世界中医药

作者	单位
向利珠，侯璐瑶，周兰，黄芳婷，任一华，黄文玲，黄海涛	北京中医药大学第二临床医院东方医院，北京，100078

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中文摘要:

目的：系统评价桂枝茯苓胶囊（丸）联合曼月乐治疗子宫腺肌病的疗效和安全性。方法：运用计算机检索国家知识基础设施数据库、中国学术期刊数据库、中文科技期刊数据库、中国生物医学文献数据库、PubMed、The Cochrane Library、The Web of Science、Springer等中英文数据库从建库至2020年5月关于桂枝茯苓胶囊（丸）联合曼月乐治疗子宫腺肌病的随机对照试验和临床对照试验。应用Revman5.3软件进行Meta分析。结果：经筛选，纳入12篇文献，共1 206例患者。Meta分析结果显示：桂枝茯苓胶囊（丸）联合曼月乐治疗子宫腺肌病临床总有效率更高（OR=3.31，95%Cl为2.12~5.18，P<0.000 01），并能减轻痛经程度：慢性疼痛分级问卷法评分方法（MD=-0.46，95%CI为-0.62～-0.29，P<0.000 01）和VAS评分方法（MD=-1.75，95%CI为-2.01～-1.49，P<0.000 01），减少月经量（MD=-15.47，95%CI为-20.20～-10.73，P<0.000 01），使子宫内膜厚度变薄（MD=-15.47，95%CI为-2.14～-2.38，P<0.000 01），子宫体积缩小（MD=-16.23，95%CI为-19.45～-13.02，P<0.000 01），降低血清促卵泡素（FSH）（MD=-1.30，95%CI为-1.86～-0.74，P<0.000 01）、黄体生成素（LH）（MD=-1.18，95%CI为-1.37～-1.00，P<0.000 01）和血清CA125水平（MD=-9.68，95%CI为-12.83～-6.54，P<0.000 01），降低不良反应发生率（OR=0.53，95%CI为0.29～0.94，P=0.03）。结论：桂枝茯苓胶囊（丸）联合曼月乐治疗子宫腺肌病疗效优于单用曼月乐组，不良反应发生率低于单用曼月乐组。受纳入文献的数量和质量的限制，将来需要更大样本和高质量的研究文献，对二者联合治疗子宫腺肌病有更精确的评估。

English Summary:

To evaluate the efficacy and safety of Guizhi Fuling Capsules (Pills) combined with levonorgestrel intrauterine system (LIS) in the treatment of patients with adenomyosis.Methods:Randomized controlled trials (RCTs) and clinical trials (CCTs) on the treatment of adenomyosis with Guizhi Fuling Capsules (Pills) and LIS were retrieved from China National Knowledge Infrastructure (CNKI),VIP,China Biology Medicine disc (CBMdisc),PubMed,The Cochrane Library,The Web of Science,Springer,and other databases (from inception to May of 2020).Revman5.3 was employed for Meta-analysis of the extracted data.Results:A total of 10 RCTs and 2 CCTs were screened out,involving 1 206 patients.The Meta-analysis showed that Guizhi Fuling Capsules (Pills) combined with LIS demonstrated higher total effective rate in the treatment of adenomyosis (OR=3.31,95%CI=2.12 to 5.18,P<0.000 01).Moreover,the combination alleviated the dysmenorrhea with decrease in chronic pain grade questionnaire score (MD=-0.46,95%CI=-0.62 to -0.29,P<0.000 01) and Visual Analogue Scale (VAS) score (MD=-1.75,95%CI=-2.01 to -1.49,P<0.000 01) and reduced menstrual blood volume (MD=-15.47,95%CI=-20.20 to -10.73,P<0.000 01),endometrial thickness (MD=-15.47,95%CI=-2.14 to -2.38,P<0.000 01),uterine volume (MD=-16.23,95%CI=-19.45 to -13.02,P<0.000 01),serum follicle-stimulating hormone (FSH) (MD=-1.30,95%CI=-1.86 to -0.74,P<0.000 01),serum luteinizing hormone (LH) (MD=-1.18,95%CI=-1.37 to -1.00,P<0.000 01),serum CA125 (MD=-9.68,95%CI=-12.83 to -6.54,P<0.000 01),and the incidence of adverse reactions (OR=0.53,95%CI=0.29 to 0.94,P=0.03).Conclusion:The combination Guizhi Fuling Capsules (Pills) and LIS is superior to LIS alone in the treatment of adenomyosis,and the incidence of adverse reactions is lower than that of LIS alone.In the future,large-scale samples and high-quality articles should be included to further evaluate the combination.

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