Efficacy Of raum-tonifying Traditional Chinese Medicine Prescriptions in Hypoplastic Uterus Treatment
Mar 05, 2022
Hu rau: emily.li@wecistanche.com
Kev ua tau zoo ntawm lub raum-tonifying tsoos suav tshuaj tshuaj hauv kev kho mob uterus hypoplastic: Kev tshuaj xyuas thiab kev tshuaj xyuas meta
Xichuang Chen1ua al.
Abstract
Hom phiaj:Txhawm rau tshuaj xyuas thiab ntsuas qhov ua tau zoo ntawmraum tonifyingCov tshuaj suav tshuaj suav tshuaj (KT-TCMP) hauv hypoplastic uterus (HU) kho.
Txoj kev:Peb tau tshawb nrhiav MEDLINE, Cochrane Library, CNKI (Tuam Tshoj National Knowledge Infrastructure), WAN FANG, thiab VIP databases txog 14 Kaum Ob Hlis 2013 ntawm nws tus kheej nrog ob tus neeg tshawb xyuas. Randomized controlled trials (RCT) uas koom nrog KT-TCMP raws li kev sib koom ua ke lossis kev kho mob monotherapy hauv kev kho mob ntawm HU raug tshuaj xyuas thiab tshuaj xyuas. Meta-analysis tau ua los ntawm Tus Thawj Saib Xyuas Kev Ntsuam Xyuas (version 5.2). Cov txiaj ntsig: cuaj RCT ntawm 1745 tus neeg mob tau tsim nyog rau qhov kev tshuaj xyuas no thiab kev tshuaj ntsuam xyuas meta, ntawm uas yim RCT tau piav qhia thawj qhov txiaj ntsig ntawm kev kho mob thiab peb RCTs tau txais txiaj ntsig thib ob ntawm lub tsev menyuam loj. Meta-analyzed 'rov qab' kev soj ntsuam kev ua tau zoo ntawm KT-TCMP nyob rau hauv xya RCT tau ua uas suav tias yog kev kho diethylstilbestrol ib leeg raws li kev tswj hwm, nrog rau peb RCT uas tau txheeb xyuas cov txiaj ntsig ntawm KT-TCMP ntawm lub uterine txoj kab uas hla. Raws li qhov tshwm sim, KT-TCMP txoj kev kho tau muaj qhov sib txawv ntawm qhov nce 'rov qab' kev kho mob ua tau zoo (kev pheej hmoo piv, 2.34; 95 feem pua ntawm kev ntseeg siab [CI], 1.90–2.89) thiab ua kom lub uterine txoj kab uas hla (tus qauv sib txawv, 1.62; 95% CI, 1.39–1.84). Ib txoj kev tshawb fawb tau tshaj tawm cov kev tsis zoo uas yog qhov txiaj ntsig tseem ceeb thiab pom tias nws muaj kev nyab xeeb thaum kho KT-TCMP.
Xaus:Kev kho mob ntawm kev siv KT-TCMP ua ke los yog monotherapy hauv kev kho mob ntawm HU yuav ua tau zoo dua. Txawm li cas los xij, RCT no yog cov txheej txheem kev ua tau zoo thiab cov qauv me me; Yog li, cov txiaj ntsig yuav tsum tau lees paub nrog kev tswj hwm nruj dua ntxiv kev tshawb fawb.
Ntsiab lus:tshuaj ntsuab, hypoplastic uterus, infantile uterus,raum tonifyingCov tshuaj suav tshuaj suav tshuaj, tshuaj ntsuam xyuas, tshuaj xyuas.
Cistanche tuaj yeem tonify raum
Taw qhia
Los ntawm kev xav ntawm Western tshuaj, lub tsev menyuam hypoplastic (HU, tseem hu ua lub tsev menyuam mos) feem ntau suav hais tias yog ib qho teeb meem tsis tshua muaj tshwm sim los ntawm disruption ntawm txoj kev loj hlob ntawm Müllerian duct.1 Qhov no anomaly yog ib feem ntawm lub spectrum ntawm Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS), thiab sawv cev rau cov mob hnyav tshaj plaws ntawm Müllerian anomalies.2 Cov neeg mob feem ntau tsis muaj phenotypic txawv txav thaum yug los,thaum feem ntau tshwm sim nrog thawj amenorrhea thaum cev xeeb tub hauv lub tsev kho mob, 3 lossis tuaj yeem tshwm sim thaum lub cev xeeb tub nrog lub tsev menyuam thaiv lossis tom qab lub neej yog tias muaj kev tshawb nrhiav txog kev xeeb tub lossis nchuav menyuam.4 Raws li cov poj niam no yuav ntsib teeb meem hauv kev xeeb menyuam, 5 qhov kev kuaj mob tuaj yeem tshwm sim. mob lub siab thiab/los yog muaj kev hloov lub neej.
