补肾健脾法治疗复发性流产的meta分析

武桐; 王媛中; 李伟莉; 余欣慧

doi:10.16766/j.cnki.issn.1674-4152.002523

补肾健脾法治疗复发性流产的meta分析

doi: 10.16766/j.cnki.issn.1674-4152.002523

1.
安徽中医药大学研究生院，安徽合肥 230031
2.
安徽中医药大学第一附属医院妇科，安徽合肥 230031

基金项目:

国家自然科学基金项目 81804233

安徽中医药大学第一附属医院临床科学研究项目 2020yfyzc28

详细信息

通讯作者:
李伟莉, E-mail: liweiliah@163.com

中图分类号: R714.21 R289.53
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- 文章访问数: 223
- HTML全文浏览量: 145
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2021-12-10
- 网络出版日期: 2022-09-21

Meta-analysis of tonifying kidney and invigorating spleen in the treatment of recurrent abortion

1.
Graduate School of Anhui University of Chinese Medicine, Hefei, Anhui 230031, China

摘要

摘要: 目的运用meta分析系统评价补肾健脾法治疗复发性流产的临床疗效。方法从数据库中检索利用补肾健脾法治疗复发性流产的文献，检索时间从建库开始，截至2021年9月，采用RevMan 5.4软件进行meta分析。结果最终纳入符合标准的文献共17篇。Meta分析显示，补肾健脾法相关治疗组的有效率比未采用补肾健脾法的对照组高[风险比(RR)=1.34，95% CI：1.26~1.43，P＜0.001]；妊娠成功率高于对照组(RR=1.38，95% CI：1.22~1.56，P＜0.001)；中医证候积分改善优于对照组[均数差值(SMD)=-1.69，95% CI：-2.20~-1.18，P＜0.001]；封闭抗体阳转情况与对照组差异无统计学意义(RR=1.12，95% CI：0.92~1.36，P=0.250)；血人绒毛膜促性腺激素(HCG)值与对照组差异无统计学意义[均差(MD)=33 861.57，95% CI：-25 012.30~92 735.43，P=0.260]；血孕酮(P)值优于对照组(MD=7.31，95% CI：2.17~12.46，P=0.005)。结论补肾健脾法在提高临床有效率、妊娠成功率和改善中医证候积分、血P值等方面均具有优势，而在封闭抗体阳转情况、血HCG值方面与西医治疗差异无统计学意义。但由于本研究样本数有限且文章质量相对较低, 加之存在选择偏倚及测值偏倚, 对结果均有不同程度影响, 在未来研究中需要更多高质量的临床对照试验进行验证。
- 复发性流产 /
- 补肾健脾 /
- Meta分析 /
- 随机对照试验
Abstract: Objective To systematically evaluate the clinical efficacy of tonifying kidney and invigorating spleen in the treatment of recurrent abortion using Meta-analysis. Methods Literature on the treatment of recurrent abortion by tonifying kidney and spleen was retrieved from the database construction until September 2021. Meta-analysis was conducted by RevMan 5.4 software. Results Finally, 17 literatures were included. Meta-analysis showed that the effective rate of the tonifying kidney and invigorating spleen treatment group was higher than that of the control group without tonifying kidney and invigorating spleen therapy [risk ratio (RR)=1.34, 95% CI: 1.26 to 1.43, P < 0.001]. The success rate of pregnancy of the treatment group was better than that of control group (RR=1.38, 95% CI: 1.22 to 1.56, P < 0.001). Traditional Chinese medical syndrome score of the treatment group was better than the control group [standard mean difference (SMD)=-1.69, 95% CI: -2.20 to-1.18, P < 0.001]. There was no significant difference in the positive conversion of closed antibody between the two groups (RR=1.12, 95% CI: 0.92 to 1.36, P=0.250). There was no significant difference in blood human chorionic gonadotrophin (HCG) value between the two groups [mean difference (MD)=33 861.57, 95% CI: -25 012.30 to 92 735.43, P=0.260]. The progestin value of the treatment group was better than the control group (MD=7.31, 95% CI: 2.17 to 12.46, P=0.005). Conclusion The method of tonifying kidney and invigorating spleen has advantages in improving the clinical effective rate, pregnancy success rate, TCM syndrome score and blood progestin, but there is no significant difference in blocking antibody positive conversion and blood HCG value compared with western medicine. However, due to the limited sample size and relatively low article quality in this study, as well as selection bias and measurement bias, the results are affected to varying degrees. Therefore, more high-quality controlled clinical trials are needed for validation in future studies.
- Recurrent abortion /
- Tonifying kidney and invigorating spleen /
- Meta-analysis /
- Randomized controlled trial

