| Research purposes1 Based on the Cochrane systematic review research method,the clinical efficacy of traditional Chinese medicine in the treatment of adenomyosis is systematically evaluated,providing evidence-based basis for the treatment of adenomyosis by traditional Chinese medicine.The distribution of TCM syndrome types,the types of Chinese medicines for promoting blood circulation and removing blood stasis,and the frequency of use were statistically included in the literature,and the clinical ideas and rules of Chinese medicine for treating adenomyosis were discussed2 To observe the clinical efficacy and safety of Qi Dan Yin in treating uterine adenomyosis due to Qi deficiency and blood stasis,and to provide clinical basis for Chinese medicine to treat uterine adenomyosis.Research method1 Systematic review(1)Search Chinese and English databases(Building Database-October 1,2019),and import the related documents Note Express software determines eligible documents for inclusion in accordance with the proposed inclusion and exclusion criteria(2)The "bias risk assessment tool" provided by Cochrane Collaboration was used to evaluate the quality of the literature and draw graphics(3)Extract the effective data from various studies and import them into RevMan5.3 software for statistical analysis(4)Statistics of the distribution of TCM syndromes,types of Chinese medicine for activating blood circulation and removing blood stasis,and the frequency of use included in the literature.EXCEL tables were used for statistics.2 Clinical researchUsing self-contrast,retrospective clinical research methods,42 patients with multiple menstrual periods of adenomyosis of qi deficiency and blood stasis type were selected as the research objects,all of whom were treated in the Zhao Ruihua Professor's clinic from January 1,2017 to October 30,2019 Patient.All patients in the group took Qi Dan Yin.Before treatment,1 month of treatment,2 months of treatment,and 3 months of treatment as time observation points,menstrual PBAC score,menstrual color quality score,and TCM syndrome score were observed.Before and after 3 months of treatment,the menstrual period,hemoglobin content,uterine volume,and serum CA125 were observed.To evaluate the clinical efficacy of Qi Dan Yin in treating uterine adenomyosis due to qi deficiency and blood stasis.SPSS 26.0 software package was used for statistical analysis.Research result1 Systematic reviewBased on the search strategy,1045 articles that could meet the criteria were obtained.According to the inclusion criteria,18 systematic reviews were finally included.All were randomized controlled trials,with a total of 1393 patients with adenomyosis,a total of 700 in the Chinese medicine group,and a western medicine group A total of 693 cases,including a minimum sample size of 59 cases and a maximum sample size of 147 cases.(1)Total efficiencyIncluded in the 16 studies are total effective data that can be extracted and tested for heterogeneity.The results are:Chi2=12.58,df=15(P=0.63),I2=0%,which indicates that the homogeneity is good.The fixed statistics model was used to calculate the combined statistics.The results were:OR=3.84,95%CI(2.81,5.23),P<0.00001,the difference was statistically significant,indicating that the total effective rate of Chinese medicine for adenomyosis is better than that of western medicine.The funnel chart shows that most of the scattered points are concentrated,but the left and right sides are not completely symmetrical,and there is a certain publication bias.(2)Dysmenorrhea VAS scoreThe VAS scores for dysmenorrhea in all three studies are all valid data that can be extracted and tested for heterogeneity.The results are:Chi2=3.64,df=2(P=0.16),I2=45%,less heterogeneity.Using a fixed-effects model to calculate the combined statistics,the results are:MD=-1.70,95%CI(-2.01,-1.40),P<0.00001,the difference is statistically significant,and Chinese medicine can be considered to relieve dysmenorrhea of adenomyosis The effect is more obvious than western medicine.(3)Menstrual improvement(PBAC score)One study provided valid data on menstrual flow(PBAC score),which was only used for descriptive qualitative analysis.The results showed that the Chinese medicine group improved menstrual flow better than the western medicine group,and the difference was statistically significant:MD=39.45,95%CI(31.51,47.39).(4)Serum CA125A total of 10 studies provided valid data on serum CA125 due to greater heterogeneity in the initial analysis(Chi2=71.07,df=9(P<0.00001),I2=87%).Subgroup analysis was performed according to different Western medicine treatment measures.One of the studies did not describe specific measures,so 9 studies were included and divided into five subgroups.