Hauv cov tshuaj Western cov tshuaj, feem ntau ntawm cov neeg mob no yuav tsum tau noj tshuaj hormonal tsis tu ncua raws li HU feem ntau cuam tshuam nrog kev ua haujlwm hormonal. Ntawm qhov tod tes, tus neeg mob tuaj yeem kho qhov phais yog tias nws sawv cev rau kev ua haujlwm tsim nyog thiab tsis muaj kev ua haujlwm contraindication. Feem ntau, ib qho khoom siv hauv tsev menyuam yuav raug siv rau hauv cov neeg mob no kom maj mam txhawb txoj kev loj hlob ntawm lub tsev menyuam, lossis lwm yam kev kho mob tau ua. Txawm li cas los xij, kev siv tshuaj kho mob ntawm cov txheej txheem no yog qhov tsis xav tau thiab tej zaum yuav ua rau muaj kev phom sij loj yog tias lub tsev menyuam raug mob perforated thaum lub sijhawm ua haujlwm.6,7 Ntxiv rau, lwm txoj kev pabcuam hu ua hysteroscopic metroplasty tau ua tiav rau qee cov neeg mob, thaum nws yog. tseem muaj kev pheej hmoo siab ua haujlwm uas tus neeg mob yuav muaj kev cia siab tsawg dua los ntawm yog tias nws ua tsis tiav.8,9 Hauv Suav teb, HU yog nyob rau hauv spectrum ntawmraumKev tsis txaus raws li txoj kev xav ntawm cov tshuaj suav tshuaj (TCM).10 Tsuas yog cov kev kho mob sab hnub poob, muaj lwm txoj hauv kev sivraum tonifyingTCM cov tshuaj (KTTCMP) rau kev kho mob hauv Suav teb, uas tau ua tiav cov txiaj ntsig tseem ceeb hauv cov neeg ib txwm muaj.10 Tu siab heev, txawm li cas los xij, tseem tsis tau muaj kev soj ntsuam loj hauv kev kawm thiab lees paub nws cov txiaj ntsig ntxiv. Yog li ntawd, peb tau ua ib qho kev tshuaj xyuas thiab metanalysis ntawm randomized tswj kev sim (RCT) los ntsuas qhov ua tau zoo ntawm KT-TCMP raws li kev sib xyaw lossis monotherapy hauv kev kho mob ntawm HU txhawm rau muab cov ntaub ntawv tseem ceeb los nthuav peb cov kev paub tam sim no thiab nthuav tawm cov kev tshawb fawb tshiab.
Cov txheej txheem
Nrhiav tswv yim
Cov kev tshawb fawb tau tshawb xyuas los ntawm ob tus neeg tshawb xyuas tshawb xyuas cov ntaub ntawv hluav taws xob hauv qab no ntawm nws tus kheej (XCC, YH), ntxiv los ntawm kev txheeb xyuas cov npe ntawm cov ntaub ntawv tseem ceeb thiab cov ntim ntawm kev paub daws teeb meem ntawm cov rooj sib tham: PubMed / MEDLINE, Cochrane Library, thiab tshwj xeeb tshaj yog cov ntaub ntawv nyob hauv Suav teb. ntawm CNKI (China National Knowledge Infrastructure), WAN FANG thiab VIP tau siv los tshawb xyuas txog 25 Lub Peb Hlis 2013. Cov tswv yim tshawb fawb yog: 'hypoplastic uterus' LOSSIS 'uterine dysplasia' OR 'hypoplasia ntawm uterus' LOSSIS 'infantile uterus' hauv lub npe / abstract yam khoom rau kev tshawb nrhiav cov ntaub ntawv ntawm PubMed / MEDLINE thiab Cochrane Library, thaum cov ntawv sau tag nrho tau siv rau kev tshawb nrhiav cov ntaub ntawv hauv Suav teb. Tsis muaj kev txwv kev hais lus. Cov ntaub ntawv tau hloov kho rau 14 Kaum Ob Hlis 2013.
