| Objective1 Through the network meta-analysis of the therapeutic effects of Invigorating the kidney and spleen,Tonifying kidney and holding Qi,Tonifying kidney and moving b lood,Nourishing qi and blood in the treatment of recurrent abortion,to prove the eff ectiveness of traditional Chinese medicine in the treatment of recurrent spontaneous ab ortion(RSA),and compare the effectiveness of different treatment principles and metho ds on recurrent abortion,so as to provide evidence-based medicine evidence for the o ptimization of TCM treatment of recurrent abortion in clinical practice.2 Through observe the clinical effect of Peiyuan Bushen Antai Formula in the tre atment of recurrent abortion,to provide more reference for the clinical treatment of re current abortion.Methods1 CNKI,VIP,Wanfang,CBM,PubMed,EMBASE,Cochrane Library and other Chinese and English databases were searched by computer to search all the clinical ra ndomized controlled studies on the treatment of recurrent abortion with traditional Chi nese Medicine published abroad and abroad.All the retrieved literatures were screened and included.Statal4.0 was used for statistical analysis.By comparing the total clinic al effective rate,the success rate of pregnancy preservation(beyond the previous abort ion time,or the effective rate of pregnancy lasting more than 12 weeks),the live birt h rate,TCM syndrome score,?-HCG and P and E2 levels,and adverse reactions duri ng treatment,to systematically evaluate the effectiveness and safety of different treatm ents for recurrent abortion,including tonifying kidney and spleen,tonifying kidney an d holding Qi,tonifying kidney and activating blood,tonifying qi and nourishing bloo d.2 A total of 40 patients with recurrent abortion of kidney deficiency type who m et the inclusion criteria and exclusion criteria were collected from Professor Liu Yanfe ng's department of gynecology,Dongzhimen Hospital,Beijing University of Chinese Medicine from December 2019 to December 2020,and 36 patients remained after she dding.The included patients were treated with the addition and subtraction of Peiyuan Bushen Antai Formula,and the core prescriptions were:Mulberry parasitic,Radix di psaci,dodder,Ejiao,Dangshen,raw Astragalus membranaceus,white peony root,proce ssed liquorice,Atractylodes,Radix Scutellariae,etc.,which were added or subtracted according to the symptoms.Subjects were observed from the time of intrauterine preg nancy at 5-6 weeks of enrollment to 12 weeks of gestation.The TCM syndrome scor e,B-ultrasound examination,serum ?-HCG value,P value,E2 value changes before a nd after treatment,as well as the total effective rate,the success rate of fetal protecti on,the live birth rate and other conditions were closely observed in the two groups,so as to observe the clinical efficacy of Peiyuan Bushen Antai Formula on the recurr ent abortion.Results1 Network meta-analysis of TCM Syndrome Differentiation in Treatment of Recur rent AbortionFinally,a total of 70 articles were included,including 15 articles on tonifying ki dney and spleen,13 articles on tonifying kidney and Qi,41 articles on tonifying kidn ey and activating blood,and 1 article on tonifying qi and nourishing blood.Among t hem,59 papers studied the clinical comprehensive effect;Seventeen articles studied th e success rate of pregnancy(the effective rate of more than the previous abortion tim e or continuous pregnancy for more than 12 weeks);20 papers studied live birth rate,18 papers studied TCM syndrome score;Twenty three articles studied hormone ?-H CG;Twenty two papers studied hormone P;Ten papers studied the level of E2;11 articles described the adverse reactions during the treatment.The results of mesh meta-analysis showed that:(1)In terms of total effective rate:all four TCM treatments were included in the study.Compared with western medicine alone,Bushen Yiqi method plus Western me dicine has the best effect on recurrent abortion;There was no significant difference b etween the two treatments.Compared with western medicine alone,Bushen Jianpi met hod and Bushen Yiqi method were better than western medicine alone,and there was no significant difference between them.The order of curative effect(Sucra value)of different intervention measures was:Qi tonifying and blood nourishing method+wes tern medicine(80.9)>kidney-tonifying and qi replenishing method+western medicine(73.8)>kidney-tonifying and blood activating method+ western medicine(62.7)>kidney-tonifying and spleen strengthening method+western medicine(32.0)>western medicin e(0.7);Kidney tonifying and spleen strengthening method(85.8)>tonifying kidney and invigorating qi method(67.0)>tonifying kidney and promoting blood circulation meth od(44.9)>western medicine(2.2).