徐赫 陈莹 千运龙

[摘要]目的系統评价中药补肾疏肝法治疗绝经综合征的症状及激素指标改善的有效性。方法检索 CNKI、万方、CBM、维普、The Cochrane Library、Embase、PubMed、Web of Science 等数据库公开发表的文献，纳入随机对照（RCT）研究。通过 Cochrane 手册5.1.0推荐的 RCT 偏倚风险评估，对纳入的结局指标使用RevMan 5.3软件进行统计学分析。结果共纳入19个研究，共1677例患者，均为中文发表。meta 分析结果显示使用中药补肾疏肝法较其他疗法的临床有效率更高[RR=4.37，95%CI （3.20，5.97），Z=9.28，P <0.00001]，临床症状Kupperman评分降低效果更好[MD=-5.52，95%CI （-7.39，-3.65），P <0.00001]。试验组较常规西药组降低血清促卵泡激素（FSH）效果更佳[SMD=-1.49，95%CI （-2.42，-0.56），Z=3.13，P=0.002<0.05]。结论以补肾疏肝法治疗绝经综合征对比西药及中成药更有优势，从临床总有效率、症状改善、血清激素值方面可以得知，期待开展样本充足、方法学完善、多中心的研究，为补肾疏肝法治疗女性绝经综合征提供更新、质量更高的循证医学证据。

[关键词]绝经;补肾疏肝法;随机对照试验; meta 分析;系统评价;有效性

[中图分类号] R271.1  [文献标识码] A   [文章编号]2095-0616（2021）23-0053-05

Meta-analysis of treating menopausal syndrome with the method of tonifying the kidney and soothing the liver with traditional Chinese medicine

XU  He1      CHEN  Ying2      QIAN  Yunlong1

1.Graduate School， Liaoning University of Traditional Chinese Medicine， Liaoning， Shenyang 110847， China;2.Department of Obstetrics and Gynecology， the First Affiliated Hospital of Liaoning University of Traditional Chinese Medicine， Liaoning， Shenyang 110032， China

[Abstract] Objective To systematically evaluate the effectiveness of the method of tonifying the kidney and soothing the liver with Chinese materia medica in treating symptoms of menopausal syndrome and ameliorating hormone indices. Methods The relevant published literature was searched through the databases such as CNKI， Wanfang， CBM， VIP， The Cochrane Library， Embase， PubMed， Web of Science， etc. and was included in the randomized controlled trial （RCT） study. The included outcome indices were statistically analyzed by RevMan 5.3 software according to the RCT bias risk assessment recommended by Cochrane Handbook 5.1.0. Results A total of 19 studies with 1，677 patients were included， all of which were published in Chinese. Meta-analysis results showed that compared with other therapies， the method of tonifying kidney and soothing liver with Chinese materia medica has higher clinical effective rate （RR=4.37， 95%CI [3.20， 5.97]， Z=9.28， P <0.00001）， and the decreasing of Kupperman score of clinical symptoms is significant（MD=-5.52， 95%CI [-7.39， -3.65]， P <0.00001）. As far as the reduction of serum follicular-stimulating hormone （FSH） was concerned， the effect in the experimental group was better than that in the conventional Western medicine group （SMD=-1.49， 95%CI [-2.42， -0.56]， Z=3.13， P=0.002<0.05）. Conclusion The method of tonifying the kidney and soothing the liver has more advantages than Western medicine and Chinese patent medicine in treating menopausal syndrome. Judged by clinical total effective rate， symptom relief and serum hormone value， multi-center studies with sufficient samples and perfect methodology are expected， so as to provide newer evidence-based medicine evidence with higher quality for treating female menopausal syndrome with the method of tonifying the kidney and soothing the liver.  [Key words] Menopause; Method of tonifying the kidney and soothing the liver; Randomized controlled trial; Meta analysis; Systematically evaluate; Effectiveness

绝经综合征又称更年期综合征、围绝经期综合征，为妇女在绝经前后出现性激素波动或减少所致的一系列躯体及精神心理症状。首发症状虽常为月经的改变，但随之的血管舒缩症状及自主神经失调症状都会降低他们的生活质量。据统计，我国每天约有6000名女性进入更年期，到2030年我国绝经人数将达到2.8亿[1]。

西医疗法以激素补充治疗（hormone replacement therapy， HRT）为主，使用前需严格评估以规避副作用及禁忌证。因此，临床医生也在寻找更多有确切疗效的治疗方式。对比 HRT，中医药在治疗女性绝经综合征方面具有疗效显著、药性温和、不良反应少等优势。中医药治疗本病常以补肾填精、调和阴阳为基础[2]，但患者常伴紧张、焦虑等情绪，故在此基础上常结合疏肝之品。但本治疗多为样本量较少的随机对照试验或回顾性分析，循证级别普遍较低。为进一步探究，本研究拟对中药补肾疏肝法治疗绝经综合……