Kev xaiv cov kev kawm
Cov kev tshawb fawb muaj feem cuam tshuam tau raug soj ntsuam ntawm tus kheej los ntawm ob tus neeg tshuaj xyuas (XCC thiab YH). Cov kws tshuaj ntsuam xyuas tag nrho cov npe thiab cov lus piav qhia thaum muaj thiab lawv tau tshuaj xyuas tag nrho cov ntawv nyeem thiab pom tias nws tsim nyog yog tias qhov kev tshawb fawb luam tawm tau ua raws li cov hauv qab no: (i) yog RCT; (ii) suav nrog cov neeg koom nrog kuaj mob HU nkaus xwb tsis muaj lwm yam kab mob loj; (iii) siv KT-TCMP ua ke los yog monotherapy hauv kev sim kho HU; (iv) tsis suav nrog kev txwv ntawm haiv neeg lossis haiv neeg uas muaj hnub nyoog nruab nrab ntawm 19–35 xyoo; thiab (v) thawj qhov tshwm sim yog kev kho mob tau zoo thiab qhov thib ob yog uterine txoj kab uas hla. Txawm li cas los xij, cov kev tshawb fawb nrog cov qauv hauv qab no tau raug cais tawm: (i) yog kev tshuaj xyuas ua haujlwm luam tawm, luam tawm lossis cov ntaub ntawv rov qab (thaum ob lossis ntau tshaj tawm cov ntaub ntawv tshaj tawm cov ntaub ntawv los ntawm tib cov neeg kawm, peb tsuas yog khaws cov ncauj lus kom ntxaws tshaj plaws thiab / lossis ntau dua. tshaj tawm tsis ntev los no); (ii) suav nrog cov txheej txheem tsis zoo lossis cov ntaub ntawv tsis tiav; thiab (iii) cov neeg koom nrog tsawg dua 15 hauv ob pawg.
Cov ntaub ntawv txheeb xyuas
Ob tus kws sau ntawv (XCC, YH) nws tus kheej tau tshuaj xyuas tag nrho cov kev tshawb fawb uas ua tau raws li peb cov txheej txheem suav nrog, uas tau coj los ntawm Cochrane Phau Ntawv Qhia rau Kev Ntsuam Xyuas Txheej Txheem thiab PRISMA nqe lus.11,12Kev tsis pom zoo thaum kawg tau daws los ntawm kev sib tham nrog tus kws sau thib peb (JHF). Cov lus qhia dav dav ntawm cov kev tshawb fawb (xws li tus sau thiab xyoo ntawm kev tshaj tawm), cov ntaub ntawv qhia meej ntawm cov neeg mob (xws li tus qauv loj, hnub nyoog, haiv neeg, kab mob, thiab keeb kwm kho mob), thiab cov ntaub ntawv ntawm cov txiaj ntsig tau tshaj tawm (xws li kev kho mob, qhov feem ntawm uterine cev thiab ncauj tsev menyuam, uterine loj, qhov tseem ceeb ntawm kev sib deev hormone, basal lub cev kub, thiab cov tshuaj tiv thaiv tsis zoo) tau muab rho tawm los ntawm cov kev sim.
Cov kev kawm zoo
Cov txheej txheem zoo ntawm cov kev sim siab tau raug soj ntsuam raws li tau hais tseg hauv Cochrane Phau Ntawv Qhia ntawm thaj chaw hauv qab no: kev tsim ua ntu zus, kev faib zais cia, qhov muag tsis pom kev ntawm cov neeg koom thiab cov neeg ua haujlwm, qhov muag tsis pom ntawm qhov kev ntsuam xyuas qhov tshwm sim, cov ntaub ntawv tsis tiav, thiab cov lus qhia xaiv cov txiaj ntsig tau muab cais ua qhov pheej hmoo tsawg. , muaj kev pheej hmoo siab lossis tsis meej qhov kev pheej hmoo ntawm kev tsis ncaj ncees rau txhua yam khoom.11Ob tus kws sau ntawv (PPZ thiab JLY) tau koom nrog nws tus kheej hauv kev ntsuam xyuas zoo. Txhua qhov tsis sib xws tau raug daws los ntawm kev pom zoo nrog tus sau thib peb (XYZ).
