| Objective:Analysis the distribution of TCM syndrome study by Using latent class method,and evaluate the clinical efficacy of TCM syndrome differentiation and treatment of ovarian reserve dysfunction by using evidence-based methods.The clinical characteristics of clinical treatment are discussed to provide reference for future clinical research and application,through the understanding of the current clinical classification and circulation of ovarian reserve dysfunction of the point of view of evidence.Method:The ideas of the study and experimental design of this paper are divided into three parts:the first part summarizes the research progress of traditional Chinese medicine and Western medicine in the treatment of ovarian reserve dysfunction;the second part uses Meta analysis method to explore the treatment of ovarian reserve with TCM syndrome differentiation treatment.The third part is based on the potential categories of probabilistic statistical software to analyze the distribution of TCM syndromes of ovarian reserve dysfunction and make preliminary preparations for further clinical research and treatment.1.Clinical research:This study collected 160 cases of Chinese and Western medicine diagnosis in patients with ovarian reserve dysfunction as the subject of clinical syndrome questionnaire survey,using potential class analysis method to study the distribution of TCM syndromes,combined with literature review,prospects Cross-sectional investigation of two survey methods.Using Proc LCA module of SAS software with the aid of latent variable category analysis technology is to explore the establishment of ovarian reserve dysfunction syndrome subtype syndrome model.2.Meta-analysis:According to the standards of the International Centre for Evidence-Based Medicine/Cochrane Collaboration Network Workbook,the use of evidence-based medicine methods,a comprehensive search of domestic literature libraries(China Knowledge Network,VIP Database,Wanfang Database)and foreign documents published since the establishment of the database the Pubmed,Cochrane library,and World Health Organization's clinical research literature on the treatment of ovarian reserve dysfunction by TCM included internal randomized controlled trials in which Chinese medicine and external treatment were used to treat ovarian reserve.The bias risk measurement tool evaluates the quality of the included literature.A Meta-analysis of the outcomes of the included literature is performed by using Review Manager 5.1 statistical software.Result:1.Clinical studies:The distribution of TCM syndromes in 160 patients with DOR was including 117 cases(73.1%)with liver depression and kidney deficiency,35 cases(21.9%)with kidney-yang deficiency,and 8cases(5%)with liver-kidney yin deficiency syndrome.2.Meta analysis:A search strategy was developed for different databases.A total of 656 Chinese and English documents were retrneved,and 68 articles were excluded from the investigation.By reading the titles and abstracts,82 articles not clearly meeting therequirements were excluded,and the remaining 506 articles were read and further screened,excluding 488 articles that were not marked with "randomized controls "or that did not meet the criteria for systematic diagnosis,inclusion,and exclusion criteria.The 18 articles eventually included can be divided into randomized controlled trials(RCT)or quasi-randomized comparisons of traditional Chinese medicine decoctions or granules and western medicine hormones and traditional Chinese medicine decoctions or granules in combination with Western medicine hormone control western medicine hormone group in the treatment of ovarnan reserve dysfunction.The test(CCT),at the same time,adopts syndrome differentiation for subgroup analysis;then data extraction and literature quality evaluation are performed.The risk assessment of bias showed that the methodological quality and reporting quality of the literature included in the study were generally low and had a high risk of bias.Meta analysis of the included literature are the following results:(1)follicle-stimulating hormone(FSH):Chinese herbal decoction was more effective than western medicine in improving follicle-stimulating hormone,and the result was statistically significant.Chinese medicine combined with western medicine hormone was more effective than Western medicine hormone in improving follicle-stimulating hormone,and it had statistical significance.