本文關鍵詞：中西醫(yī)結合藥物治療輸卵管妊娠的Meta-分析　出處：《廣州中醫(yī)藥大學》2016年碩士論文　論文類型：學位論文

  更多相關文章： Meta-分析 輸卵管妊娠 中西醫(yī)結合 藥物保守治療

【摘要】：研究目的：客觀評估中西醫(yī)結合藥物治療輸卵管妊娠的科研質(zhì)量,為中西藥結合治療輸卵管妊娠提供療效和安全性證據(jù)；通過對輸卵管妊娠的中西藥結合治療與西藥治療在療效和安全性上的比較,顯示中醫(yī)藥在輸卵管妊娠中的重要治療作用。研究方法：1.檢索PubMed、Google scholar、Cochrane Library循證醫(yī)學數(shù)據(jù)庫、Clinical trial、中文知網(wǎng)(Cnki)、萬方數(shù)據(jù)、中文科技期刊數(shù)據(jù)庫(Cqvip),獲取對比研究中西醫(yī)結合藥物治療輸卵管妊娠的隨機對照試驗(RCT),并追索納入文獻的參考文獻。2.根據(jù)納入及排除標準,納入文獻進行中西藥結合治療輸卵管妊娠的文獻計量學研究,對納入文獻的一般情況,診斷標準,納入及排除標準,療效判定標準,研究方案等四方面進行描述性分析。3.進一步篩選文獻,納入文獻進行薈萃分析,描述中西藥結合治療輸卵管妊娠RCT的PICOS(對象、干預、對照、結局和試驗設計)。4.依據(jù)5.0.2版Cochrane系統(tǒng)評價員手冊,客觀評價納入文獻的隨機方法學。5.采用循證醫(yī)學中的系統(tǒng)評價專用軟件Review Manager5.3(Revman5.3)分析軟件,對納入文獻進行定量合成的統(tǒng)計處理。研究結果：1.共檢索到可能相關的1496篇文獻。根據(jù)納入及排除標準,總納入62篇比較研究中西藥結合治療輸卵管妊娠的隨機對照研究文獻。2.在文獻一般情況方面,納入文獻均發(fā)表于2004年以后,且在數(shù)量上基本呈上升趨勢,主要發(fā)表于國家級雜志,占60% (37/62),病例均來源于相關醫(yī)院住院部,無門診患者,62篇文獻均為單中心研究。在診斷及療效判定標準方面,所有病例均按西醫(yī)診斷標準診斷,其中31篇文獻采用教科書標準,占66% (33/62)；納入與排除標準均提到的有58篇,占94% (58/62)；納入文獻中根據(jù)自定標準來判斷療效的有39篇,占63% (39/62)。歸入研究文獻的整體研究方案質(zhì)量一般,只有14篇描述了隨機方法,占19.3%(12/62),均未提及盲法、分配方案隱藏,無一篇提及樣本含量的估算；有54篇進行了試驗組與對照組間的平衡性檢驗,占87% (54/62)；有58篇文獻的干預措施施行良好,占94%(58/62)；有55篇列出具體的統(tǒng)計學方法并給出P值范圍,占89% (55/62)；在不良事件的記錄方面,僅有33篇既描述了具體癥狀、例數(shù),又進行了統(tǒng)計學檢驗,占53% (33/62)；13篇文獻追蹤患者治療后情況,占20.9%(13/62),僅有1篇對退出與失訪病例進行記錄與分析。3.納入46篇文獻進行薈萃分析,其中有17篇比較研究中藥聯(lián)合甲氨蝶呤與單用甲氨蝶呤的治療效果,共包含1656例病例,包含中藥聯(lián)合甲氨蝶呤組：847例,甲氨蝶呤單藥組：809例。有9篇研究中藥聯(lián)合米非司酮與單用米非司酮的對比效果,其中中藥聯(lián)合米非司酮組：371例,米非司酮單藥組：346例；共包含717例病例。將中藥、甲氨蝶呤、米非司酮三藥聯(lián)合與甲氨蝶呤、米非司酮兩藥聯(lián)合用藥做對比研究的有20篇,共1744例病例,其中兩藥聯(lián)合組有840例,三藥聯(lián)合組含有904例病例。4.納入研究的方法學質(zhì)量一般,質(zhì)量評分為4分的有4篇,19篇為3分,20篇為2分,3篇為1分。5.中藥聯(lián)合甲氨蝶呤的治療較單用甲氨蝶呤治療的總有效率高[RR=1.20, 95%CI (1.12,1.27)],血β-HCG轉陰所需時間短[MD=-7.10,95%CI (-10.03,-4.17)],盆腔包塊消失時間快 [MD=-7.97,95%CI (-11.68,-4.26)],復查輸卵管通暢率高[RR=1.29,95%CI (1.06,1.57)],能有效降低胃腸不適[RR=0.78,95%CI (0.65,0.94)],及口腔潰瘍的發(fā)生率[RR=0.42,95%CI (0.21,0.84)],但對白細胞的影響無明顯差異(P=-0.82)。6.中藥聯(lián)合米非司酮治療輸卵管妊娠較米非司酮單獨治療的總有效率高[RR=1.35,95%CI (1.24,1.47)],血β-HCG轉陰所需時間短[MD=-8.39, 95%CI (-10.82,-5.97)],盆腔包塊吸收時間快[MD=-21.92,95%CI(-27.30,-16.54)],輸卵管復通率高[RR=1.55,95%CI(1.12,2.16)],但關于不良反應的影響無顯著性差異(P0.05)。7.中藥聯(lián)合甲氨蝶呤、米非司酮治療輸卵管妊娠較甲氨蝶呤聯(lián)合米非司酮成功率局[RR=1.22,95%CI(1.17,1.27)],血β-HCG降低至正常時間所需時間短[MD=-5.23, 95%CI(-8.73,-1.74)],盆腔包塊消失時間快[MD=-8.42,95%CI (-15.51,-1.34)],輸卵管復通率高[RR=1.38,95%Cl(1.11,1.71)],可減少胃腸不適[RR=0.71, 95%CI (0.57,0.89)]、白細胞降低的發(fā)生[RR=0.53,95%CI (0.24,1.18)],但口腔潰瘍的影響無明顯差異(P=0.43)。8.三組研究的治療總有效率的倒漏斗圖表的特征是對稱性較差、有一定偏性,考慮可能存在發(fā)表性偏倚,或與納入文獻的研究質(zhì)量有關。研究結論：1.中西醫(yī)結合藥物結合治療輸卵管妊娠的臨床試驗質(zhì)量一般,需在試驗設計、實施及統(tǒng)計方案等方面加以改進,臨床研究者及相關部門應注重監(jiān)查試驗數(shù)據(jù)、結局的報告是否規(guī)范及有無安全性風險,以避免產(chǎn)生較大的研究偏倚風險。2.中西藥結合治療輸卵管妊娠是一種有效的治療方法,治療后復查輸卵管通暢率高,較單純西藥治療可能可提高育齡期患者的再妊娠率。3.本研究納入文獻質(zhì)量一般,存在較多偏倚,因此中西醫(yī)結合藥物治療輸卵管妊娠的療效與安全性評價仍需更多高質(zhì)量、大樣本的多中心隨機對照試驗加來驗證。