Kev txheeb cais
Cov ntaub ntawv pov thawj tau txheeb xyuas los ntawm kev siv Tus Thawj Saib Xyuas Kev Ntsuam Xyuas version 5.2 (lub Nordic Cochrane Center, Copenhagen, Denmark). Risk ratio (RR; Mantel–Haenszel), standardized mean sib txawv (SMD; inverse variance), thiab lawv 95 feem pua kev ntseeg siab nyob rau hauv (95 feem pua CI) tau xam rau dichotomous los yog nruam cov ntaub ntawv feem. Kev txheeb xyuas heterogeneity ntawm qhov kev sim tau raug soj ntsuam los ntawm kev siv I2-test nrog rau χ2-test.11 Ib qho I2 tus nqi ntau dua 50 feem pua yog suav tias yog heterogeneity ntau. Tus qauv ruaj-effect tau siv nyob rau hauv rooj plaub uas tsis muaj feem cuam tshuam txog kev txheeb cais, thaum tus qauv siv cov nyhuv random siv oppositely. Qhov tseem ceeb tau xav tias yog 95 feem pua CI tsis suav nrog tus nqi 1.0 rau RR lossis xoom rau SMD. Egger's precision weighted linear regression tests thiab Begg's funnel plots are used to test potentially publication bias by using Stata/SE version 12.0 (Stata Corp, College Station, Texas, USA).13
Cov txiaj ntsig
Kawm kev xaiv thiab cov yam ntxwv
Cov ntaub ntawv tshawb fawb tau ua tiav 2443 cov kev tshawb fawb, ntawm 102 cov ntaub ntawv tau los ntawm PubMed thiab Cochrane Library. Ntawm cov ntaub ntawv no, 73 yog lus Askiv thiab tus so yog cov lus tsis yog lus Askiv (xws li Japanese, Polish thiab Fab Kis), thaum txhua tus ntawm cov ntawv no muaj lub npe Askiv thiab / lossis lus Askiv uas peb tuaj yeem yooj yim tshem tawm ntawm cov kev tshawb fawb no los ntawm cov txheej txheem suav nrog. Ntawm qhov tod tes, muaj 2341 cov ntaub ntawv los ntawm Suav cov ntaub ntawv lub sijhawm nyob rau hauv tag nrho, ntawm 40 cov ntaub ntawv raug tshuaj xyuas tag nrho tom qab tshuaj xyuas tag nrho cov npe thiab cov lus piav qhia thaum muaj (Fig. 1). Thaum kawg, cuaj txoj kev tshawb fawb uas ua tiav cov txheej txheem tau suav nrog hauv peb qhov kev tshuaj xyuas, thiab yim ntawm lawv rau kev tshuaj ntsuam meta, suav nrog cov ntaub ntawv rau 1745 tus neeg koom nrog tag nrho.14–22Cov txheej txheem ntawm kev kawm xaiv tau pom nyob rau hauv daim ntawv qhia ntws (Fig. 1), thiab cov yam ntxwv ntawm kev kawm tau teev nyob rau hauv Cov Lus 1 thiab 2. Tag nrho cov kev tshawb fawb tau RCT luam tawm los ntawm 1997 txog 2011 nrog cov hauv paus zoo sib xws thiab muaj yim txoj kev tshawb fawb ntawm KT. -TCMP kev kho mob (KT-TCMT) nrog15,21 los yog tsis muaj14,16–19,22Diethylstilbestrol (DES) kev kho mob hauv pab pawg kho mob piv rau tib txoj kev kho mob DES hauv pawg tswj hwm thiab ib qho kev tshawb fawb23ntawm KT-TCMT thiab cov pa Western tshuaj kho (CWMT; piv txwv li kev tswj hwm tshuaj hormones, kev kho kev ua haujlwm, thiab kev tso cov khoom siv hauv lub cev) hauv pab pawg kho mob piv rau tib txoj cai ntawm CWMT hauv pawg tswj hwm. Tus qauv loj yog nyob rau hauv thaj tsam ntawm 64-730, thiab tag nrho cov neeg koom nrog tau kuaj pom nrog HU thiab tag nrho yog Suav. Cov txiaj ntsig tau tshaj tawm muaj yim qhov kev tshawb fawb txog kev kho mob tau zoo,14–21peb txoj kev tshawb fawb ntawm uterine loj,14,15,19ib qho kev tshawb fawb txog kev phiv tshuaj thiab kev faib ua feem ntawm lub tsev menyuam lub cev thiab lub tsev menyuam,14thiab lwm txoj kev tshawb fawb txog qhov tseem ceeb ntawm kev sib deev hormone thiab basal lub cev kub (Table 1).18Tsis tas li ntawd, cov ntsiab lus ntawm KT-TCMP hauv txhua qhov kev kawm suav nrog tau teev nyob rau hauv Table 3.
