补肾活血法治疗血栓前状态复发性流产Meta分析

目的:系统评价补肾活血法治疗血栓前状态复发性流产的临床疗效。方法:计算机网络检索中国知网、万方、维普、中国生物医学数据库、中国中医科学院西苑医院数字图书馆、Pubmed、Cochrane Library、EMbase等数据库,纳入补肾活血法治疗血栓前状态复发性流产的临床随机对照试验,评价纳入文献的质量,通过RevMan5.4软件完成Meta分析。结果:纳入11篇文献,共796例患者,Meta分析结果表明:观察组在提高有效率[OR=3.18,95%CI(1.89,5.36),P<0.0001]及妊娠早期保胎成功率[OR=3.62,95%CI(2.35,5.59),P<0.00001],降低中医证候积分[MD=-5.51,95%CI(-8.19,-2.84),P<0.00001]及改善血栓前状态,如降低D-二聚体水平[MD=-0.09,95%CI(-0.11,-0.07),P<0.00001]及纤维蛋白原水平[MD=-0.67,95%CI(-1.22,-0.12),P=0.02<0.05],增加活化部分凝血活酶时间[MD=5.92,95%CI(3.02,8.82),P<0.0001]、凝血酶时间[MD=1.77,95%CI(1.48,2.07),P<0.00001]方面明显优于对照组,差异均有统计学意义。结论:补肾活血法运用于血栓前状态复发性流产保胎,可提高妊娠早期保胎成功率,降低中医证候积分,改善血栓前状态。但是,本研究纳入文献数量有限,且质量普偏低,大部分文献均为小样本研究、疾病诊断标准不一致、结局指标不完整。今后,需要质量更高、样本量更大、研究设计更规范的文献,来进一步为补肾活血法治疗血栓前状态复发性流产提供可靠证据。

A Meta Analysis of Method of Tonifying the Kidney and Activating Blood Circulation in the Treatment of Recurrent Abortion in Pre-thrombotic State

Objective:To systematically evaluate the clinical efficacy of method of tonifying the kidney and activating blood circulation in the treatment of recurrent abortion in pre-thrombotic state.Methods:The databases of CNKI,Wanfang,VIP,China biomedical database,digital library of Xiyuan Hospital of China Academy of Chinese Medical Sciences,Pubmed,Cochrane Library and EMbase were searched on computer network.The clinical randomized controlled trials of tonifying the kidney and activating blood circulation in the treatment of recurrent abortion in pre-thrombotic state were included,and the quality of the included literature was evaluated,and a Meta analysis was completed by RevMan5.4 software.Results:A total of 796 patients were included in 11 literature.The results of Meta-analysis showed that the observation group was significantly better than the control group in improving the clinical effective rate[OR=3.18,95%CI(1.89,5.36),P<0.0001],the success rate of early pregnancy fetal protection[OR=3.62,95%CI(2.35,5.59),P<0.00001],and reduced the level of TCM syndrome score[MD=-5.51,95%CI(-8.19,-2.84),P<0.00001]and D-dimer level[MD=-0.09,95%CI(-0.11,-0.07),P<0.00001]and fibrinogen level[MD=-0.67,95%CI(-1.22,-0.12),P=0.02<0.05],increased activated partial thromboplastin time[MD=5.92,95%CI(3.02,8.82),P<0.0001],thrombin time[MD=1.77,95%CI(1.48,2.07),P<0.00001],etc.Conclusion:The method of tonifying the kidney and activating blood circulation can be used to protect the fetus of recurrent abortion in pre-thrombotic state,which can improve the success rate of fetal protection in early pregnancy,reduce the score of TCM syndrome and better the pre-thrombotic state.However,the number of literature included in this study is limited,and the quality is generally low.Most of the literature has small sample studies,inconsistent disease diagnostic criteria and incomplete outcome indicators.Therefore,in the future,higher quality,larger sample size and more standardized research design are needed to further provide reliable evidence for the treatment of recurrent abortion in pre-thrombotic state by tonifying the kidney and activating blood circulation.