中医药治疗子宫肌瘤的系统评价

目的评价中医药治疗子宫肌瘤的临床疗效与安全性。方法通过检索1989～2006年发表的有关中医药治疗子宫肌瘤的临床研究文献，比较中医药与西药、安慰荆、空白组，以及中药加用某种疗法与单用这种疗法治疗的随机对照试验或半随机对照试验，从文献的一般情况、诊断纳入排除标准、疗效判定标准、研究方案设计四个方面进行质量评价，利用Cochrane协作网专用软件Review Manager（Revman4．2）进行Meta分析。结果共纳入临床研究文献293篇，可进行系统评价的文献31篇。结果显示部分中医药治疗子宫肌瘤在缩小子宫体积方面优于西药[效应值——加权均数差值（weighted mean differences，WMD）=-46．02，95％可信区间（-82．32，-9．72）]；调节雌孕激素水平优于西药[效应值分别为WMD=-201．34，95％可信区间（-208．83，-193．85）和WMD=-0．20，95％可信区间（-0．26，-0．14）]；改善贫血优于西药[效应值WMD=2．87，95％可信区间（1．42，4．32）]；闭经的发生率低于西药[效应值RR=0．26，95％可信区间（0．09，0．71）]。部分中药联合西药在缩小肌瘤体积方面有增效作用[效应值WMD=-1．02，95％可信区间（-1．42，-0．63））。结论结果表明，部分中医药治疗子宫肌瘤有一定疗效。但由于在严格随机、双盲等方面还有欠缺，纳入研究的文献很少，其疗效目前尚无充分的证据，在以后的研究中尚需要设计良好的随机、双盲、多中心治疗子宫肌瘤的随机对照临床研究文献，以对本研究的结果能更进一步地证实。

Systematic review of traditional Chinese medicine for the treatment of uterus myoma

Objective To evaluate the effectiveness and safety of traditional chinese medicine（TCM） subjectively. Methods The data collecting Randomized Controlled Trial（RCT） and half - RCT articles from both do- mestic and abroad data base from 1989 to 2006 was made meta analysis with software of Review Manager （RevMan4.2） on the basis of statistic analysis in four aspects, that are general condition of the articles, criteria of di- agnosis, inclusion and exclusion, criteria of effect judgement and research design. Results There were 293 articles, only 69 referring to randomized controlled trial. 31 articles were preceded in systematic review. In conclusion, some TCM had better effect than west medicine in the diminution of uterus volume, improving anemia, and the adeverse effects was less than west medicine in amenorrhea. The combination of TCM and west medicine had a supplementary effect in the diminution uterus myoma volume. Conclusion The system - atic reviews showed that some chinese medicine had certain effects in treating uterus myoma. There was no sufficient evidence to confirm the therapeutic effect due to the lower quality of the trials. More strict, multi - centric and randomized double blind controlled trails should be designed in the following research to validate the results in this research.