A Meta-analysis Of The Clinical Effect Of Renal Syndrome Differentiation In The Treatment Of Decreased Ovarian Reserve

Objective:A meta-analysis was performed to retrieve the Randomized Controlled trials（RCTS）in the treatment of Diminished Ovarian Reserve based on renal syndrome differentiation.To evaluate the difference of clinical efficacy of DOR in the treatment based on kidney differentiation with traditional Chinese medicine alone or combined with Western medicine in comparison with western medicine alone,in order to bring certain evidence-based basis for clinical practice.Methods:RCTs of DOR for renal treatment were retrieved from January 1,2012 to December 31,2021,in conjunction with manual retrieval for leak detection.The diagnosis of DOR patients in the study was clear.Pure Chinese medicine or combination of Chinese and Western medicine was used in the experimental group,while western medicine was used in the control group.The retrieval results were resculled and strictly screened according to the criteria of admittance and exclusion to determine the inclusion of the study.Risk assessment and quality assessment were carried out according to the"Bias Risk Assessment Tool"in the Cochrane manual,and general data such as author,year,patient age and course of disease,as well as data such as test diagnostic criteria,intervention methods,recipe composition,treatment cycle and outcome indicators were extracted.Statistical analysis,such as heterogeneity test,subgroup analysis,sensitivity analysis and publication bias detection,was conducted for each outcome index data by Revman5.4 software.Results:A total of 905 articles were retrieved and included in 35 RCTs,A total of 2883 cases（1440/1443）were included in the study.8 key indicators（total effective rate,FSH,AMH,AFC,FSH/LH,LH,E₂,and incidence of adverse reactions）were selected from the outcome indicators reported in the included literature.The results of meta-analysis were as follows:（1）The total effective rate of renal syndrome differentiation treatment was better than western medicine treatment,OR=3.26,95%CI[2.56,4.15],P<0.00001.（2）FSH:The reduction of FSH from renal syndrome differentiation treatment was better than western medicine treatment,combined with SMD=-1.19,95%CI[-1.55,-0.83],P<0.00001.（3）AMH:The improvement of AMH from renal syndrome differentiation treatment was better than that from western medicine alone,SMD=0.84,95%CI[0.41,1.26],P=0.0001.（4）AFC:The increase of AFC from renal syndrome differentiation treatment was better than western medicine alone,MD=1.20,95%CI[0.72,1.68],P<0.00001.（5）FSH/LH:The reduction of FSH/LH from renal syndrome differentiation was superior to western medicine alone,MD=-0.19,95%CI[-0.32,-0.07],P=0.003.（6）LH:The reduction of LH level by renal syndrome differentiation was better than that by western medicine alone,SMD=-0.98,95%CI[-1.32,-0.63],P<0.00001.（7）E₂:There was no significant difference in the level of E₂ from the treatment of renal syndrome differentiation compared with the treatment of western medicine（SMD=0.17,95%CI[-0.35,0.70],P=0.52>0.05）.（8）The incidence of adverse reactions:The incidence of adverse reactions was lower in renal syndrome differentiation treatment than in western medicine treatment,OR=0.58,95%CI[0.36,0.93],P=0.02.Conclusion:（1）The treatment based on renal syndrome differentiation is superior to pure western medicine in improving AMH and clinical total effective rate,increasing AFC,reducing FSH,LH and FSH/LH levels.（2）Compared with western medicine,the incidence of adverse reactions is lower in the treatment of renal syndrome differentiation.（3）Compared with western medicine,renal syndrome differentiation therapy is roughly equivalent on improving E₂ level.