Kev soj ntsuam zoo
Ntawm cov cuaj RCT no, peb muaj kev pheej hmoo tsawg rau kev tsis ncaj ncees rau kev faib ua ntu zus, thaum cov kev tshawb fawb ntxiv tsis tau tshaj tawm lawv txoj kev randomization kom meej. Tsis tas li ntawd, tsis muaj ib qho ntawm cov kev tshawb fawb tau qhia txog kev siv kev faib zais zais thiab qhov muag tsis pom. Txawm li cas los xij, peb suav hais tias qhov kev pheej hmoo ntawm kev tsis ncaj ncees cuam tshuam nrog qhov tsis muaj qhov muag tsis pom thiab kev faib zais zais kom tsawg, vim tias cov txiaj ntsig tseem ceeb ntawm lub hom phiaj. Tsis tas li ntawd, tag nrho cov kev tshawb fawb muaj kev pheej hmoo tsawg ntawm kev tsis ncaj ncees nyob rau hauv cov khoom ntawm kev xaiv cov txiaj ntsig tau tshaj tawm thiab cov ntaub ntawv tsis tiav, tshwj tsis yog tias ib qho kev tshawb fawb 15 muaj kev pheej hmoo siab ntawm kev tsis ncaj ncees hauv cov khoom ntawm cov ntaub ntawv tsis tiav cov ntaub ntawv poob ntawm cov lus piav qhia txog kev faib ua feem ntawm lub tsev menyuam lub cev thiab ncauj tsev menyuam hauv kab lus. Hauv cov ntsiab lus, peb suav hais tias tag nrho cov kev pheej hmoo ntawm kev tsis ncaj ncees ntawm peb cov kev tshawb fawb suav nrog yuav tsum nyob nruab nrab (Table 4).
Cov txiaj ntsig ntsuas
Categorization ntawm kev kho mob ua tau zoo
Kev ua tau zoo ntawm kev kho mob yog qhov txiaj ntsig tseem ceeb tau soj ntsuam hauv yuav luag txhua qhov kev kawm suav nrog hauv qhov kev tshuaj xyuas no. Raws li pom nyob rau hauv Table 5, yim txoj kev tshawb fawb tau qhia txog qhov tshwm sim ntawm kev kho mob ua tau zoo, ntawm uas ib txoj kev tshawb fawb tau muab faib ua cov txiaj ntsig ntawm kev kho mob rau ob yam (rov qab thiab tsis muaj peev xwm),14 plaub qhov kev tshawb fawb ua peb yam (rov qab, ua tau zoo / kev txhim kho, thiab tsis muaj peev xwm),18–21 thiab lwm yam peb txoj kev tshawb fawb ua plaub yam (rov qab, kev ua tau zoo, kev txhim kho, thiab kev ua tsis tau zoo).15–17 Txawm hais tias cov txheej txheem tsis zoo ib yam hauv tib yam khoom ntawmCov txiaj ntsig tau ntsuas Categorization ntawm kev soj ntsuam kev ua tau zoo yog qhov txiaj ntsig tseem ceeb tau soj ntsuam hauv yuav luag txhua qhov kev kawm suav nrog hauv qhov kev tshuaj xyuas no. Raws li pom nyob rau hauv Table 5, yim txoj kev tshawb fawb qhia txog qhov tshwm sim ntawm kev kho mob ua tau zoo, ntawm uas ib txoj kev tshawb no pab pawg neeg cov txiaj ntsig ntawm kev kho mob rau hauv ob nqe lus (rov qab thiab inefficiency),14plaub qhov kev tshawb fawb ua peb yam (rov qab, ua tau zoo / kev txhim kho, thiab tsis muaj peev xwm),18–21thiab lwm yam peb txoj kev tshawb fawb ua plaub yam (rov qab, kev ua tau zoo, kev txhim kho, thiab kev ua tsis tau zoo).15–17Txawm hais tias cov txheej txheem tsis zoo ib yam hauv tib yam khoom ntawm categorization nyob rau hauv txhua tus neeg txoj kev tshawb fawb raws li teev nyob rau hauv Table 5. Los ntawm cov khoom ntawm 'rov qab', peb tuaj yeem pom tias qhov ntsuas ntawm cev xeeb tub lossis qhov loj ntawm lub tsev menyuam rov qab los yog qhov ntsuas. ntawm 'rov qab' cov txheej txheem hauv xya qhov kev tshawb fawb,14–19,21 thaum ib qho piv txwv loj heev (730 tus neeg koom nrog) tau txiav txim siab qhov ua tau zoo ntawm kev xeeb tub thiab xa cov menyuam mos noj qab haus huv thaum kawg ua lub hom phiaj, uas yog qhov nyuaj dua los ua kom tau raws li.20
'Rov qab' kev kho mob ntawm KT-TCMT hauv HU kho