[Abstract]:Research purposes: the combination of Chinese medicine and Western medicine for treatment of fallopian tube pregnancy drug quality research objective evaluation, for the combination of Chinese and Western medicine treatment of tubal pregnancy and provide evidence of efficacy and safety of tubal pregnancy; through the combination of Chinese and Western medicine treatment and Western medicine treatment efficacy and safety in the display of Chinese medicine in the treatment of tubal pregnancy important role in. Methods: 1. PubMed, Google scholar, Cochrane retrieval Library evidence-based medicine database and Clinical trial, Chinese HowNet (Cnki), Wanfang Data, Chinese journal database (Cqvip), random controlled trials get combined with drugs in the treatment of tubal pregnancy comparative study of Chinese and Western Medicine (RCT), and searched references included in the. 2. according to the inclusion and exclusion criteria, the bibliometric study of tubal pregnancy treated with combination of Chinese and Western medicine was included in the literature. The descriptive analysis was conducted in four aspects, including general situation, diagnostic criteria, inclusion criteria and exclusion criteria, curative effect criteria and research plan. 3., we further screened the literature, included in the literature, and conducted meta-analysis to describe the PICOS (object, intervention, control, outcome and trial design) of Chinese and Western medicine in the treatment of RCT of tubal pregnancy. 4. according to the 5.0.2 Cochrane system evaluator's manual, the random methodology of the literature was objectively evaluated. 5. the software Review Manager5.3 (Revman5.3) analysis software of the system evaluation software in evidence-based medicine was used to deal with the quantitative synthesis of the included literature. Results: 1. a total of 1496 relevant documents were retrieved. According to the inclusion and exclusion criteria, a total of 62 randomized controlled studies on the combination of Western medicine and Western medicine in the treatment of tubal pregnancy were included. 2., in the literature general situation, the literature was published after 2004, and the number is basically on the rise. It is mainly published in national magazines, accounting for 60% (37/62). All cases were from the relevant hospital inpatients, no outpatients, and 62 papers were single center research. In terms of criteria in diagnosis and treatment, all cases according to the diagnostic criteria of Western medicine diagnosis, of which 31 articles with standard textbooks, accounting for 66% (33/62); the inclusion and exclusion criteria were mentioned in 58, accounting for 94% (58/62); included in the literature according to the custom standard to judge the curative effect of the 39 articles, accounting for 63% (39/62). The overall research program in the research literature quality in general, only 14 papers describe the random method, accounting for 19.3% (12/62), were not mentioned blind method, the distribution plan, without a mention of sample size estimation; 54 tested the balance between test group and control group, accounting for 87% (54/62) there are 58 articles; interventions performed well, accounting for 94% (58/62); 55 articles lists the specific statistical method and gives the value range of P, accounting for 89% (55/62); the adverse events recorded, only 33 articles describe the specific symptoms, number of cases, and conducted statistical tests, accounting for 53% (33/62); 13 articles follow patients after treatment, accounted for 20.9% (13/62), only 1 pieces of exit and lost cases were recorded and analyzed. 3. 