Integrated Traditional Chinese And Western Medicine Compared With Western Medicine Alone As Medicine Treatment For Tubal Pregnancy:A Meta-Analysis

Objective:Since more and more young patients with tubal pregnancy who have not got any children tend to choose conservative treatment for their future fertility, this essay aims to provide an effective and reliable treatment for tubal pregnancy through evaluating the safety and effectiveness of these conservative treatments and revaluating the quality of these clinical studies that comparing the therapeutic effects and adverse effects between associated traditional Chinese with Western medicine and Western medicine alone in their scientific research design.Methods:1. Randomized controlled trials (RCTs) that comparing combining using traditional Chinese and western medicine with western medicine alone for treatment of tubal pregnancy were extensively searched in 7 databases including PubMed, Google Scholar, Cochrane Library, Clinicaltrials, Cnki Data, Wanfang Data and Cqvip Data, and these applicable papers of the included were also searched.2.These studies were scanned, and eliminated by two reviewers independently, meanwhile information of these references were extracted. Make descriptive analysis of the literatures on the following 4 parts, including their general situation, diagnostic code, criteria of inclusion and exclusion, criteria for therapeutic, RCT design, statistical processing, etc.3. Conduct a further screening according the inclusion and exclusion criteria to make a meta-analysis, and describe the PICOS of these literatures.4. The related papers are revaluated according to the Cochrane collaboration’s tool for accessing risk of bias. The statistical analysis is also focused on the following 4 aspects:general conditions of articles, the diagnosis of the diseases, the judgment of the treatment’s success and the qualities of the research designing.5. The efficacy of the combining using of traditional Chinese and western medicine for tubal pregnancy was assessed by meta-analysis, which was performed with Review Manager5.3 software.Results1. According to the strategy of retrieval and the criteria of inclusion and exclusion,62 articles of randomized controlled studies about the conservative treatment of tubal pregnancy are included.2. The general situation of the included literature are as follows, all the essays were published after 2004, in major magazines, accounting for 60%, and all the included trails were recruited from inpatient department, in China. 31 articles (66%) are clear in diagnosis code based on text books,39 articles (63%) have acute effect judgment drafted by the experimentalists, and the qualities of the studies are generally low:54 essays (87%) have clear comparisons for the description of group balance,12 documents (19.3%) mentioning sequence generation, none of which referring to allocation concealment and blinding, while 13 pieces (20.9%) have follow-up visit, and only 1 piece recorded and analyzed the exit and lost cases.3. There are 46 RCTs adopted in the meta-analysis, in which 17 compare integrated traditional Chinese medicine and methotrexate with methotrexate alone, involving 1656 participants, including traditional Chinese medicine combined MTX group:847 cases, and MTX alone group:809 cases.9 make contrast between integrated traditional Chinese medicine with RU486 and RU486 alone, involving 717 participants, including traditional Chinese medicine combined mifepristone group:371 cases, and mifepristone single group:346 cases.20 exploit integrated traditional Chinese medicine with methotrexate and RU486 with integrated methetrexate and RU486, involving 1744 participants, including three drug combination group:904 cases, and the two drug group:840 cases.4. The scores of the RCTs are 1-4, indicating the low methodological quality of included studies.5. Compared with the group of MTX alone, integrated traditional Chinese and MTX are more effective in the following aspects:the efficiency of clinical treatment, the time required for serum β-HCG turning negative and for pelvic mass disappearing and the rate of fallopian tube patency. Meanwhile the later group can effectively reduce gastrointestinal discomfort and dental ulcer, while there is no significant difference between two groups in the declining of white blood cells.6. Compared with the group of RU486 alone, integrated traditional Chinese and RU486 are more effective in the following aspects:the efficiency of clinical treatment, the time required for serumβ-HCG turning negative and for pelvic mass disappearing and the rate of fallopian tube patency. Meanwhile there is no significant difference between two groups in the adverse aspects.7. Compared with the group of integrated MTX and RU486, integrated traditional Chinese, MTX and RU486 are more effective in the following aspects: the efficiency of clinical treatment, the time required for serum β-HCG turning negative and for pelvic mass disappearing and the rate of fallopian tube patency. Meanwhile the later group can effectively reduce gastrointestinal discomfort and the declining of white blood cells, while there is no significant difference between two groups in the dental ulcer.8. The funnel plots of the efficiency of clinical treatment for publication bias show poor asymmetry, and it indicates that the pooled results may be influenced by the publications bias, which could be related to the design and the quality of the clinical experiments.Conclusion1. The methodology of clinical trials on the combining using of TCM and western medicine is relatively weak, lacking in rigorous and reasonable design.2. Integrated traditional Chinese and western medicine has higher therapeutic effects for tubal pregnancy when comparing with western medicine alone.3. We need more high-quality and scientific randomized controlled trials as evidence-based recommendation to support the efficiency and safety of the combining use.