Efficacy of black cohosh extracts for improving low estrogen status induced by postoperative GnRHa treatment in patients with endometriosis: a systematic review

doi:10.3785/j.issn.1008-9292.2020.06.06

J Zhejiang Univ (Med Sci)

2020, Vol. 49

Issue (3): 397-405 DOI: 10.3785/j.issn.1008-9292.2020.06.06

Efficacy of black cohosh extracts for improving low estrogen status induced by postoperative GnRHa treatment in patients with endometriosis: a systematic review

PENG Jie¹(

),XU Wenfei²,LI Xuhui²,WU Qiaoai^1,*(

)

1. Department of Pharmacy, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
2. Zhejiang Provincial Key Laboratory of Applied Enzymology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing 314006, Zhejiang Province, China

Download:

HTML( 6 )

PDF(2185KB)
Export: BibTeX | EndNote (RIS)

Abstract

Objective: To evaluate the efficacy of black cohosh extracts (BCE) in improving the low estrogen status induced by postoperative gonadotropin-releasing hormone agonist (GnRHa) in patients with endometriosis. Methods: Randomized clinical controlled trial about the improvement of low estrogen status caused by GnRHa with the treatment of BCE in patients with endometriosis after laparoscopic surgery were retrieved from Medline (Ovid), PubMed, Cochrane Library, CNKI, CBMdisc, Wanfang and VIP databases before January 2020, and meta-analysis of included studies was performed by Revman 5.3 software. Results: Seven randomized controlled trials involving 745 patients were included in this study. Meta-analysis results showed that the addition of BCE did not alter hormone levels of patients, including serum estradiol levels [MD=1.24, 95% CI(-4.58, 7.08), P>0.05] and luteinizing hormone levels [MD=-0.02, 95% CI(-0.15, 0.11), P>0.05]. BCE effectively improved the perimenopausal symptoms induced by low estrogen status:improving hectic fever and sweating [OR=0.1, 95% CI(0.02, 0.47), P < 0.01], reducing the occurrence of insomnia symptoms [OR=0.23, 95% CI(0.13, 0.39), P < 0.01], improving fatigue [OR=0.09, 95% CI(0.04, 0.20), P < 0.01], reducing the occurrence of vaginal dryness [OR=0.04, 95% CI(0.01, 0.30), P < 0.01]. BCE affected Kupperman's menopausal index (KMI) score 12 weeks after the surgery [MD=-11.50, 95% CI(-20.09, -2.90), P < 0.01] and KMI score 24 weeks after the surgery [MD=-23.68, 95% CI(-39.66, -7.69), P < 0.01]. Conclusion: The limited evidence so far indicates that BCE could efficiently improve perimenopausal symptoms cause by low estrogen status of the patients recieved GnRHa treatment after surgery for endometriosis, but does not alter hormone levels of patients.

Key words： Black cohosh extracts Endometriosis Gonadotropin-releasing hormone agonist meta analysis

Received: 25 July 2019 Published: 24 July 2020

CLC:

R711.71

Corresponding Authors: WU Qiaoai E-mail: pengjieshihezi@163.com;hangzhouwqa@126.com

	Service
	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	PENG Jie
	XU Wenfei
	LI Xuhui
	WU Qiaoai

Cite this article:

PENG Jie,XU Wenfei,LI Xuhui,WU Qiaoai. Efficacy of black cohosh extracts for improving low estrogen status induced by postoperative GnRHa treatment in patients with endometriosis: a systematic review. J Zhejiang Univ (Med Sci), 2020, 49(3): 397-405.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2020.06.06 OR http://www.zjujournals.com/med/Y2020/V49/I3/397

黑升麻提取物可改善子宫内膜异位症患者术后治疗的低雌激素状态

目的: 系统评价黑升麻提取物改善子宫内膜异位症患者术后促性腺激素释放激素激动剂（GnRHa）治疗导致低雌激素状态的有效性。方法: 计算机检索至2020年1月，在Medline、PubMed、Cochrane Library、中国期刊全文数据库（CNKI）、中国生物医学文献数据库、万方数据和维普中国科技期刊数据库中，检索子宫内膜异位症患者腹腔镜手术后GnRHa疗程中加入黑升麻提取物辅助治疗以缓解GnRHa造成的低雌激素状态的临床随机对照试验，对符合纳入标准的文献进行质量评价，使用Revman 5.3软件对数据进行meta分析。结果: 最终纳入7篇随机对照研究，总计745例患者。meta分析结果显示，与对照组比较，黑升麻提取物的加入不会影响患者体内激素水平，包括血清雌二醇水平（MD=1.24，95% CI：-4.58~7.08，P>0.05）和促黄体激素水平（MD=-0.02，95% CI：-0.15~0.11，P>0.05）。黑升麻提取物可以有效改善由于GnRHa造成患者体内低雌激素所产生的围绝经期症状：改善患者潮热出汗（OR=0.1，95% CI：0.02~0.47，P < 0.01），减少失眠症状的发生（OR=0.23，95% CI：0.13~0.39，P < 0.01），改善乏力（OR=0.09，95% CI：0.04~0.20，P < 0.01），减少阴道干燥的发生（OR=0.04，95% CI：0.01~0.30，P < 0.01）。黑升麻提取物的加入会影响手术12周后患者Kupperman绝经指数（KMI）评分（MD=-11.50，95% CI：-20.09~-2.90，P < 0.01）及24周后KMI评分（MD=-23.68，95% CI：-39.66~-7.69，P < 0.01）。结论: 目前有限的证据表明，黑升麻提取物能够有效地改善子宫内膜异位症患者术后GnRHa治疗造成体内雌激素含量降低所引起的围绝经期症状，且不会影响体内激素水平。