46 articles were included in the meta analysis. 17 of them compared the efficacy of methotrexate combined with methotrexate alone, including 1656 cases, including Chinese medicine plus methotrexate group: 847 cases, methotrexate monotherapy group: 809 cases. There are 9 studies on the effect of mifepristone combined with mifepristone, including mifepristone combined with mifepristone: 371 cases, mifepristone monotherapy group: 346 cases; a total of 717 cases. A comparative study of Chinese medicine, methotrexate, mifepristone, three drugs combined with methotrexate and mifepristone combined with two drugs has made 20 comparative studies, including 1744 cases, of which two drug combination group has 840 cases, three drug combination group contains 904 cases. 4. the quality of the methodology included in the study was general, with a quality score of 4 points in 4, 19 for 3, 20 for 2, and 3 for 1. 5. treatment of traditional Chinese medicine combined with methotrexate compared with the total effective rate of methotrexate in the treatment of high [RR=1.20, 95%CI (1.12,1.27)], serum -HCG negative short time [MD=-7.10,95%CI (-10.03, -4.17)], pelvic mass disappeared time [MD=-7.97,95%CI (-11.68, -4.26)], review of tubal patency rate of [RR=1.29,95%CI (1.06,1.57)], can effectively reduce gastrointestinal discomfort ([RR=0.78,95%CI 0.65,0.94)], the incidence of [RR=0.42,95%CI and oral ulcer (0.21,0.84), but there was no significant difference in the effects of the white blood cells (P=-0.82). 6. traditional Chinese medicine combined with mifepristone in the treatment of tubal pregnancy with mifepristone treatment the total effective rate of high [RR=1.35,95%CI (1.24,1.47)], serum -HCG negative short time [MD=-8.39, 95%CI (-10.82, -5.97)], pelvic mass absorption time [MD=-21.92,95%CI (-27.30, -16.54)], fallopian tube recanalization rate of [RR=1.55,95%CI (1.12,2.16), but no significant effect on the adverse reaction (P0.05). 7. traditional Chinese medicine combined with methotrexate and mifepristone in treatment of tubal pregnancy with mifepristone combined with methotrexate (1.17,1.27), the success rate of [RR=1.22,95%CI, serum -HCG decreased to normal time required for a short time [MD=-5.23, 95%CI (-8.73, -1.74)], pelvic mass disappeared time [MD=-8.42,95%CI (-15.51, -1.34)], the recanalization rate of fallopian tube high [RR=1.38,95%Cl (1.11,1.71)], can reduce gastrointestinal discomfort and [RR=0.71, 95%CI (0.57,0.89)], leukopenia occurred in [RR=0.53,95%CI (0.24,1.18)], but no significant difference between the effects of oral ulcer (P= 0.43). 8., the funnel chart of the total effective rate of the three groups is characterized by poor symmetry and bias. Considering publication bias may be related to the quality of research included in the literature. Conclusion: the quality of clinical trials of combined treatment of tubal pregnancy with 1. drugs of traditional Chinese medicine and Western medicine in general, needs to be improved in the aspects of design, implementation and test of statistical programs, clinical researchers and relevant departments should focus on monitoring test data, the outcome of the report is standard and there is no security risk,
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R714.221

