| Objective:Using the method of evidence-based medicine,the efficacy and safety of Hongteng decoction enema combined with antibiotics for the treatment of Chronic Pelvic Inflammatory Disease(CPID)were analyzed by meta-analysisMethods:The full-text databases of the VIP journals,the Wanfang data knowledge service platform,the CNKI Chinese academic journal full-text database,the web of science,the Medline(pubMed),the EMbase,the Cochrane Library and other databases as of January 2019,were retrieved by searching the Hongteng soup enema combined with antibiotics in the treatment of CPID.According to the literature screening process,the standard studies were selected,and a table for extracting data from the included studies was developed.The quality of the included studies was assessed according to the Cochrane manual using Review Manager5.3.Finally meta data analysis was performed by using Review Manager5.3 softwareResults:A total of 22 studies were included,only one of which was a low-risk bias study,the other 21 were all moderate risk bias studies.Meta analysis results showed:?Total effective rate:The total efficiency of Hongteng decoction enema with antibiotic for the treatment of CPID was better than using antibiotic alone,the combined RR value was 1.17 with 95%CI[1.13,1.20],the difference was statistically significant(P<0.05)and the begg's test suggested no publication bias(P>0.05).Subgroup analysis of antibiotics:There are four sub-type of antibiotics,P-type amide/nitroimidazole antibiotics,quinolone/nitroimidazole antibiotics,the quinolone antibiotics,and macrolide antibiotics in combination with the Hongteng decoction enema,the effects of all were better than those of the control group,the RR values were all greater than 1,and 95%CI did not cross the ineffective line 1,the difference was statistically significant(P<0.05).The treatment of Hongteng decoction enema combined with lincolamide/nitroimidazole antibiotics showed that 95%Cl crossed the ineffective line 1 and the difference was not statistically significant(P>0.05).Subgroup analysis of treatment courses:The treatment(<14 days)of Hongteng decoction enema combined with antibiotics is better than antibiotic treatment alone,the combined RR value was 1.15 with 95%Cl[1.08,1.24],and the difference was statistically significant(P<0.05).The treatment(>14 days)of Hongteng decoction enema combined with antibiotics is also better than antibiotic treatment alone,the combined RR value was 1.16 with 95%CI[1.11,1.22],the difference was statistically significant(P<0.05).?Recovery rate:The recovery rate of CPID treated with Hongteng decoction enema combined with antibiotics was better than that treated with antibiotics alone in the control group,the combined RR was 1.53 with the 95%CI[1.41,1.67],the difference was statistically significant(P<0.05)and the egger's testsuggested no publication bias(P>0.05).?Diameter of pelvic inflammatory mass:The diameter of pelvic inflammatory mass after the treatment with Hongteng decoction enema combined with antibiotics was smaller than that with antibiotics alone,the combined MD value was-1.41 with the 95%CI[-1.70,-1.13],the difference was statistically significant(P<0.05).?Pelvic effusion:The pelvic effusion after the treatment with Hongteng decoction enema combined with antibiotics was less than that with antibiotics alone,the combined SMD value was-2.11 with the 95%CI[-2.97,-1.26],the difference was statistically significant(P<0.05).Pain score:pain score of CPID treated with Hongteng decoction enema combined with antibiotics is lower than that with antibiotics alone,and the combined MD value is-1.55 with the 95%Cl[-1.89,-1.20],statistically significant difference(P<0.05).?Recurrencerat:The recurrence rate of CPID treated with Hongteng decoction enema combined with antibiotics is lower than that with antibiotics alone,the combined RR value is 0.20 with the 95%CI[0.10,0.42],the difference is statistically significant(P<0.05).?Adverse reaction rate:The adverse reaction rate of CPID treated with Hongteng decoction enema combined with antibiotics was lower than that with antibiotics alone,the RR value was 0.45 with the 95%CI[0.28,0.72],and the results were statistically signnificant(P<0.05).Sensitivity analysis results:sensitivity analysis was used by different effect models which showing little change in RR value and 95%CI.Sensitivity analysis of the total effective rate by eliminating studies one by one showed little change in RR value,95%CI and heterogeneity,indicating the result was relatively robust.Conclusion:for CPID patients,the treatment of Hongteng decoction enema combined with antibiotics could improve clinical efficiency,reduce pelvic inflammatory mass,pelvic effusion,adverse reactions,the recurrence rate and alleviate pain,which is worthy of clinical promotion. |
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