Raws li peb paub, 'rov qab' kev kho mob ua tau zoo muaj qhov tseem ceeb ntawm kev kho mob ntau dua li lwm pawg. Muaj xya qhov kev tshawb fawb (xws li 987 tus neeg mob)14–19,21 uas ua raws li cov txheej txheem zoo sib xws ntawm 'rov qab' kev ua tau zoo raws li teev nyob rau hauv Table 5 thiab, lub sijhawm no, lawv cov kev kho mob hauv ob pawg tau zoo sib xws (KT-TCMT nrog lossis tsis muaj DES kev kho mob hauv pab pawg kho mob vs tib txoj kev kho DES hauv kev tswj hwm. pab pawg). Yog li, peb tau tsim ib qho kev tshuaj ntsuam xyuas txog qhov 'rov qab' kev ua tau zoo ntawm KT-TCMT nrog lossis tsis muaj DES piv rau DES txoj kev kho ib leeg hauv kev kho cov menyuam mos hauv tsev menyuam (Daim duab 2). Raws li qhov tshwm sim, tsis muaj kev txheeb xyuas qhov sib txawv ntawm cov kev tshawb fawb no (P=0.66, I2=0} feem pua), yog li peb tau siv tus qauv tsim kho rau kev tshuaj ntsuam meta. Daim duab 2 qhia txog RR ntawm 2.34 (95 feem pua CI, 1.90–2.89) thiab P <0.01 los="" ntawm="" z-test;="" yog="" li,="" kev="" tswj="" hwm="" ntawm="" kt-tcmp="" hauv="" kev="" kho="" mob="" ntawm="" hu="" tau="" txhim="" kho="" qhov="" sib="" txawv="" ntawm="" kev="" tswj="" hwm.="" tsis="" tas="" li="" ntawd,="" txoj="" kev="" tshawb="" fawb="" los="" ntawm="" qi="" et="" al.="" (730="" tus="" neeg="" koom="" nrog="" rau="" npe)20="" piv="" kt-tcmt="" nrog="" cwmt="" (xws="" li="" kev="" tswj="" hwm="" tshuaj="" hormone,="" tso="" cov="" khoom="" siv="" hauv="" lub="" cev="" lossis="" kev="" ua="" haujlwm)="" piv="" rau="" tib="" txoj="" kev="" tswj="" hwm="" ntawm="" cwmt;="" tus="" nqi="" ntawm="" 'rov="" qab'="" thiab="" 'tsis="" ua="" haujlwm'="" yog="" 72.02="" feem="" pua="" thiab="" 8.93="" feem="" pua="" hauv="" kt-tcmt="" nrog="" cwmt="" pawg,="" feem,="" thiab="" 31.97="" feem="" pua="" thiab="" 51.02="" feem="" pua="" hauv="" cwmt="" ib="" leeg,="" raws="" li="" (table="" 6).="" yog="" li,="" peb="" tseem="" yuav="" xaus="" lus="" tias="" kev="" kho="" mob="" ntxiv="" ntawm="" kt-tcmp="" rau="" cwmt="" tuaj="" yeem="" txhim="" kho="" cov="" nyhuv="" curative="" hauv="" hu="">
Qhov cuam tshuam ntawm KT-TCMP ntawm lub uterine txoj kab uas hla o
Qhov thib ob tshwm sim yog uterine txoj kab uas hla. Muaj peb txoj kev tshawb fawb uas tau piav qhia txog qhov loj ntawm lub tsev menyuam raws li qhov tshwm sim, ntawm qhov kev tshawb fawb qhia txog tus nqi ntawm qhov nruab nrab txoj kab uas hla ntawm lub tsev menyuam ua ntej kev kho mob thiab tom qab ob chav kawm sib law liag hauv ob pawg ncaj qha;22thaum lwm qhov ob txoj kev tshawb fawb qhia txog thaj chaw uterine17thiab loj,18raws li; Yog li, peb hloov cov ntaub ntawv no rau hauv tus nqi ntawm qhov nruab nrab txoj kab uas hla ntawm lub tsev menyuam. Tom ntej no, peb xam qhov txawv nruab nrab ntawm lub tsev menyuam ua ntej thiab tom qab kev kho mob hauv ob pawg thiab tsim ib qho kev ntsuam xyuas meta (Daim duab 3). Kev kuaj heterogeneity pom P=0.15 thiab kuv2=47 feem pua uas peb tau siv tus qauv tsim los ntsuas. Raws li qhov tshwm sim, pawg KT-TCMT tau txhim kho qhov tseem ceeb hauv kev nthuav dav txoj kab uas hla ntawm lub tsev menyuam tiv thaiv kev tswj hwm (SMD=1}.62 [95 feem pua CI, 1.39–1.84], Z=13.99 [P <>
Kev nyab xeeb ntawm KT-TCMP hauv HU kho
Tsuas yog ib txoj kev tshawb fawb tau tshaj tawm cov tshuaj tiv thaiv tsis zoo raws li qhov txiaj ntsig tseem ceeb hauv kev kho mob ntawm HU hauv ob pawg.14 Nws tau pom tias kwv yees li 11.65 feem pua ntawm cov neeg mob hauv pawg tswj kev kho DES tau muaj kev cuam tshuam ntawm plab hnyuv xws lialexithymia,thaum cov neeg mob hauv pab pawg KT-TCMT tsis muaj qhov cuam tshuam tsis zoo.