(2)In terms of the success rate of pregnancy and fetus protection,two traditional Chinese medicine treatment methods of Tonifying the kidney and promoting blood ci rculation and tonifying the kidney and strengthening the spleen were included in the s tudy.The success rate of two methods combined with western medicine in the treatm ent of recurrent abortion was better than that of Western medicine alone;Indirect com parison showed that there was no significant difference between the two methods.The order of efficacy of the success rate of fetal preservation was the method of tonifying kidney and invigorating spleen+western medicine(90.9)>method of tonifying kidne y and promoting blood circulation+western medicine(59.0)>western medicine(0.0).(3)In terms of live birth rate:all four TCM treatments were included in the stu dy.The effect of traditional Chinese medicine plus Western medicine intervention on t he live birth rate of patients with recurrent abortion was better than that of Western medicine intervention alone.The effect of Bushen Yiqi method plus Western Medicine on recurrent abortion is the best;Indirect comparison showed that there was no signi ficant difference among different TCM treatments.The order of efficacy of live birth r ate was kidney tonifying qi method+western medicine(81.2)>tonifying kidney and p romoting blood circulation method+western medicine(67.7)>tonifying kidney and in vigorating spleen method+western medicine(53.0)>tonifying qi and nourishing blood method+western medicine(47.5)>western medicine(0.6).(4)In terms of TCM syndrome integral,three TCM treatment methods including kidney tonifying and spleen strengthening method,kidney tonifying and Qi tonifying method and kidney activating and blood activating method were included in the study.Bushen Huoxue Method plus Western medicine is better than western medicine alone in reducing TCM syndrome score of patients with recurrent abortion;Indirect compar ison showed that there was no significant difference among the TCM treatments.The o rder of efficacy of TCM syndrome score was kidney tonifying and blood promoting method+western medicine(74.1)>tonifying kidney and invigorating qi method+wes tern medicine(71.0)>tonifying kidney and invigorating spleen method+western medic ine(46.9)>western medicine(7.9).(5)In terms of ?-HCG,three traditional Chinese medicine treatment methods wer e included in the study.Compared with western medicine alone,Bushen Huoxue Met hod plus Western medicine can increase the incidence of recurrent abortion ?-There was no significant difference in hCG level between the other two groups;Indirect co mparison showed that there was no significant difference among the TCM treatments.The therapeutic order of ?-HCG increased was the method of tonifying kidney and pr omoting blood circulation+western medicine(85.4)>tonifying kidney and strengthenin g spleen+western medicine(65.7)>tonifying kidney and replenishing qi+ western m edicine(26.6)>western medicine(22.4).(6)P:four kinds of traditional Chinese medicine treatment were included in the study.The effect of Yiqi Yangxue method+western medicine,Bushen Huoxue Metho d+western medicine,Bushen Jianpi method +western medicine on the increase of P value in patients with recurrent abortion was better than that of Western medicine a lone;Indirect comparison between groups showed that the methods of Supplementing Qi and nourishing blood,invigorating kidney and activating blood,invigorating kidney and invigorating spleen were better than those of invigorating kidney and Qi.The ord er of efficacy of increasing P value was:Qi tonifying and blood nourishing method+western medicine(91.8)>tonifying kidney and promoting blood circulation method+western medicine(72.2)>tonifying kidney and invigorating spleen method+western m edicine(60.6)>western medicine(14.5)>tonifying kidney and replenishing qi method+western medicine(11.0).(7)E2:All the four TCM treatments were included in the study.Compared with western medicine,there was no significant difference in the increase of E2;There wa s no significant difference between the two methods.The order of efficacy of increasin g E2 was kidney tonifying and blood promoting method+western medicine(72.1)>to nifying kidney and invigorating spleen method+western medicine(57.9)>tonifying qi and nourishing blood method+western medicine(56.2)>western medicine(33.2)>toni fying kidney and qi method+western medicine(30.6).