001),but a lower rate of adverse reactions(OR=0.06,95%CI:0.01-0.23,P<0.00001).There was no statistically significant difference in the percentage of morphologically abnormal sperm between TCM and Western medicine alone in the treatment of MII(MD=-7.53,95%CI:-15.50-0.44,P=0.06).Conclusion:TCM has a definite effectiveness and high safe in the treatment of male immune infertility.

关 键 词：中医药 男性免疫性不育 META分析 有效性 安全性 

分 类 号：R698.2[医药卫生—泌尿科学]