| Purposes: The first part studies the distribution of basic information of patients with Abnormal Uterine Bleeding-Ovulatory dysfunction(AUB-O),the distribution of TCM syndrome types,and the relationship between TCM syndrome types and related factors.Beneficial to syndrome differentiation and treatment based on syndrome type.The second part systematically evaluated the efficacy and safety of integrated traditional Chinese and western medicine in the treatment of AUB-O(Qi deficiency and blood stasis syndrome),providing evidence-based basis for integrated traditional Chinese and western medicine in the treatment of AUB-O(Qi deficiency and blood stasis syndrome).Methods:(1)Clinical research: Through the field investigation of patient information and fill in the questionnaire,collected during April 2019 to November2020 in chengdu university of traditional Chinese medicine hospital outpatient and the inpatient of department of gynaecology and diagnosis for patients with AUB-O information(including the general situation,see a doctor when illness profiles,history and related inspection,disease diagnosis and syndrome diagnosis of traditional Chinese medicine,western medicine diagnosis).The collected information was input into the "TCM Gynecology Clinical Flow Survey Data Center",and then exported to the Excel database.SPSS 23.0 software was used for statistical analysis.(2)Meta analysis: Literature related to the treatment of AUB-O(Qi deficiency and blood stasis syndrome)with integrated traditional Chinese and western medicine was retrieved by computer from the four Chinese databases and the three English databases,and manual retrieval was combined.The retrieval time was from the establishment of each database to February,2021.Two researchers with knowledge of evidence-based medicine independently screened the literatures on the treatment of AUB-O(Qi deficiency and blood stasis syndrome)with integrated traditional Chinese and western medicine according to the standard of intake and exhaust,extracted the data,and performed Meta-analysis with Review Manager5.3 software.Results: 1.Clinical study results: Results:(1)A total of 355 patients with abnormal uterine bleeding caused by ovulation disorders were collected in this survey,including 38 adolescent patients(10.7%),194 patients of childbearing age(54.7%),and 123 patients of perimenopausal period(34.6%).The TCM diagnosis was premenstruation in 4 cases(1.1%),menorrhagia in8 cases(2.3%),intermenstrual bleeding in 23 cases(6.5%),prolonged menstruation in52 cases(14.6%),and leakage in 268 cases(75.5%).(2)Among 355 patients with abnormal uterine bleeding caused by ovulation disorder,227 cases(63.9%)had mixed syndrome of deficiency and excess,73 cases(20.6%)had positive syndrome,and 55 cases(15.5%)had deficiency syndrome.(3)The syndrome elements of 355 patients with abnormal uterine bleeding caused by ovulation disorders were as follows: 209 cases(58.9%)of kidney,189cases(53.2%)of liver,175 cases(49.3%)of spleen.The diseases included 268 cases of blood stasis(75.5%),224 cases of qi deficiency(63.1%),182 cases of qi stagnation(51.2%),107 cases of Yin deficiency(30.1%),91 cases of blood deficiency(25.6%),65 cases of solid heat(18.3%),56 cases of Yang deficiency(15.8%),and 55 cases of dampness(15.5%).(4)The 355 patients with ovulatory disorders with abnormal uterine bleeding were divided into 11 syndromes,among which 110 cases(31.0%)had the highest frequency of kidney deficiency and liver stagnation.There were 52 cases of liver stagnation and spleen deficiency syndrome(14.6%),48 cases of dampness-heat stasis syndrome(13.5%),46 cases of spleen and kidney deficiency syndrome(13.0%),33 cases of spleen deficiency and kidney stasis syndrome(9.3%),23 cases of spleen deficiency and blood stasis syndrome(6.5%),13 cases of liver stagnation and blood stasis syndrome(3.7%),12 cases of liver stagnation and blood heat syndrome(3.4%),and kidney deficiency and blood stasis syndrome 9 cases(2.5%),5 cases(1.4%)of spleen deficiency syndrome,4 cases(1.1%)of kidney deficiency syndrome.(5)The 355 patients with abnormal uterine bleeding caused by ovulation disorders had different syndrome types in puberty,reproductive age and perimenopausal period,and the difference was statistically significant(P < 0.05).