Kev tshaj tawm tsis ncaj ncees
Kev soj ntsuam pom los ntawm Begg's funnel plot thiab ntau qhov kev ntsuam xyuas los ntawm Egger's test (P=0.599) tsis tau nthuav tawm ib qho pov thawj ntawm kev tshaj tawm tseem ceeb ntawm cov kev tshawb fawb uas suav nrog cov txiaj ntsig ntawm kev kho mob (Daim duab 4).
Kev sib tham
Rau peb txoj kev paub, cov ntawv sau no tau tshuaj xyuas qhov ua tau zoo ntawm kev kho mob ntawm KT-TCMP raws li kev sib xyaw lossis monotherapy rau HU kev kho mob ntxov. Qhov kev tshuaj xyuas no tau sau cuaj RCT ntawm 1745 tus neeg mob (Daim duab 1) thiab cov txiaj ntsig sib xyaw ua ke qhia tias KT-TCMP tau muaj qhov sib txawv tseem ceeb hauv kev ua kom cov kev kho mob zoo ntawm 'rov qab' (Daim duab 2) thiab nthuav dav uterine txoj kab uas hla (Fig. 3. ).
Raws li peb paub, cov poj niam physiologically coj khaub ncaws thiab cev xeeb tub, thiab ob complex physiological txheej txheem nyob rau hauv uas Tiangui, ib yam ntawm refined khoom noj khoom haus hloov los ntawm.raum essence,ua lub luag haujlwm tseem ceeb tshaj plaws.23Yog li ntawd, ob lub raum tswj kev yug me nyuam tseem ceeb hauv txoj kev xav ntawm TCM.24Raws li tau piav qhia hauv Table 3, cov khoom xyaw tseem ceeb ntawm TCM cov tshuaj hauv txhua qhov kev kawm suav nrograum tonifyingthiab txhawb cov ntshav cov tshuaj xws li Radix Rehmanniae Preparata (Shudihuang), Radix Angelicae Sinensis (Danggui), thiab Rhizoma Chuanxiong (Chuanxiong), thiab cov tshuaj ntsuab ntxiv tau npaj los soothe siab thiab tswj Qi xws li Rhizoma Cyperi (Xiangfu), txhawb cov ntshav. Kev tshem tawm cov ntshav stasis xws li Flos Carthami (Honghua), los yog ntxiv dag zog rau tus po thiab tshem tawm dampness xws li Poria (Fuling) thiaj li tsim kom muaj kev sib haum xeeb raws li txoj kev xav ntawm TCM.25
Cov kev tshawb fawb pharmacological tsis ntev los no ntawm TCM tau qhia tiasraum tonifyingtshuaj ntsuab tau qhia txog kev ua haujlwm zoo li cov tshuaj hormones,26uas tuaj yeem tswj cov lus tawm tswv yim ntawm hypothalamus-pituitary-sexual gland axis nrog nce cov ntsiab lus ntawm follicle-stimulating hormone, luteinizing hormone, thiab estradiol (E2) hauv cov ntshav ntshav thiab nce qhov hnyav ntub ntawm zes qe menyuam nrog qhov sib txawv ntawm cov poj niam laus.27Lwm daim ntawv tshaj tawm tau piav qhia txog kev txhim kho kev sib deev-hormone ntawm E2 tom qab thovraum tonifyingtshuaj ntsuab tiv thaiv kev tswj hauv cov poj niam cov neeg mob.18Tsis tas li ntawd, nws tau tshaj tawm tias muaj qhov pom tseeb ua haujlwm ntawmraum tonifyingtshuaj ntsuab ntawm kev txhim kho ovulation thiab cev xeeb tub tus nqi thaum ua ke nrog clomiphene citrate nyob rau hauv kev kho mob infertility piv nrog rau cov neeg mob noj clomiphene citrate ib leeg.28Nws yuav yog tias nws txhim kho kev