补肾活血法治疗抗心磷脂抗体阳性复发性流产的Meta分析
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摘要
目的:运用循证医学的方法系统评价补肾活血法治疗抗心磷脂抗体(ACA)阳性复发性流产的疗效与安全性,为临床提供循证参考。方法:计算机检索国内外数据库及手动检索国内核心期刊(检索期限为1990年1月至2018年4月),纳入以补肾活血法为组方依据治疗抗心磷脂抗体阳性复发性流产的临床随机对照试验,提取资料,用Cochrane系统评价的方法对文献质量进行评分,采用RevMan 5.3统计软件对纳入研究的结果进行Meta分析。结果:13篇相关研究文献被纳入本研究,Meta分析显示,与对照组相比,治疗组疗效总有效率增加,差异具有统计学意义[OR=3.77,95%CI(2.42,5.90)];治疗组中医证候积分明显高于对照组,差异具有统计学意义[MD=-5.45,95%CI(-5.92,-4.99)];治疗组ACA转阴率明显高于对照组,差异具有统计学意义[OR=3.71,95%CI(2.54,5.43)];治疗组ACA水平明显低于对照组,差异具有统计学意义[MD=-1.99,95%CI(-2.31,-1.66)];治疗组保胎至12周成功率明显高于对照组,差异具有统计学意义[OR=3.36,95%CI(2.14,5.28)];治疗组血清人绒毛膜促性腺激素(β-HCG)明显高于对照组,差异具有统计学意义[MD=35.96,95%CI(33.20,38.71)]。结论:现有临床文献所评价补肾活血法治疗抗心磷脂抗体阳性复发性流产较西医有显著优势,是一种很有前景的治疗手段。
Objective: To provide evidence-based reference for clinical work by assessing clinical effects and the safety of invigorating-kidney and promoting blood-circulation method in the treatment for positive anticardiolipin antibody(ACA) recurrent spontaneous abortion(RSA) using the method of evidence-based medicine. Methods:Clinical randomized control test for the recipe based on the method of invigorating-kidney and promoting blood-circulation in the treatment for positive-ACA RSA were searched in domestic and foreign databases by computer and domestic core journals manually(retrieval period from January, 1990 to April, 2018) to extract the data, the quality of the papers were scored using Cochrane system evaluation method, the results of the included studies were performed Meta analysis using statistical software RevMan 5.3. Results: All 13 papers about the related studies were included in the study. Meta analysis showed that, compared with the control group, total effective rate of clinical effects in the treatment group raised, and the difference had statistical meaning [OR=3.77, 95% CI(2.42,5.90)];the treatment group was higher than the control group in TCM syndrome scores obviously, and the difference showed statistical meaning [MD=-5.45, 95%CI(-5.92,-4.99)]; the treatment group was notably higher than the control group in ACA negative-conversion rate, and there was a significant difference [OR=3.71, 95%CI(2.54, 5.43)];the treatment group was lower than the control group in the levels of ACA obviously, and the difference was statistically significant [MD=1.99, 95%CI(-2.31,-1.66)]; the treatment group was higher than the control group in the success rate of protecting the fetus to 12 th week, and the difference had statistical meaning [OR=3.36, 95%CI(2.14, 5.28)]; the treatment group was notably higher than the control group in/3-HCG, and the difference had statistical meaning [MD=35.96, 95%CI(33.20, 38.71)]. Conclusion: The method of invigorating-kidney and promoting blood-circulation in the treatment for positive ACA RSA shows the distinct advantages compared with Western medicine assessed by the existing clinical literature, and it's a promising therapeutic measure.
Objective: To provide evidence-based reference for clinical work by assessing clinical effects and the safety of invigorating-kidney and promoting blood-circulation method in the treatment for positive anticardiolipin antibody(ACA) recurrent spontaneous abortion(RSA) using the method of evidence-based medicine. Methods:Clinical randomized control test for the recipe based on the method of invigorating-kidney and promoting blood-circulation in the treatment for positive-ACA RSA were searched in domestic and foreign databases by computer and domestic core journals manually(retrieval period from January, 1990 to April, 2018) to extract the data, the quality of the papers were scored using Cochrane system evaluation method, the results of the included studies were performed Meta analysis using statistical software RevMan 5.3. Results: All 13 papers about the related studies were included in the study. Meta analysis showed that, compared with the control group, total effective rate of clinical effects in the treatment group raised, and the difference had statistical meaning [OR=3.77, 95% CI(2.42,5.90)];the treatment group was higher than the control group in TCM syndrome scores obviously, and the difference showed statistical meaning [MD=-5.45, 95%CI(-5.92,-4.99)]; the treatment group was notably higher than the control group in ACA negative-conversion rate, and there was a significant difference [OR=3.71, 95%CI(2.54, 5.43)];the treatment group was lower than the control group in the levels of ACA obviously, and the difference was statistically significant [MD=1.99, 95%CI(-2.31,-1.66)]; the treatment group was higher than the control group in the success rate of protecting the fetus to 12 th week, and the difference had statistical meaning [OR=3.36, 95%CI(2.14, 5.28)]; the treatment group was notably higher than the control group in/3-HCG, and the difference had statistical meaning [MD=35.96, 95%CI(33.20, 38.71)]. Conclusion: The method of invigorating-kidney and promoting blood-circulation in the treatment for positive ACA RSA shows the distinct advantages compared with Western medicine assessed by the existing clinical literature, and it's a promising therapeutic measure.
引文
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[10]杜娟.补肾活血法治疗免疫性复发性自然流产的临床观察[D].哈尔滨:黑龙江中医药大学,2011.