(6)The course distribution of 355 patients with ovulatory disorder abnormal uterine bleeding was different among different syndrome types,and the difference was statistically significant(P < 0.05).(7)The hemoglobin levels of 355 patients with ovulatory disorder abnormal uterine bleeding were different among different syndromes,and the difference was statistically significant(P < 0.05).(8)The distribution of pregnancy times in 355 patients with ovulatory disorder abnormal uterine bleeding was different among different syndromes,and the difference was statistically significant(P < 0.05).(9)There was no statistical significance in the distribution of occupation,age of menarche,body mass index and occupational physical activity types among 355 patients with abnormal uterine bleeding caused by ovulation disorder with different TCM syndrome types(P > 0.05).2.Meta-analysis results of integrated traditional Chinese and western medicine in the treatment of AUB-O(Qi deficiency and blood stasis syndrome):(1)Twelve RCT studies on the treatment of AUB-O(Qi deficiency and blood stasis syndrome)with integrated traditional Chinese and western medicine were finally included,involving a total of 1004 patients.(2)The effective rate of integrated traditional Chinese and western medicine in the treatment of AUB-O(Qi deficiency and blood stasis syndrome)in improving menstrual cycle,menstrual volume and menstrual duration was significantly better than that of western medicine alone(P<0.00001,95% 2.71-6.58).(3)The bleeding control time of AUB-O(Qi deficiency and blood stasis syndrome)treated by integrated traditional Chinese and western medicine was shorter than that treated by western medicine alone(P < 0.05,95%CI:-12.08 ～-8.62).The hemostasis time of AUB-O(Qi deficiency and blood stasis syndrome)treated by integrated traditional Chinese and western medicine was shorter than that treated by western medicine alone(P<0.00001,95%CI-18.95-7.37).(4)The combination of traditional Chinese and western medicine in the treatment of AUB-O(Qi deficiency and blood stasis syndrome)was better than western medicine alone in reducing endometrial thickness(P<0.00001,95%CI:-2.51～-1.68).The treatment of AUB-O(Qi deficiency and blood stasis syndrome)with integrated traditional Chinese and western medicine for increasing hemoglobin level(correcting anemia)was significantly better than western medicine alone(P<0.00001,95%CI: 10.10-11.69).Integrated Chinese and Western medicine in the treatment of AUB-O(Qi deficiency and blood stasis syndrome)was better than western medicine alone in reducing the TCM syndrome score(P < 0.05,95%CI:-4.86 ～-0.64).The recurrence rate of AUB-O(Qi deficiency and blood stasis syndrome)treated by integrated traditional Chinese and western medicine was lower than that treated by western medicine alone(P < 0.05,95%CI 0.08-0.56).(5)The incidence of adverse reactions in the treatment of AUB-O(Qi deficiency and blood stasis syndrome)by integrated traditional Chinese and western medicine was lower than that by western medicine alone(P < 0.05,95%CI 0.25-0.81).Conclusion:1.Abnormal uterine patients with ovulatory disorder are mainly characterized by mixed syndrome of deficiency and deficiency,with common syndrome of deficiency of kidney and stagnation of liver,stagnation of liver and deficiency of spleen,dampness-heat stasis,and deficiency of spleen and kidney.2.The type of uterine syndrome with ovulatory disorder was correlated with age,course of disease,hemoglobin level and number of pregnancies,but had no significant correlation with age of menarche,BMI,occupation and occupational physical activity type.3.Through the Meta analysis found that combine traditional Chinese and western medicine treatment AUB-o(qi deficiency and blood stasis syndrome)compared to western medicine therapy,can improve the clinical curative effect,can effectively improve the menstrual cycle and the adjustment period,by volume,effective hemostasis,decrease the thickness of the endometrium and TCM syndrome integral,increase hemoglobin levels,reduce the AUB-o recurrence rate,and higher security. |
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