杨新春 鲍美如 时光 赵瑞华

摘要 目的：對少腹逐瘀汤加减联合西医治疗子宫内膜异位症（Endometriosis，EMs）的有效性和安全性进行系统评价。方法：检索中国期刊全文数据库、中国学术期刊数据库、中文科技期刊数据库、CBM数据库、PubMed、The Cochrane Library、EMbase、Web of Science，选取有关少腹逐瘀汤加减联合西医治疗子宫内膜异位症的随机对照试验（RCT），检索时限为建库至2020年4月。运用RevMan5.3软件进行统计分析。结果：总共纳入11篇文献，包含1 003例患者。Meta分析结果显示：少腹逐瘀汤加减联合西医组较对照组可降低痛经视觉模拟评分法（VAS）评分及血清CA125水平，提高总有效率（RR=1.21，95%CI为1.15～1.28，P<0.000 01），缩减盆腔包块（MD=-1.06，95%CI为-1.59～-0.52，P=0.000 1）、降低LH水平（MD=-0.55，95%CI为-0.67～-0.43，P<0.000 01）及E2水平（MD=-15.23，95%CI为-17.15～-13.31，P<0.000 01），2组FSH水平及不良反应发生率差异无统计学意义。结论：少腹逐瘀汤加减联合西医疗法可有效提高总有效率，降低痛经VAS评分，缩小盆腔包块，降低LH、E2及血清CA125水平，且不增加不良反应发生率。但受纳入文献质量的限制，还需开展更多高质量、大规模的随机对照试验，为临床提供更强有力的循证医学证据。

关键词 子宫内膜异位症;少腹逐瘀汤;随机对照试验;系统评价;Meta分析;中医药;西药;有效性

Meta-analysis of Modified Shaofu Zhuyu Decoction Combined with Western Medicine in the Treatment of Endometriosis

YANG Xinchun，BAO Meiru，SHI Guang，ZHAO Ruihua

（Department of Gynecology，Guang′anmen Hospital，China Academy of Chinese Medical Sciences，Beijing 100053，China）

Abstract Objective：To conduct a systematic review on efficacy and safety of Modified Shaofu Zhuyu Decoction combined with Western medicine in the treatment of endometriosis（EMs）.Methods：The databases of WanFang Data，VIP，CNKI，CBM，PubMed，the Cochrane Library，EMbase and Web of Science were retrieved to gather randomized controlled trials（RCTs） on the efficacy of modified Shaofu Zhuyu Decoction combined with Western medicine in the treatment of endometriosis patients from the establishment of the database to April，2020.Meta-analysis was conducted with RevMan 5.3 software.Results：A total of 11 papers were retrieved with 1003 patients.Meta-analysis showed that，modified Shaofu Zhuyu Decoction combined with Western medicine group provided more reduction in the VAS score of dysmenorrhea and serum CA125，more improvement in the total effective rate[RR=1.21，95%CI（1.15 to 1.28），P<0.000 01 ]and more decrease in the size of pelvic mass[MD=-1.06，95%CI（-1.59 to -0.52），P=0.000 1]，the level of LH[MD=-0.55，95%CI（-0.67 to -0.43），P<0.000 01] and E2[MD=-15.23，95%CI（-17.15 to -13.31），P<0.000 01].There were no significant difference in the level of FSH and the rate of adverse reactions between the 2 groups.Conclusion：Modified Shaofu Zhuyu Decoction combined with Western medicine can more effectively improve the total effective rate and reduce the VAS score of dysmenorrhea，the size of pelvic mass，the levels of LH and E2，and serum CA125 and do not increase the rate of adverse reactions.Because of the limited quality of the included papers，more high-quality，large-scale studies are needed to support clinic with evidence of evidence-based medicine.

Keywords Endometriosis; Shaofu Zhuyu Decoction; Randomized controlled trials; Systematic review; Meta-analysis; Traditional Chinese medicine; Western medicine; Effectiveness

中图分类号：R289.4;R711文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.23.019

子宫内膜异位症（Endometriosis，EMs）是指具有生长功能的子宫内膜组织出现在子宫腔被覆内膜及子宫以外部位的炎症性疾病，影响着5%～10%的育龄期女性即全世界1.76亿妇女[1]，被视为一种现代病、综合征[2]。主要临床表现为疼痛、不孕、包块，其中，盆腔疼痛高达70%～80%[3]，被视为一种慢性病，需要长期管理以减轻疼痛，提高患者的生命质量[4-5]。目前西医疗法通常为单纯激素类药物或联合手术治疗。……