【相似文獻】

相關期刊論文 前10條

1 俞希媛;輸卵管妊娠保守治療失敗51例分析[J];現(xiàn)代中西醫(yī)結合雜志;2000年06期

2 陳羽;輸卵管絕育術后異位妊娠9例分析[J];浙江實用醫(yī)學;2000年02期

3 王震俠,劉桂玲,王淑俠;女扎術后輸卵管妊娠62例分析[J];河北醫(yī)學;2001年03期

4 張淑芝,秦莉,聶莉,羅紅,楊孟君,江麗琴;雙側輸卵管妊娠1例報告[J];交通醫(yī)學;2001年02期

5 張科榮,黃小萍,陽志寧;輸卵管妊娠的保守治療[J];川北醫(yī)學院學報;2001年04期

6 駱東招;1例輸卵管妊娠多次誤診[J];現(xiàn)代醫(yī)藥衛(wèi)生;2001年08期

7 劉輝春,邢秀云;中西醫(yī)結合保守治療輸卵管妊娠32例[J];山東醫(yī)藥;2002年18期

8 劉力華,蔣殷宗,吳琳琳;輸卵管妊娠110例分析[J];中國實用婦科與產(chǎn)科雜志;2002年09期

9 孫旭妍 ,王玉東 ,秦立紅;輸卵管妊娠后再次妊娠的中西醫(yī)治療體會[J];現(xiàn)代中西醫(yī)結合雜志;2002年08期

10 ;輸卵管妊娠 測驗題(第四套題)[J];成都醫(yī)藥;2002年02期

相關會議論文 前10條

1 肖波;阿家應;穆鳳仙;柏魏;鄧志春;張麗明;劉繼鳳;;經(jīng)陰道彩色多普勒超聲、非血管途徑介入治療輸卵管妊娠[A];慶祝中國超聲醫(yī)學工程學會成立20周年——第八屆全國超聲醫(yī)學學術會議論文匯編[C];2004年

2 葉敦敏;鄧高丕;郜潔;;輸卵管妊娠的研究新進展和新思路[A];全國中醫(yī)婦科第七次學術研討會論文匯編[C];2007年

3 田秀娟;程桂萍;;輸卵管妊娠77例分析[A];中華醫(yī)學會全國第五次急診醫(yī)學學術會議論文集[C];1994年

4 廖麗金;林碧珠;;輸卵管妊娠102例臨床分析[A];紀念卓越的人民醫(yī)學家林巧稚大夫誕辰100周年——全國婦產(chǎn)科高級學術論壇論文集[C];2001年

5 鄧高丕;;輸卵管妊娠的中西醫(yī)診斷與治療策略[A];全國第六屆中西醫(yī)結合婦產(chǎn)科學術會議論文及摘要集[C];2002年

6 姚雪蓉;張保柳;;輸卵管妊娠的中西醫(yī)治療[A];全國第六屆中西醫(yī)結合婦產(chǎn)科學術會議論文及摘要集[C];2002年

7 閆鳳琴;耿梅;楊漪;孫霞;;輸卵管妊娠的超聲表現(xiàn)與腹腔鏡治療的探討[A];慶祝中國超聲醫(yī)學工程學會成立20周年——第八屆全國超聲醫(yī)學學術會議論文匯編[C];2004年

