| Objective: To systematically evaluate the efficacy of traditional Chinese medicine(TCM)in the treatment of ovarian dysfunction reserve(DOR)and premature ovarian failure(POF).Methods: CBM database,VIP database,CNKI database,Embase database,Pub Med database and Cochrane Library database were retrieved by computer.Randomized controlled clinical studies of DOR and POF treated with traditional Chinese medicine or combined with western medicine were collected from the databases until April 2019.Literature review,meta-analysis of outcome indicators such as symptom score,pregnancy rate,improvement of FSH,E2 and adverse reactions.Bias Risk Assessment Tool was used for literature quality evaluation,and Review Manager 5.3 software was used for meta-analysis of outcome indicators.Results: A total of 26 DOR articles and 85 POF articles were included.Literature quality analysis shows that the quality of literature research in this study is low,most of the literature is not explicitly hidden grouping,all the literature can not judge other sources of bias.1.Through the layered study of DOR and POF,the results are as follows:(1)DORThere were 3 literatures in this subgroup for the comparative study of traditional Chinese medicine and Western medicine.The observation group used the method of tonifying kidney and soothing liver.The results of META analysis showed that there was no significant difference in the serum levels of FSH and E2 between traditional Chinese medicine and Western medicine(P > 0.05).In terms of pregnancy rate,there was only one literature report,so no META analysis was done,but the data in this paper showed that there was no significant difference between traditional Chinese medicine for tonifying kidney and soothing liver and Western medicine(P > 0.05).There was no significant difference in the efficacy of Western medicine alone(P > 0.05).Compared with Western medicine,the combination of traditional Chinese medicine and Western medicine included 11 literatures,and then divided into four subgroups according to traditional Chinese medicine treatment methods: Kidney-Tonifying and liver-soothing,Kidney-Tonifying and essence-filling,Kidney-Tonifying and spleen-invigorating,and traditional Chinese medicine cycle therapy.META analysis showed that in TCM symptom score,the curative effect of Kidney-Tonifying and essence-filling TCM combined with western medicine and Kidney-tonifying and spleen-invigorating TCM combined with western medicine was better than that of Western medicine(P < 0.05);in pregnancy rate,the curative effect of Kidney-Tonifying and Liver-soothing TCM combined with western medicine was better than that of Western medicine(P < 0.01);in serum FSH level,TCM periodic therapy combined with western medicine reduced blood pressure(P < 0.01).The curative effect of clearing FSH level was better than that of Western medicine(P < 0.05);in serum E2 level,the curative effect of Kidney-Tonifying and spleen-invigorating traditional Chinese medicine combined with western medicine was better than that of Western medicine alone(P < 0.05);in AMH and AFC,the curative effect of Kidney-Tonifying and spleen-invigorating traditional Chinese medicine combined with Western Medicine was better than that of Western medicine alone(P < 0.05).(2)POFCompared with Western medicine,Chinese medicine has 13 articles.According to Chinese medicine treatment methods such as Kidney-Tonifying and essence-filling,Kidney-Tonifying and blood-activating,Kidney-Tonifying and meridian-regulating,and traditional Chinese medicine cycle therapy,they are divided into four sub-groups.Meta analysis shows that in terms of serum E2 level,Chinese medicine for Kidney-Tonifying and Blood-activating and traditional Chinese medicine cycle therapy are better than western medicine alone in improving serum E2 level(P < 0.05).In the aspect of SH level,the curative effect of Kidney-Tonifying and Blood-Activating Herbs on reducing serum FSH level was better than that of Western medicine(P < 0.05).Compared with Western medicine,47 literatures were included in this study.They were divided into seven sub-groups according to TCM treatment methods: tonifying kidney and essence,tonifying kidney and soothing liver,tonifying kidney and activating blood,tonifying kidney and regulating meridian,tonifying kidney and tonifying yang,tonifying kidney and nourishing yin,and traditional Chinese medicine cycle therapy.Meta-analysis showed that in terms of serum FSH level,the curative effect of Kidney-Tonifying and essence-filling Chinese medicine combined with Western medicine,Kidney-Tonifying and Blood-Activating Chinese medicine combined with Western medicine,Kidney-Tonifying and yang-tonifying Chinese medicine combined with western medicine on reducing serum FSH level was better than that of Western medicine(P<0.05);in terms of serum E2 level,there was no significant difference in the curative effect of traditional Chinese medicine periodic therapy combined with western medicine and Western medicine(P>0.05).The curative effect of high serum E2 level was better than that of Western medicine alone(P < 0.05);in AFC,the curative effect of Kidney-Tonifying and essence-filling Chinese medicine combined with western medicine and Kidney-tonifying and Blood-Activating Chinese medicine combined with western medicine was better than that of Western medicine alone(P < 0.05).Conclusion: 1.The quality of literature on randomized controlled trials of traditional Chinese medicine or combination of Western medicine in the treatment of DOR and POF is on the low side,which reduces the evidence intensity of systematic evaluation,and can not make a favorable conclusion on the effectiveness of traditional Chinese medicine in the treatment of DOR and POF.2.The data of this study show that the treatment of DOR and POF with traditional Chinese medicine or combined with western medicine has better effect in improving serum FSH,E2,FSH/LH,AMH and increasing AFC,but it needs further confirmation by high-quality RCT research. |
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