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图 1 文献筛选过程

Figure 1. Literature selection process

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图 2 纳入文献质量评估

Figure 2. The results of literature quality assessment were included

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图 3 2组复发性流产患者临床总有效率森林图

Figure 3. Forest plot of clinical total effective rate

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图 4 2组复发性流产患者妊娠成功率森林图

Figure 4. Forest plot of pregnancy success rate

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图 5 2组复发性流产患者中医证候积分森林图

Figure 5. Forest plot of TCM syndrome intergral

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图 6 2组复发性流产患者封闭抗体阳转情况森林图

Figure 6. Forest plot of blocking antibody conversion

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图 7 2组复发性流产患者血HCG值水平森林图

Figure 7. Forest polt of serum HCG levels

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图 8 2组复发性流产患者血P值水平森林图

Figure 8. Forest plot of serum P levels

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图 9 临床总有效率meta分析漏斗图

Figure 9. Funnel plot of clinical total effective rate meta-analysis

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图 10 妊娠成功率meta分析漏斗图

Figure 10. Funnel plot of pregnancy success rate

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表 1 纳入研究的基本信息

Table 1. Basic information about the included study

第一作者	发表年份	样本量	治疗组药物	对照组药物	疗程	观察指标
胡晓华^[4]	2017	60	育胎灵煎剂	孕康口服液	自妊娠第6周确诊为宫内孕开始至妊娠12周结束	①
贾金平^[5]	2020	104	单纯中药治疗	淋巴细胞免疫治疗	2个月	①②④
张晓^[6]	2015	61	孕育口服液	去T淋巴细胞主动免疫治疗	孕前至妊娠后超过既往流产时间2周	①②③
陈浩波^[7]	2012	96	中西医对症治疗	西医对症治疗	妊娠10~12周或超过以往发生流产的月份	①
何飞^[8]	2018	43	自拟益肾健脾助孕方联合地屈孕酮	地屈孕酮片	至孕12周	③⑥
李晖^[9]	2018	80	主动免疫疗法联合暖宫消抗汤	主动免疫疗法	3个月	②④
齐丹^[10]	2017	80	补肾健脾方联合地屈孕酮和人绒毛膜促性腺激素	地屈孕酮和人绒毛膜促性腺激素	确诊妊娠至停经10~14周	①②⑤⑥
宋艳丽^[11]	2018	115	滋肾健脾方联合淋巴细胞免疫疗法	淋巴细胞免疫疗法	孕前至妊娠12周	①②③
杨慧^[12]	2016	56	补肾健脾中药联合黄体酮	黄体酮	4周	①②
孙云^[13]	2012	160	自拟调冲汤联合维生素E胶丸和叶酸	维生素E胶丸+叶酸	3个月	②③
田丹^[14]	2015	73	补中益气汤联合淋巴细胞免疫疗法	淋巴细胞免疫疗法	孕前至妊娠16周	①②④
吴婕^[15]	2017	70	自拟益肾健脾汤联合叶酸等常规治疗	黄体酮、叶酸等常规治疗	至妊娠满12周	①⑤⑥
许英^[16]	2018	61	补肾健脾方联合HCG+黄体酮	HCG+黄体酮	孕前至妊娠3个月	①②
杨春^[17]	2013	90	寿胎丸加减联合HCG+叶酸+维生素E	HCG+叶酸+维生素E	2个月	①③
孙晶^[18]	2013	60	补肾健脾中药联合淋巴细胞免疫治疗	淋巴细胞免疫治疗	孕前至妊娠后超过以往发生流产的月份	②④
张颖^[19]	2018	60	补肾健脾安胎汤联合黄体酮+HCG	黄体酮+HCG	至孕12周	①②③④
周芳^[20]	2017	60	固肾安胎方联合常规西药治疗	常规西药治疗	至孕12周	①②⑤⑥
注：观察指标如下，①临床有效率；②妊娠成功率；③中医证候评分；④封闭抗体阳转情况；⑤血β-HCG值；⑥血P值。

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