qhia ntawm cathepsin-L protein,29 uas plays lub luag haujlwm tseem ceeb hauv cov txheej txheem ovulation.30Txawm li cas los xij, cov txheej txheem tseeb ntawm KT-TCMP hauv HU kev kho mob tseem tsis tau meej thiab tsis pom qhov kev txiav txim siab pom zoo. Hauv txoj kev tshawb fawb tam sim no, kev kho mob tau zoo ntawm KT-TCMP hauv HU kev kho mob tau lees paub (Fig. 2, Table 6). Daim ntawv tshuaj ntawm TCM feem ntau yog kev sib xyaw ntawm 'tus tswv' tshuaj ntsuab (rau cov kab mob tseem ceeb lossis cov tsos mob), 'tus kws pab tswv yim' tshuaj ntsuab (rau kev txhawb nqa 'tus tswv' thiab kho cov tsos mob nrog), 'tub rog' tshuaj ntsuab (rau kev txhim kho cov teebmeem kev kho mob thiab kev hloov kho. cov teebmeem tsis zoo ntawm 'tus tswv' thiab 'tus kws tshaj lij' tshuaj ntsuab thiab rov ua kom lub cev ua ntej kev mob sib npaug) thiab 'qhia' tshuaj ntsuab (rau kev coj ua cov khoom siv ntawm lwm cov tshuaj ntsuab rau cov meridian tshwj xeeb thiab kev sib koom ua haujlwm ntawm lwm yam tshuaj ntsuab).31Tej zaum nws yuav yog tias cov tshuaj sib xyaw ua ke txhim kho cov kev xaiv kho mob thiab cov hom phiaj.32
Tsis tas li ntawd, ntau lub hom phiaj tuaj yeem nyob hauv tib txoj hauv kev los yog sib txawv thiab cov ntaub so ntswg, thiab lawv cov kev hloov kho tuaj yeem tsim ntau dua li cov teebmeem ntxiv uas tshwm sim los ntawm kev ua sib koom ua ke ntawm ib qho chaw tshwj xeeb.33Tsis tas li ntawd, peb qhov kev tshuaj xyuas thiab kev ntsuas meta yog raws li cov txiaj ntsig ntawm kev tshawb fawb yav dhau los; li no, nws lub hom phiaj thiab qhov tseeb yog nyob ntawm qhov zoo ntawm cov ntawv xaiv no. Peb tau txiav txim siab tag nrho cov kev pheej hmoo ntawm kev tsis ncaj ncees ntawm peb cov kev tshawb fawb suav nrog yuav tsum nyob nruab nrab raws li cov cuab yeej ntawm Cochrane Handbook (Table 4). Txawm li cas los xij, cuaj RCT thiab 1745 tus neeg mob hauv tag nrho tseem yog ib qho qauv me me; ntawm qhov tod tes, txhua tus neeg mob suav nrog ntawm no yog Suav; yog li ntawd, qhov tshwm sim yuav raug txwv los ntawm haiv neeg. Yog li, peb xav tau ntau qhov zoo, ntau qhov kev tshawb fawb thiab randomized ob qhov muag tsis pom kev kuaj mob los sib piv, txheeb xyuas thiab lees paub qhov kev tshawb pom ntxiv.
Qhia tawm
Txhua tus kws sau ntawv tshaj tawm tias tsis muaj peev txheej ntawm kev txhawb nqa nyiaj txiag lossis kev sib raug zoo uas yuav ua rau muaj kev tsis sib haum xeeb txog cov ntawv sau no.
Los ntawm: 'Kev ua tau zoo ntawm lub raum-tonifying tshuaj suav tshuaj suav tshuaj hauv kev kho mob hauv tsev menyuam hypoplastic: Kev tshuaj xyuas thiab kev tshuaj xyuas meta-los ntawmXichuang Chen1ua al.
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Cov ntaub ntawv
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