目的 系統(tǒng)評價中西藥聯(lián)合對比西藥治療復(fù)發(fā)性流產(chǎn)的綜合療效，為臨床用藥提供依據(jù)。方法 通過計(jì)算機(jī)檢索PubMed、Cochrane library、Embase、中國學(xué)術(shù)期刊全文數(shù)據(jù)庫（CNKI）、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫（CBM）、萬方數(shù)據(jù)庫建庫-2017年5月中西藥聯(lián)合治療復(fù)發(fā)性流產(chǎn)患者的隨機(jī)對照研究（RCT），對納入文獻(xiàn)進(jìn)行質(zhì)量評價，并用Revman 5.3軟件進(jìn)行Meta-分析。結(jié)果 最終納入43篇文獻(xiàn)共3 298名患者。Meta-分析結(jié)果顯示，中西藥聯(lián)合組的有效率明顯高于西藥組[OR=3.57，95% CI（2.73，4.67），P=0.98]；針對不同中醫(yī)癥型，亞組分析顯示補(bǔ)腎組、補(bǔ)腎健脾組、補(bǔ)氣補(bǔ)血組以及補(bǔ)腎活血組療效均優(yōu)于單獨(dú)使用西藥[OR=3.47，95% CI（2.60，4.63），P=0.97]；中西藥聯(lián)合使用能提高中醫(yī)癥候療效[OR=4.54，95% CI（2.95，6.99），P=1.00]，顯著降低癥狀積分[MD=-3.46，95% CI（-4.32，-2.60），P<0.000 1]；中西藥聯(lián)合使用組和西藥組在孕8周[SMD=-0.65，95% CI（-0.10，1.40），P<0.000 01]、孕10周[SMD=0.10，95% CI（-0.78，0.98），P<0.000 01]血清β-HCG、IL-10[SMD=0.14，95% CI（-0.87，1.15），P<0.000 01]沒有顯著差異。結(jié)論 與單獨(dú)使用西藥治療相比，中西藥聯(lián)用增加了治療有效率，改善了再次妊娠時的流產(chǎn)癥狀；針對不同中醫(yī)癥型的患者，均能夠取得更好的療效。中西藥聯(lián)用在血清β-HCG以及血清IL-10因子方面沒明顯改善。

Objective To compare the comprehensive curative effect of Chinese and western medicine combined with western medicine alone in the treatment of patients with recurrent spontaneous abortion. Methods Clinical control trials of patients with recurrent spontaneous abortion were conducted through the computer search of PubMed, Cochrane library, Embase, CBM, CNKI and Wanfang Data from inception to May 1, 2017. And then the quality of the included documents was evaluated, Revman 5.3 software was used to perform Meta-analysis of the eligible studies. Results A total of 3 298 patients with recurrent spontaneous abortion were included in 43 literatures. Meta-analysis showed that the effective rate of the combination group was significantly higher than that of the western medicine group[OR=3.57,95% CI(2.73, 4.67), P=0.98]; For different TCM types, the kidney group, bushenjianpi group, qixuejunbu group and bushenhuoxue group were all better than medicine alone[OR=3.57, 95% CI(2.73, 4.67), P=0.98]; At the same time, the combination of Chinese and western medicine can significantly improve the efficacy of TCM symptoms[OR=4.54, 95% CI(2.95, 6.99), P=1.00], significant reduced symptom scores[MD=-3.46, 95% CI (-4.32, -2.60), P<0.000 1]; However, there was no significant difference between the western medicine group and Chinese and western medicine for 8 weeks[SMD=-0.65, 95% CI (-0.10, 1.40), P<0.000 01]and 10 weeks of[SMD=0.10, 95% CI (-0.78, 0.98), P<0.000 01] serum β-HCG, serum IL-10[SMD=0.14, 95% CI (-0.87,1.15), P<0.000 01]. Conclusion s Compared with the use of western medicine alone in the treatment of recurrent spontaneous abortion, the effective rate of combined use of Chinese and western medicines has increased significantly, which has improved the symptoms of miscarriage when recurrent miscarriage occurs during re-pregnancy; and for the recurrent abortions of different TCM syndrome types, combined Chinese medicine treatment can achieve better efficacy. Analysis of serum β-HCG levels and serum IL-2 and IL-10 levels in the two groups showed no statistical significance.

北京市醫(yī)學(xué)獎勵基金資助項(xiàng)目（YJHYXKYJJ-502）