(5)Ad verse reaction rateThe adverse reactions in the five studies were all extractable valid data,and they were tested for heterogeneity.The results were:Chi2=1.32,df=3(P=0.72),I2=0%,and the homogeneity was good.The fixed effect model calculates the combined statistics,and the results are:OR=0.16,95%CI(0.06,0.41),P=0.00001,the difference is statistically significant.It can be considered that the traditional Chinese medicine treatment of adenomyosis is lower than western medicine.(6)Syndrome type and drug analysisThe highest frequency of the syndromes involved was Qi stagnation and blood stasis syndrome(27.99%).Angelica(61.11%)is most commonly used.2 Clinical research(1)Situation of menstruation?Menstrual multi-effect evaluation:12 cases were cured,12 cases were markedly effective,13 cases were effective,5 cases were ineffective,the total number of effective cases was 37,and the total effective rate was 88.10%.?Menstrual PBAC score:With the change of the treatment time node,menstrual PBAC score gradually decreased,showing a downward trend.There were significant differences in menstrual PBAC scores before and 1 month before treatment.2 months before treatment,and 3 months before treatment(P<0.05).? Menstrual period:Compared with 3 months before treatment,there were significant differences in menstrual period(P<0.05).?Menstrual color quality score:As the treatment time node changes,the menstrual color quality score gradually decreases,showing a downward trend.There were significant differences in menstrual color quality scores before and 2 months before treatment,3 months before treatment,1 month and 2 months,1 month and 3 months,and 2 months and 3 months(P<0.05).(2)Situation of TCM syndromes?Evaluation of the efficacy of TCM syndromes:9 cases were cured,14 cases were markedly effective,13 cases were effective,the total number of cases was 36 cases,6 cases were ineffective,the total effective rate was 85.71%.?TCM Syndrome Score:With the time point of treatment,the TCM Syndrome score gradually decreased,showing a downward trend.Compared with before treatment and 1 month,before treatment and 2 months,before treatment and 3 months,before 1 month and 2 months,between 1 month and 3 months,and after 2 months and 3 months,There were significant differences in scores(P<0.05).(3)Hemoglobin contentAfter 3 months of treatment,the hemoglobin content increased significantly(P<0.05).(4)Uterine volumeAfter 3 months of treatment,there was no significant difference in uterine volume compared with that before treatment(P>0.05).(5)Serum CA125 levelAfter 3 months of treatment,there was no significant difference in serum CA125 compared with that before treatment(P>0.05).(6)Safety evaluationDuring the clinical study period,no adverse reactions occurred in 42 clinically observed patients;blood,urine routine,heart,liver,and kidney function(ECG,ALT,AST,Cr,BUN)did not show significant abnormalities before and after treatment.Analysis conclusion1 Systematic reviewIn terms of total effectiveness,dysmenorrhea VAS score,menstrual improvement(PBAC score),and down-regulation of serum CA125,Chinese medicine treatment has certain advantages,and Chinese medicine treatment has fewer adverse reactions than western medicine,which is safer.Although there are some limitations in this study,an important step has been taken in the path of evidence-based medicine in the treatment of adenomyosis with traditional Chinese medicine,which has initially confirmed that the effect of traditional Chinese medicine in treating adenomyosis is good.and there is evidence to support it.It is hoped that there will be more large samples and high-quality randomized controlled trials in the future to further confirm the clinical efficacy of Chinese medicine in treating adenomyosis and provide more rigorous evidence.2 Clinical researchQidan Decoction for the treatment of qi deficiency and blood stasis type adenomyosis has multiple curative effects,good safety,and can significantly control the menorrhea caused by adenomyosis,with a clinical effective rate of 88.10%;shorten the length of menstrual period,Improve menstrual color,menstruation;significantly improve the syndrome of Qi deficiency and blood stasis,the clinical effective rate of 85.71%;correct anemia.However,the effect is not obvious in reducing uterine volume and decreasing Serum CA125. |
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