| 1 BackgroundThe decline in female ovarian function is a gradual process.Diminished ovarian reserve(DOR)is the early stage of decreased ovarian function.It refers to a disease in which the number of recruitable follicles in the ovaries decreases or the quality of oocytes decreases,resulting in a decrease in ovarian reactivity and reproductive potential compared with women of the same age,which doesn’t emphasize the cause of the disease and the patient’s age and menstrual status.In recent years,with changes in the social economy,living environment,and work rhythm,the prevalence of DOR has continued to increase,and its incidence has increased year by year and is showing a trend of younger generation,accounting for about 20%of female ovarian diseases.Without intervention,DOR patients will develop premature ovarian insufficiency or premature ovarian failure within 1 to 6 years.Such patients are at increased risk of cardiovascular disease,osteoporosis,Alzheimer’s disease,Parkinson’s disease,and tumors.Premature ovarian insufficiency(POI)refers to the disease state when women’s ovarian function declines to a certain extent before the age of 40.It is mainly manifested as menstrual disorders such as amenorrhea,oligomenorrhea or frequent menstruation,and elevated gonadotropin levels(Follicle-stimulating Hormone,FSH>25 U/L),a disease in which estrogen levels fluctuate.Premature ovarian failure(POF)is the terminal stage of decreased ovarian function.It refers to women’s menstrual changes,infertility,estrogen deficiency,and increased gonadotropin levels(FSH>40 U/L)caused by a variety of reasons before the age of 40.)Is a disease characterized by.According to statistics,the general incidence of the disease in different populations in the world:about 1.1%of women in the world suffer from POF,and the prevalence of POF in Chinese women is about 0.5%.2 Objective2.1 To systematically evaluate the effectiveness and safety of TCM therapy for tonifying the kidney in the treatment of diminished ovarian reserve(DOR).2.2 In this study,we observed the clinical effect of Bushen Tianjing Chinese Medicine on decreased ovarian function,and evaluated the therapeutic effect and mechanism of Bushen Tianjing Chinese Medicine.This topic evaluates the clinical effects of Bushen Tianjing Chinese Medicine on the decline of ovarian function in different stages through the stratified treatment of diseases.3 Methods3.1 The database of CNKI,WanFang,VIP,CBM,PubMed,EMbase,Cochrane Library was searched by computer to collect randomized controlled trials of Bushen Chinese medicines for the treatment of DOR until October 2020.The studies were screened according to inclusion and exclusion criteria.Risk of bias evaluation tools were adopted to conduct quality evaluation.Meta-analysis on outcome indicator was performed by RevMan Version 5.3 Software.3.2 72 patients with decreased ovarian function who conformed to liver and kidney yin deficiency were divided into subgroups of diminished ovarian reserve and premature ovarian failure according to the disease stratification.According to the treatment group,the control group was 2:1,and the treatment group was randomly divided into 24 cases,12 cases in the control group.The treatment group took the Chinese medicine for Bushen Tianjing on the 5th day of menstruation;the control group only took Cremeng from the 5th day of menstruation,and the two groups were treated for 3 menstrual cycles.To observe the improvement of laboratory indexes and ultrasound indexes before and after treatment,the difference of menstrual score,TCM syndrome score and safety evaluation.4 Results4.1 Finally,45 studies were included,with a total of 3019 patients.Due to the different intervention measures included in the study,the subgroup analysis was carried out,and the random effects model was combined with the effect size.Meta-analysis results show that:in reducing FSH levels and improving TCM syndrome scores,all treatments of Bushen have advantages;in increasing AMH levels,the treatment of Bushen Shugan,and the treatment of Bushen Tianjing have obvious advantages;in improving the level of AFC,the treatment of Bushen JianpiHuoxue and Bushen Tianjing have significant advantages;in terms of improving the total effective rate,the method of Bushen Tianjing,the method of Bushen Huoxue,and the method of Bushen Ziyin have obvious advantages.The treatment of Bushen Tianjing has obvious advantages in reducing FSH levels,increasing AMH and AFC levels,and improving total effective rate.4.2 The total effective rate of patients in the treatment group and the control group were 90.00%and 80.00%after treatment with diminished ovarian reserve.The effective rate of the treatment group was higher than that of the control group,but it was not statistically significant(P>0.05).The total effective rates of the patients in the premature ovarian failure treatment group and the control group were 90.00%and 90.00%respectively,and the total effective rates of the two groups were the same.4.3 Diminished ovarian reserve and premature ovarian failure treatment group had a statistically significant difference in FSH before and after treatment(P<0.05),which was better than before treatment.There was no statistically significant difference between the two groups(P>0.05);ovarian reserve decreased by two There was a statistically significant difference in AMH between the group of patients before and after treatment(P<0.05),which was better than before treatment.There was no statistically significant difference between the two groups(P>0.05).4.4 Diminished ovarian reserve and premature ovarian failure treatment group and control group patients have improved ovarian volume,basic AFC,and RI levels after treatment,but the difference within the group was not statistically significant(P>0.05).There was no significant difference between the two groups.The difference was not statistically significant(P>0.05).4.5 Diminished ovarian reserve after treatment,the menstrual scores and TCM syndrome scores of the two groups were lower than before treatment,but there was no statistical significance(P>0.05).There were statistically significant differences in menstruation scores and TCM syndrome scores between the two groups of premature ovarian failure before and after treatment(P<0.05),which were improved compared to before,and the differences between the groups were statistically significant(P<0.05).The treatment group was better than the control group.5 Conclusion5.1 Bushen Chinese medicine for DOR has certain curative effects in improving TCM syndrome scores,hormone levels,ultrasound indicators,and increasing total effective rate.However,due to the low quality of literature research,the above conclusions still require a standardized multi-center and large sample High-quality research to verify.5.2 Bushen Tianjing Method had obvious curative effect in the treatment of liver and kidney yin deficiency-type diminished ovarian reserve and premature ovarian failure.It can effectively relieve clinical symptoms and improve the ovarian function of patients with diminished ovarian reserve without obvious side effects.It is safe and reliable. |
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