A Systematic Review Of The Clinical Efficacy Of Integrated Traditional Chinese And Western Medicine In The Treatment Of Chronic Endometritis

Objective:Through systematic evaluation and meta-analysis,the clinical efficacy and safety in the treatment of Chronic Endometritis(CE)with the combination of traditional Chinese and western medicine were analyzed and evaluated to provide evidence-based basis for the clinical use of combined traditional Chinese and western medicine in the treatment of CE.Methods:1.Literature retrieval:according to the established retrieval strategy and retrieval expression,6 databases,namely CNKI,WF,VIP,CBM,PubMed and Central,were retrieved by computer.All Randomized controlled trials(RCTS)of CE in integrated Chinese and western medicine published until 31 December 2019 were retrieved.The retrieval language is limited to Chinese and English.2.Document management:Document management adopt EndnoteX9.1 software.According to the inclusion and exclusion criteria,the final inclusion documents were determined and the corresponding data were extracted.The risk of bias was assessed using the Cochrane risk assessment tool.3.Statistical analysis:Review Manager5.3 was used for Meta analysis.Relative Risk(RR)and Risk Difference(RD)were selected as the effect variables.When the units of measurement data were identical,weighted Mean Difference(MD)was used as the effect quantity,and Standardized Mean Difference(SMD)was used as the effect quantity for different units of measurement data.The combined effect quantity is fixed effect model or random effect model.The results of heterogeneity test were expressed by I2.Sensitivity analysis was used to evaluate whether the results of meta-analysis were stable and reliable,or to explore the sources of heterogeneity.We just do descriptive analysis,when heterogeneity is too great to be combined.The combined effect was tested by Z test and 95%Confidence Interval(CI),and the results of Meta analysis were represented by forest graph.Funnel plots were developed to identify publication bias.Results:1.Retrieval and screening results:3249 relevant literatures were retrieved,and 16 were finally included.2.Results of meta-analysis:Integrated Chinese and western medicine treatment is better than conventional western medicine treatment,reflected in:? Can improve the clinical efficacy(I2=0%,RR=1.22,95%CI=[1.17,1.27],Z=8.82,P<0.00001),sensitivity analysis is relatively stable,funnel plot has a certain publication bias.?Could improve the efficacy of hysteroscopy(I2=0%,RR=1.63,95%CI=[1.21,2.18],Z=3.23,P=0.001).?Decreased CD38 content(I2=0%,MD=-10.85,95%CI=[-15.36,-6.34],Z=4.71,P<0.00001).?Increase the content of interleukin-2(interleukin-2,Il-2)(I2=0%,SMD=3.55,95%CI=[3.07,4.02],Z=14.62,P<0.000001).?Tumor Necrosis factor-gamma(TNF-gamma)was down-regulated(I2=0%,SMD=-2.24,95%CI-[-2.53,-1.95],Z=15.08,P<0.00001).?Shorten menstrual cycle(I2=0%,RR=1.33,95%Cl=[1.10,1.60],Z=2.98,P=0.003).?Increased endometrial thickness(I2=0%,MD=1.22,95%CI=[1.09,1.42],Z=15.13,P<0.00001).?Reduce TCM syndrome score(I2=0%,MD=-8.01,95%CI=[-9.65,-6.37],Z=9.58,P<0.00001).?The incidence of adverse reactions was not increased(I2=42%,RD=-0.01,95%CI=[-0.09,0.07],Z=0.26,P=0.80).3.Descriptive analysis results:The combined treatment of Chinese and western medicine is better than the conventional treatment of western medicine in the following aspects:The curative effect of pathological tissue was better than that of western medicine treatment group;The expression of interleukin-1(Il-1?)was down-regulated;Change pregnancy outcome,improve clinical pregnancy rate and embryo implantation rate;Reduce the recurrence rate.Conclusions:Clinical efficacy evaluation:CE treatment with integrated traditional Chinese and western medicine has an accurate efficacy,promising and worthy of further study,based on the results of this systematic evaluation.?The integrated treatment of Chinese and western medicine is better than the conventional treatment of western medicine in improving the clinical symptoms,reducing the TCM syndrome score,Shorting menstrual cycle,and so on?Combined treatment of traditional Chinese and western medicine is more promising than conventional treatment of western medicine in improving the long-term efficacy of patients,such as improving pregnancy outcome and reducing the recurrence rate,but more strong evidence is needed to demonstrate.Treatment mechanism:The combined treatment of traditional Chinese and western medicine is better than the conventional treatment of western medicine in reducing the proinflammatory factor Il-1? and TNF-?,and increasing the immune promoting factor Il-2,suggesting that the combined treatment of traditional Chinese and western medicine may regulate the body's inflammatory response by enhancing the body's immunity and down-regulating inflammatory mediators,so as to reduce the damage of endometrial tissue.Safety analysis:There is no clear evidence that the occurrence of adverse reactions is related to the treatment with traditional Chinese medicine,so it is necessary to strengthen the study on the safety of CE treatment with integrated traditional Chinese and western medicine in the future.Some of the literatures included in this system evaluation are of poor quality,such as small sample size and some risk of bias.Part of the conventional western medicine treatment included in the literature is not a recognized treatment method of CE,which limits the strength of the conclusion evidence.In the future,more clinical RCT with high quality and large sample will be needed to reevaluate it.Subsequent studies should exclude the literature on non-western accepted treatment methods and improve the selection of search terms.