Meta-analysis Of Yinchenhao Decoction Combined With Western Medicine In The Treatment Of Intrahepatic Cholestasis Of Pregnancy

Objective:Objective to systematically evaluate the clinical efficacy and safety of Yinchenhao Decoction(YCHD)Combined with western medicine in the treatment of intrahepatic cholestasis of pregnancy(ICP)by meta-analysis,so as to provide evidence-based medicine for clinical application.Methods:Through the computer retrieval method,the relevant literatures were comprehensively searched in CNKI,Wanfang,VIP,Pub Med,EMBASE and other relevant databases.The randomized controlled trials of Yinchenhao Decoction Combined with western medicine in the treatment of intrahepatic cholestasis of pregnancy were collected until December 31,2020,and the literatures were strictly screened according to the inclusion and exclusion criteria After extracting the effective data,revman5.3 software was used to conduct a meta-analysis of the randomized controlled trials of YCHD Combined with western medicine and Western medicine alone in the treatment of ICP.Q test and I~2 test were selected for the evaluation of inter study heterogeneity.When P≥0.1 and I~2≤50%,it was considered that there was homogeneity between the studies and fixed effect was selected When P<0.1 and I~2>50%,it is suggested that heterogeneity exists,and the source of heterogeneity should be analyzed and treated.Regression analysis,sensitivity analysis or subgroup analysis should be conducted when necessary.If heterogeneity cannot be eliminated,random effect model should be selected.Results:Finally,15 randomized controlled trials with 1169 patients were included,including 579 cases in the control group and 590 cases in the observation group.The control group was treated with conventional western medicine,and the observation group was treated with Yinchenhao Decoction on the basis of Western medicine.Meta analysis results showed that:in terms of clinical total effective rate and relieving pruritus symptoms,the Yinchenhao Decoction Combined with western medicine group was better than the western medicine control group(P<0.00001),in improving alanine aminotransferase(P<0.00001),aspartate aminotransferase(P<0.00001),direct bilirubin(P<0.00001),total bile acid(P<0.00001),total bilirubin(P=0.02)In terms of laboratory indexes such as glycocholic acid(P=0.01),interleukin-17(P<0.0001),transforming growth factor-β(P<0.0001),interferon-γ(P<0.0001),the effect of Yinchenhao Decoction Combined with western medicine group was more obvious,and the Yinchenhao Decoction Combined with Western Medicine group could effectively improve the pregnancy outcome,reduce cesarean section(P=0.001)The incidence of fetal distress(P=0.0003),amniotic fluid pollution(P<0.0001),neonatal asphyxia(P<0.0001),postpartum hemorrhage(P=0.01)and premature delivery(P<0.0001),prolonged gestational weeks(P=0.02)and increased neonatal weight(P=0.005),but there was no significant difference in IL-4 and neonatal Apgar score between the two groups.Conclusion:YCHD Combined with western medicine in the treatment of intrahepatic cholestasis of pregnancy is better than western medicine alone.It can effectively relieve itching symptoms,improve serological indicators and pregnancy outcome.