8 關錚;范文生;李亞里;;輸卵管妊娠手術中評分的臨床意義[A];第八次全國婦產(chǎn)科學學術會議論文匯編[C];2004年

9 牛樹穎;;高滲糖治療輸卵管妊娠12例分析[A];第八次全國婦產(chǎn)科學學術會議論文匯編[C];2004年

10 關錚;李亞里;李立安;;輸卵管妊娠治療方法探討[A];第八次全國婦產(chǎn)科學學術會議論文匯編[C];2004年

相關重要報紙文章 前10條

1 廣州中醫(yī)藥大學 宋陽;鄧高丕創(chuàng)新 輸卵管妊娠辨證分型體系[N];中國中醫(yī)藥報;2010年

2 馬艷紅;輸卵管妊娠保守治療成功率高但風險不可忽視[N];中國醫(yī)藥報;2007年

3 江西醫(yī)學院一附院 主任醫(yī)師 余艷萍;輸卵管狹窄是怎么回事[N];家庭醫(yī)生報;2003年

4 湘雅醫(yī)院婦產(chǎn)科 李小葉;輸卵管妊娠的保守治療[N];大眾衛(wèi)生報;2002年

5 王前 劉冬娥 崢崢;輸卵管妊娠的十大原因[N];大眾衛(wèi)生報;2002年

6 鄧高丕；何虹;穗找出輸卵管妊娠患者辨治規(guī)律[N];中國醫(yī)藥報;2004年

7 本報記者 王敬霞;子宮外寶寶不該呆的地方[N];保健時報;2004年

8 劉正英;宮外孕：誘因與防治[N];醫(yī)藥經(jīng)濟報;2002年

9 江波;宮外孕治療一瞥[N];大眾衛(wèi)生報;2001年

10 包海平;輸卵管妊娠誤診[N];農(nóng)村醫(yī)藥報（漢）;2006年

相關博士學位論文 前8條

1 李曉榮;化瘀消ve殺胚中藥誘導輸卵管妊娠滋養(yǎng)細胞凋亡的分子機制及臨床研究[D];廣州中醫(yī)藥大學;2014年

2 宋陽;輸卵管妊娠的早期診斷及中西醫(yī)結合治療方案研究[D];廣州中醫(yī)藥大學;2010年

3 季銀芬;輸卵管妊娠母胎界面著床相關因子表達的研究[D];浙江大學;2007年

4 胡春秀;輸卵管妊娠患者的輸卵管超微結構與功能改變的研究[D];天津醫(yī)科大學;2014年

5 楊筱yN;酪氨酸激酶受體EphA2在輸卵管妊娠組織中表達的研究[D];暨南大學;2010年

6 袁爍;化瘀消ve殺胚法對輸卵管妊娠影響的臨床與實驗研究[D];廣州中醫(yī)藥大學;2011年

7 張純;1α，25-二羥維生素D_3對人輸卵管上皮細胞calbindin-D28k表達調(diào)控的研究[D];暨南大學;2009年

8 許多;鈣結合蛋白Calbindin-d28k在女性生殖系統(tǒng)表達與變化的研究[D];暨南大學;2006年

相關碩士學位論文 前10條

1 王愛宏;輸卵管壺腹部妊娠具體植入位置的臨床研究[D];泰山醫(yī)學院;2014年

2 楊麗妙;淋巴細胞浸潤在輸卵管妊娠發(fā)生中的可能作用[D];河北醫(yī)科大學;2015年

3 董萌萌;腹腔鏡下輸卵管妊娠不同手術方式對卵巢功能影響的Meta分析[D];廣西醫(yī)科大學;2016年

4 姚君伊;中西醫(yī)結合藥物治療輸卵管妊娠的Meta-分析[D];廣州中醫(yī)藥大學;2016年

5 黎玲;輸卵管妊娠不同保守方案治療后生育結局的比較[D];廣州中醫(yī)藥大學;2016年

6 陳英杰;中藥聯(lián)合RU486、MTX對輸卵管妊娠治療后輸卵管復通作用的Meta分析[D];廣州中醫(yī)藥大學;2016年

7 王慧玲;腫瘤壞死因子-α與基質(zhì)金屬蛋白酶-9在輸卵管粘膜上皮的表達及與輸卵管妊娠的關系[D];蘇州大學;2010年

8 王萌;輸卵管妊娠的治療及治療后生育結局的分析[D];中國協(xié)和醫(yī)科大學;2007年

9 鄧敏君;輸卵管妊娠的早期診斷和中西醫(yī)結合治療的轉歸：經(jīng)陰道彩色多普勒超聲檢查的價值[D];廣州中醫(yī)藥大學;2008年

10 陳濤;鄧高丕教授關于輸卵管妊娠基礎研究的總結與創(chuàng)新[D];廣州中醫(yī)藥大學;2015年

，

本文編號：1342926