(2)Estradiol(E2):Traditional Chinese medicine was superior to western medicine in the improvement of estradiol,and there was a statistical difference;Chinese medicine was combined with western hormones in the improvement of LH:MD kidney failure=16.75,95%Cl(10.4323.07),P<0.00001,indicating that the combination of Chinese and Western medicines for kidney deficiency syndrome was superior to Western medicine hormones in improving E2,and had statistical differences;MD liver and kidney yin deficiency syndrome=-4.72,95%Cl(-14.72,5.28),P=0.36,indicating that the effect of Western medicine hormones in improving E2 was better than that of traditional Chinese medicine combined with western medicine hormones in liver and kidney yin deficiency syndromes,and there was no statistical difference;MD blood deficiency syndrome=-6.08,95%Cl(-8.18,-3.98)),P?0.20,indicating that western medicine hormones were better than blood deficiency syndrome in the combination of traditional Chinese medicine with western medicine hormones in improving E2,and there was no statistical difference.(3)FSH/LH:Traditional Chinese medicine decoction or granules control western medicine hormone on FSH/LH:one study on kidney deficiency and blood stasis syndrome showed that Chinese medicine was better than western medicine hormone in improving FSH/LH,and had statistical significance[MD=-0.16,95%Cl(-0.30,-0.02)];one study showed that western medicine hormones was superior to traditional Chinese medicine in improving FSH/LH,with no statistical significance[MD=0.19,95%Cl(-0.13,0.51)].In the Kidney Deficiency and Liver Depression Syndrome,one study showed that Western medicine hormones were superior to the Chinese medicine group in improving FSH/LH,with no statistical significance[MD=0.59,95%Cl(-0.39,1.57)];one study showed western medicine hormones.The effect of improving FSH/LH was better than that of traditional Chinese medicine group and it was statistically significant[MD=0.27,95%Cl(0.01,0.53).One study showed that the Chinese medicine group had better effect than the western medicine group in improving FSH/LH.No statistical significance[MD?-0.24,95%Cl(-0.50,0.02)];one study showed that the effect of Chinese medicine group on improving FSH/LH was better than that of wester:n medicine group with no statistical significance[MD=-0.27,95%C1(-0.69,0.15)];One study showed that the effect of Chinese medicine group on improving FSH/LH was better than that of western medicine group,with no statistical significance[MD?-0.40,95%Cl(-0.93,0.13)].The effect of kidney-deficiency syndrome Chinese medicine on improving FSH/LH was better than that of western medicine group,but it was not statistically significant[MD=-0.10,95%Cl(-1.24,1.04),P?0.86].(4)Anti-Mullerian Hormone(AMH):Chinese Herbal Decoction or Granule Control Western Medicine Hormone effect on AMH:One study showed that Chinese Herbal Medicine was better than Western Medicine Hormone in improving AMH,but no statistically significant[MD=0.40,95%CI(-0.36,1.16)];one study showed that Chinese medicine was better than Western medicine hormones in improving AMH,and had statistical significance[MD?1.04,95%CI(0.57,1.51)];1 study showed that Western medicine Hormone was better than traditional Chinese medicine in improving AMH but not statistically significant[MD=-0.11,95%CI(-0.87,0.65)].Chinese medicine decoction or granules in combination with hormones Western medicine control Western medicine hormones on the role of AMH:Incorporating a study showed that traditional Chinese medicine decoction combined with western medicine hormones was better than simple western medicine hormones in improving AMH,and there were statistical significance.(5)Efficacy of TCM syndromes:6 studies evaluated the efficacy of TCM syndromes:TCM was superior to Western medicine hormones in improving the efficacy of TCM syndromes with statistical significance[RR=1.17,95%CI(1.02,1.33)),Z=2.27(P=0.02)].The safety evaluation showed that 13 trials reported information on adverse events:3 trials reported no adverse events;others reported adverse reactions of varying degrees.And there is publication bias.Conclusion:1.The latent categorical variable models of syndromes of TCM syndromes with diminished ovarian reserve were closely related to the kidneys,especially the liver-kidney-kidney-deficiency type.This conclusion was consistent with clinical findings of ovarian reserve dysfunction.2.The meta-analysis showed that Chinese herbal decoction or granules(combined with western medicine hormones)had a certain effect in improving ovarian reserve dysfunction.The treatment of TCM with traditional Chinese medicine had a good effect on improving ovarian reserve function,but its long-term safety issues needed further study.Of course,the quality of the literature included in this study was not very high.Therefore,a large number of high-quality randomized controlled trials were needed to verify it and improve its scientificity and objectivity. |
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