(8)Safety:Safety:11 of 71 studies specifically described the occurrence of differ ent degrees of adverse reactions,a total of 143 patients with adverse reactions,includ ing 51 in the experimental group and 92 in the control group.2 Clinical observation of Peiyuan Bushen Antai Formula in the treatment of recur rent abortionFinally,36 patients,aged between 26 and 42 years old,were included.The num ber of abortions was 2-5 times,and the history of intrauterine operation was the most in 5 times.The treatment results were as follows:(1)Serum chorionic gonadotropin(?-HCG),progesterone(P),estradiol(E2):6 w eeks,8 weeks,10 weeks of gestation ?-hCG,there were significant differences in be tween two groups(P<0.01).The results of P analysis showed that there was signifi cant difference between 6 weeks and 8 weeks,and between 8 weeks and 10 weeks(P<0.05);There was significant difference between 6 weeks and 10 weeks of gestati on(P<0.01).There were significant differences in E2 between the two groups at 6,8 and 10 weeks of gestation(P<0.01).(2)Ultrasound examination:after 12 weeks of gestation,the embryo development was less than the gestational age,accounting for 16.67%;75%of the embryos devel oped in accordance with gestational age;8.33%of the cases had embryo arrest or fet al bud without fetal heart.(3)The success rate of pregnancy:33 cases were successful,3 cases were failure,the success rate was 91.67%.(4)TCM syndrome score before and after treatment:the average score of TCM s yndrome was 14.11 before treatment ±41,4.94 after treatment±3.06?The results showed that the TCM syndrome score decreased after treatment,and the difference w as statistically significant(P<0.01).(5)Clinical efficacy of TCM syndrome:1 case was cured,16 cases were marked ly effective,17 cases were effective,2 cases were ineffective,the total effective numb er was 34 cases,the total effective rate was 94.44%.Conclusion1 In terms of total effective rate,the method of tonifying kidney and replenishin g qi+ western medicine had the best effect on recurrent abortion compared with wes tern medicine alone.In terms of the success rate of pregnancy preservation,the meth od of tonifying kidney and invigorating spleen+western medicine and the method of tonifying kidney and promoting blood circulation+western medicine were better tha n the western medicine alone.In terms of live birth rate,the four TCM interventions+western medicine were better than western medicine intervention alone,among whi ch the kidney-tonifying and qi-replenishing method+western medicine had the most significant effect,In terms of decreasing TCM syndrome score and increasing ?-HCG value,the effect of tonifying kidney and promoting blood circulation method+wester n medicine was better than that of western medicine alone.For increasing P,the met hod of tonifying qi and nourishing blood+western medicine,method of tonifying ki dney and promoting blood circulation+western medicine,method of tonifying kidney and strengthening spleen+western medicine all play an important role;There was n o statistical difference in E2 value between different TCM treatments plus western me dicine and western medicine alone.Different TCM treatments have their own advantag es in different outcome indicators,but in terms of total effective rate of main outcom e indicators,success rate of pregnancy and live birth rate,tonifying kidney and holdin g Qi method and tonifying kidney and spleen method have significant advantages.Bot h of them focus on tonifying kidney,which is consistent with the pathogenesis charac teristics of recurrent abortion.It suggests that in clinical practice,we should pay atten tion to tonifying kidney,invigorating spleen and Qi and nourishing and promoting blo od circulation,so as to improve the clinical efficacy of patients with recurrent abortio n.2 The results of clinical efficacy observation showed that:Peiyuan Bushen Antai formula can effectively improve the endocrine environment of patients with recurrent abortion,reduce the syndrome of spleen and kidney deficiency during pregnancy,impr ove the success rate of fetal protection,and has obvious effect in improving pregnanc y outcome,and no adverse reactions were found in the treatment process,which prov es that the clinical efficacy and safety of Peiyuan Bushen Antai formula are worthy o f affirmation. |
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