补肾疏肝中药联合来曲唑治疗多囊卵巢综合症所致排卵障碍性不孕的系统评价及Meta分析  

Kidney-Tonifying and Liver-Soothing Traditional Chinese Medicine Composition Combined with Letrozole for Treating Anovulatory Infertility Caused by Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

作　　者：叶俊宏 俞瑾 朱南孙[3,6] 董丽 潘芳[5] 杨优州 陈海勇 孟炜 

机构地区：[1]香港大学中医药学院,香港 [2]香港大学中医药学院,中西医结合妇科教研基地(香港分中心)俞瑾名中医传承工作站,香港 [3]香港大学中医药学院,海派朱氏妇科流派基地(香港分中心)朱南孙国医大师传承工作站,香港 [4]上海复旦大学妇产科医院中西结合科,上海 [5]上海泰坤堂中医院妇科,上海 [6]上海中医药大学附属岳阳中西结合医院妇科,上海

出　　处：《中医学》2023年第10期3078-3097,共20页Traditional Chinese Medicine

摘　　要：目的:系统评价补肾疏肝中药联合来曲唑治疗多囊卵巢综合症所致排卵障碍性不孕的疗效,为临床应用提供依据。方法:电子检索中文数据库:中国知网和万方知识平台;及英文数据库:PubMed、Cochrane Library,在2003年2月至2023年5月(20年)期间,发表有关补肾疏肝中药联合来曲唑治疗多囊卵巢综合症所致排卵障碍性不孕的随机对照试验。根据纳入及排除标准筛选文献,提取文献研究数据,进行质量评价,并以Review Manager 5.4.1软件进行系统评价。结果:按检索策略,共纳入22篇文献研究,共计1811例。Meta分析结果显示:1) 总体疗效补肾疏肝中药联合来曲唑组,优于单纯来曲唑对照组(OR = 4.16,95% CI [3.05, 5.67],z = 9.02,P < 0.00001);2) 试验组排卵率成功率高于对照组(OR = 2.80,95% CI [1.96, 4.01],z = 5.64,P < 0.00001);3) 试验组周期排卵率成功率高于对照组(OR = 2.18,95% CI [1.63, 2.92],z = 5.25,P < 0.00001);4) 试验组妊娠率高于对照组(OR = 2.78,95% CI [2.24, 3.45],z = 9.21,P < 0.00001);5) 试验组的黄体生成素水平低于对照组(MD = −3.22,95% CI [−3.84, −2.61],z = 10.29,P < 0.00001);6) 试验组的雌二醇水平高于对照组(MD = 13.59,95% CI [9.02, 18.17],z = 5.82,P < 0.00001);7) 试验组的睾酮水平低于对照组(MD = −0.26,95% CI [−0.60, 0.08],z = 1.52,(P < 0.00001);8) 试验组的流产率低于对照组(OR = 0.22,95% CI [0.09, 0.58],z = 3.08,P < 0.00001)。结论:临床应用补肾疏肝中药联合来曲唑较单纯应用来曲唑有效通过增加排卵率,提高妊娠率。且患者一旦妊娠,妊娠丢失率较低。同时可通过降低黄体生成素、雄激素、提高雌二醇水平,调节内分泌恢复月经周期。故补肾疏肝中药联合来曲唑,较单纯应用来曲唑,能更有效治疗多囊卵巢综合症所致排卵障碍性不孕。但因纳入文献的研究质量相对不高,疗效评价标准不一,结论仅供参考。Objective: This paper systemically reviews the efficacy of Kidney-tonifying and Liver-soothing Tra-ditional Chinese Medicine Composition (KTLSC) combined with Letrozole for the treatment of Anov-ulatory Infertility caused by Polycystic Ovary Syndrome, providing an evidence-based guidance for clinical practice. Methods: Chinese databases: China National Knowledge Infrastructure (CNKI) and Wan Fang Data;English databases: PubMed and Cochrane Library were searched to collect the ran-domized clinical trials (RCT) related to the treatment if using KTLSC combined with Letrozole to treat PCOS induced anovulatory infertility over a 20-year period from February 2003 to May 2023. The studies were screened according to the inclusion and exclusion criteria. The selected literature underwent quality evaluation prior to data extraction. Then a meta-analysis was performed by us-ing Review Manager 5.4.1. Results: 22 literature reviews were included by applying the search strategy, there were 1811 cases in total. The results of meta-analysis wereas follow: 1) the combina-tion of KTLSC and Letrozole is more effective than Letrozole-alone control group (OR = 4.16, 95% CI [3.05, 5.67], z = 9.02, P < 0.00001);2) the ovulatory rate of experimental group was higher than that of the control group (OR = 2.80, 95% CI [1.96, 4.01], z = 5.64, P < 0.00001);3) the cy-cle-ovulation rate of the experimental group was higher than that of the control group (OR = 2.18, 95% CI [1.63, 2.92], z = 5.25, P < 0.00001);4) the pregnancy rate of experimental group was higher than the control group (OR = 2.78, 95% CI [2.24, 3.45], z = 9.21, P < 0.00001);5) the levels of lute-inizing hormone in the experimental group were lower than that in the control group (MD = −3.22, 95% CI (−3.84, −2.61), z = 10.29, P < 0.00001);6) the levels of estradiol (E2) in the experimental group were higher than that in the control group (MD = 13.59, 95% CI (9.02, 18.17), z = 5.82, P < 0.00001);7) The level of testosterone of the experimental group was lower than that of th

关 键 词：补肾疏肝 中药 来曲唑 多囊卵巢综合症 排卵障碍性不孕 系统评价 META分析 

分 类 号：R71[医药卫生—妇产科学]