[11]冯晓玲,李娜,时思毛,等.补肾活血方对抗心磷脂抗体阳性复发性流产的临床研究[J].中医药信息,2015,32(2):34-36.
[12]薛文霞.补肾活血方治疗抗心磷脂抗体阳性复发性流产患者的临床效果分析[J].实用妇科内分泌杂志,2017,4(1):1-2.
[13]黄烨.补肾活血方治疗抗心磷脂抗体阳性复发性流产疗效观察[J].江西医药,2014,49(11):1265-1267.
[14]张亚平.补肾健脾法治疗ACA阳性早期复发性流产的临床观察[D].哈尔滨:黑龙江中医药大学,2012.
[15]刘艳君.加减寿胎丸联合低分子肝素钠治疗肾虚血瘀型ACA阳性RSA的研究[D].济南:山东中医药大学,2016.
[16]臧玲,孟安琪,张凤暖,等.自拟滑胎补肾Ⅲ号膏方治疗抗心磷脂阳性所致复发性流产临床观察[J].辽宁中医药大学学报,2017,19(8):122-123.
[17]玄鸿雁.补肾活血法结合及地屈孕酮治疗ACA阳性早期复发性流产的临床研究[D].哈尔滨:黑龙江中医药大学,2010.
[18]谢志燕.补肾活血法治疗复发性流产血栓前状态的临床观察[D].南京:南京中医药大学,2015.
[19]王倩倩.补肾调冲祛瘀方联合HCG和黄体酮对抗心磷脂抗体阳性致早期复发性流产患者的干预效果[D].郑州:河南中医药大学,2014.
[20]杨雁.胎儿安方治疗复发性先兆流产ACA的临床观察[D].咸阳:陕西中医药大学,2011.
[21]王会会.中西医结合疗法治疗肾虚血瘀型复发性流产抗心磷脂抗体阳性的临床疗效观察[D].南京:南京中医药大学,2013.
[2]Zheng D,Li C,Wu T,et al.Factors associated with spontaneous abortion:a crosssectional study of Chinese populations[J].Reprod Health.2017,14(10):33-45.
[3]M Banadakoppa,Chauhan MS,Havemann D.Spontaneous abortion is associated with elevated systemic C5a and reduced m RNA of complement inhibitory proteins in placenta[J].Clin Exp Immunol.2014,177(3):743-749.
[4]Jaslow CR,Carney JL,Kutteh WH.Diagnostic factors identified in 1020 women with two versus three or more recurrent pregnancy losses[J].Fertil Steril,2010,93(7):1234-1243.
[5]Santos TDS,Ieque AL,Carvalho HC,et al.Antiphospholipid syndrome and recurrent miscarriage:A systematic review and meta-analysis[J].J Reprod Immunol.2017,123(4):78-87.
[6]Kutteh WH,Hinote CD.Antiphospholipid antibody syndrome[J].Obstet Gynecol Clin North Am.2014,41(1):113-132.
[7]Akhlaghi F,keramati MR,et al.Study on antiphospholipid/anticardioliplin antibodies in women with recurrent abortion mehri tafazoli Iran[J].Red Crescent Med J.2013,15(8):718-722.
[8]Meroni PL,Tedesco F,Locati M,et al.Anti-phospholipid antibody mediated fetal loss:still an open question from a pathogenic point of view[J].Lupus.2010,19(4):453-456.
[9]鲍薇薇.补肾活血法对早期复发性流产抗心磷脂抗体阳性的临床研究[D].哈尔滨:黑龙江中医药大学,2011.
[10]杜娟.补肾活血法治疗免疫性复发性自然流产的临床观察[D].哈尔滨:黑龙江中医药大学,2011.
[11]冯晓玲,李娜,时思毛,等.补肾活血方对抗心磷脂抗体阳性复发性流产的临床研究[J].中医药信息,2015,32(2):34-36.
[12]薛文霞.补肾活血方治疗抗心磷脂抗体阳性复发性流产患者的临床效果分析[J].实用妇科内分泌杂志,2017,4(1):1-2.
[13]黄烨.补肾活血方治疗抗心磷脂抗体阳性复发性流产疗效观察[J].江西医药,2014,49(11):1265-1267.
[14]张亚平.补肾健脾法治疗ACA阳性早期复发性流产的临床观察[D].哈尔滨:黑龙江中医药大学,2012.
[15]刘艳君.加减寿胎丸联合低分子肝素钠治疗肾虚血瘀型ACA阳性RSA的研究[D].济南:山东中医药大学,2016.
[16]臧玲,孟安琪,张凤暖,等.自拟滑胎补肾Ⅲ号膏方治疗抗心磷脂阳性所致复发性流产临床观察[J].辽宁中医药大学学报,2017,19(8):122-123.
[17]玄鸿雁.补肾活血法结合及地屈孕酮治疗ACA阳性早期复发性流产的临床研究[D].哈尔滨:黑龙江中医药大学,2010.
[18]谢志燕.补肾活血法治疗复发性流产血栓前状态的临床观察[D].南京:南京中医药大学,2015.
[19]王倩倩.补肾调冲祛瘀方联合HCG和黄体酮对抗心磷脂抗体阳性致早期复发性流产患者的干预效果[D].郑州:河南中医药大学,2014.
[20]杨雁.胎儿安方治疗复发性先兆流产ACA的临床观察[D].咸阳:陕西中医药大学,2011.
[21]王会会.中西医结合疗法治疗肾虚血瘀型复发性流产抗心磷脂抗体阳性的临床疗效观察[D].南京:南京中医药大学,2013.
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