Meta-analysis Of Traditional Chinese Medicine Combined With Estrogen And Progestin To Prevent Readhesion After IUA

Objective: The aim of this study is to systematically evaluate the efficacy and safety of Chinese medicine combined with estrogen and progestin in repairing the endometrium,preventing postoperative recurrence,improving clinical symptoms and pregnancy outcome after intrauterine adhesions(IUA)surgery using Meta-analysis,an evidence-based literature evaluation method,to provide more objective and comprehensive evidence of evidence-based medicine for the prevention and treatment of postoperative re-adhesions after IUA with Chinese herbal medicine combined with estrogen and progestin,and to summarize the syndrome types and Chinese medicine prescription used in the included literature,to outline their rules of syndrome types and drug selection,and to provide some new ideas for the clinical prevention and treatment of postoperative re-adhesions after IUA.Methods: According to the steps of Meta-analysis,we collected published clinical studies related to the prevention and treatment of post-operative readhesion of IUA with Chinese medicine combined with estrogen and progestin from 2012 to 2022 through computer searches of databases such as Wanfang,China National Knowledge Infrastructure,VIP,China China Biology Medicine disc,Pub Med,Embass,Cochrane Library and Clinical Trials Registry.The collected literature was imported into Note Express software,duplicates were removed and those meeting the inclusion and exclusion criteria were screened,the Cochrane Bias Risk Assessment Tool was used to evaluate the quality of the literature,and enter the relevant outcome data into Excel table,and finally use Rev Man5.3 software to conduct a meta analysis of the outcome data.Results: A total of 27 papers were included in this study,with 889 cases in the control group and 892 cases in the observation group,for a total of 1781 cases.A Meta-analysis of12 outcome indicators was performed.1.Clinical combined efficacy: 0R=3.67,95%CI=[2.62,5.16],Z=7.53,P<0.05,the clinical combined efficacy of herbal medicine combined with estrogen and progestin for postoperative IUA was better than estrogen and progestin treatment alone.2.IUA score at 3-month postoperative treatment review hysteroscopy: SMD=-0.60,95%CI=[-0.74,-0.47],Z=8.73,P<0.05,Chinese herbal medicine combined with estrogen and progestin treatment was more effective in reducing postoperative IUA score than estrogen and progestin treatment alone.3.Uterine cavity recovery rate: 0R=3.65,95%CI=[2.01,6.64],Z=4.25,P<0.05,the combination of herbs with estrogen and progestin is superior to hormone therapy alone in improving the rate of post-surgical uterine recovery.4.Chinese medicine syndrome of efficacy: 0R=4.77,95%CI=[2.79,8.17],Z=5.69,P<0.05,Chinese medicine combined with estrogen and progesterone is better than estrogen and progesterone alone in improving and alleviating clinical symptoms.5.Chinese medicine syndrome score: SMD=-1.38,95%CI=[-1.79,-0.97],Z=6.57,P<0.05.Chinese medicine combined with estrogen and progesterone treatment can lower Chinese medicine syndrome score more than estrogen and progesterone treatment alone.6.Menstrual efficacy: Effect of menstrual period: 0R=2.76,95%CI=[1.46,5.22],Z=3.14,P<0.05;Curative effect of menstrual volume: 0R=4.56,95%CI=[2.30,9.04],Z=4.34,P<0.05;Effect of menstrual color quality: 0R=4.87,95%CI=[2.40,9.88],Z=4.39,P<0.05).Chinese herbal medicine combined with estrogen and progestin was more advantageous in improving menstrual period,menstrual volume and colour quality.7.Endometrial thickness: SMD=1.22,95%CI=[0.84,1.60],Z=6.24,P<0.05.The effect of traditional Chinese medicine combined with estrogen and progesterone to increase postoperative endometrial thickness is better than that of estrogen and progesterone alone.8.Uterine artery pulsatility index PI: MD=-0.12,95%CI=[-0.15,-0.09],Z=7.07,P<0.05,Chinese herbal medicine combined with estrogen and progestin was superior to estrogen and progestin alone in reducing uterine artery pulsatility index PI.9.Uterine artery resistance index RI: MD=-0.06,95%CI=[-0.07,-0.05],Z=12.87,P<0.05.Chinese herbal medicine combined with estrogen and progestin was superior to estrogen and progestin alone in reducing uterine artery resistance index RI.10.Endometrial penetration blood flow count: Class I: 0R=0.25,95% CI=[0.15,0.42],Z=5.16,P<0.05;Class II: 0R=1.48,95%CI=[0.92,2.39],Z=1.62,P=0.11>0.05;Class III:R=2.50,95%CI=[1.51,4.13],Z=3.58,P<0.05.The combination of herbal medicine with estrogen and progestin was better in reducing blood flow in Class I and increasing blood flow in Class III,but in improving blood flow in Class II,the results of this Meta-analysis showed no difference.11.Pregnancy rate: 0R=2.70,95%CI=[1.73,4.22],Z=4.37,P<0.05.Combining estrogen and progestin with Chinese herbal medicine improved the postoperative pregnancy rate in IUA patients compared with estrogen and progestin alone.12.Adverse reactions: 0R=0.49,95%CI=[0.14,1.70],Z=1.12,P>0.05,the results were not statistically significant,indicating that the probability of adverse reactions with oral Chinese medicine is low and the safety is high.Conclusion:1.The combination of traditional Chinese medicine and estrogen and progesterone has a good clinical comprehensive effect after IUA surgery,which can significantly improve the Chinese medicine syndrome and menstrual status,and improve the recovery rate of uterine cavity and pregnancy rate after surgery,and reduce the IUA score and Chinese medicine syndrome score after surgery.2.Traditional Chinese medicine combined with estrogen and progesterone treatment can increase the thickness of endometrium after operation,reduce the PI and RI values of uterine artery blood flow index,increase the number of endometrial perforating blood flow grade III,and improve endometrial receptivity.3.In terms of safety,there were no significant adverse reactions to oral herbal medicine and the safety profile was good.4.The syndrome type of IUA is mainly kidney deficiency and blood stasis,with liver depression and spleen deficiency.The drugs for tonifying the kidney and activating blood circulation are often selected for clinical use.This study found that the most frequently used traditional Chinese medicine are Cuscuta chinensis,Angelica sinensis,Salvia miltiorrhiza,Radix Rehmanniae and Rhizoma Cyperi.