关键词： 黑升麻提取物, 子宫内膜异位症, 促进腺激素释放激素激动剂, meta分析

Tab 1 Characteristics of studies included in meta-analysis

Fig 1 Meta analysis for estradiol level of endometriosis patients who received post-operative gonadotropin-releasing hormone agonist treatments

Fig 2 Meta analysis for follicle-stimulating hormone level of endometriosis patients who received post-operative gonadotropin-releasing hormone agonist treatments

Fig 3 Meta analysis for luteinizing hormone level of endometriosis patients who received post-operative gonadotropin-releasing hormone agonist treatments

Fig 4 Meta analysis for hectic fever and sweating of endometriosis patients who received post-operative gonadotropin-releasing hormone agonist treatments

Fig 5 Meta analysis for insomnia of endometriosis patients who received post-operative gonadotropin-releasing hormone agonist treatments

Fig 6 Meta analysis for fatigue of endometriosis patients who received post-operative gonadotropin-releasing hormone agonist treatments

Fig 7 Meta analysis for vaginal dryness of endometriosis patients who received post-operative gonadotropin-releasing hormone agonist treatments

Fig 8 Meta analysis for KMI of endometriosis patients who received post-operative gonadotropin-releasing hormone agonist treatments after 12 weeks

Fig 9 Meta analysis for KMI of endometriosis patients who received post-operative gonadotropin-releasing hormone agonist treatments after 24 weeks


[1]	MEOLA J , ROSA E SILVA J C , DENTILLO D B et al. Differentially expressed genes in eutopic and ectopic endometrium of women with endometriosis[J]. Fertil Steril, 2010, 93 (6): 1750- 1773 doi: 10.1016/j.fertnstert.2008.12.058

[2]	SHA G , WU D , ZHANG L et al. Differentially expressed genes in human endometrial endothelial cells derived from eutopic endometrium of patients with endometriosis compared with those from patients without endometriosis[J]. Hum Reprod, 2007, 22 (12): 3159- 3169 doi: 10.1093/humrep/dem266

[3]	陈继明, 吴洁, 浦丹华 . 子宫内膜异位症术后GnRH-a治疗与黑升麻制剂的使用[J]. 中国妇幼健康研究, 2014, 25 (2): 344- 347 CHEN Jiming , WU Jie , PU Danhua . Post-operative GnRH-a treatment and black cohosh preparations administration in endometriosis patients[J]. Chinese Journal of Woman and Child Health Research, 2014, 25 (2): 344- 347 doi: 10.3969/j.issn.1673-5293.2014.02.064

[4]	中华医学会妇产科学分会子宫内膜异位症协作组 . 子宫内膜异位症的诊断与治疗规范[J]. 中华妇产科杂志, 2007, 42 (9): 645- 647 Department of Obstetrics and Gynecology, Chinese medical association, endometriosis collaboration group . Guidelines for diagnosis and treatment of endometriosis[J]. Chinese Journal of Obstetrics and Gynecology, 2007, 42 (9): 645- 647 doi: 10.3760/j.issn:0529-567x.2007.09.020

[5]	李沁, 陈继明, 高红艳 . 黑升麻制剂拮抗子宫内膜异位症患者术后使用GnRH-a所致围绝经期症状的疗效[J]. 江苏医药, 2012, 38 (16): 1951- 1953 LI Qin , CHEN Jiming , GAO Hongyan . Curative effects of black cohosh on the symptoms of perimenopause caused by GnRH-a in the patients with endometriosis[J]. Jiangsu Medical Journal, 2012, 38 (16): 1951- 1953 doi: 10.1007/s11783-011-0280-z

[6]	杨玲 . 莉芙敏配合醋酸亮丙瑞林治疗子宫内膜异位症80例疗效观察[J]. 世界最新医学信息文摘, 2013, 13 (29): 129 YANG Ling . Therapeutic effects of Remifemin and leuprorelin acetate treatment in 80 women with endometriosis[J]. World Latest Medicine Information, 2013, 13 (29): 129

[7]	张文婷, 张蔚, 钟亚娟 . 醋酸亮丙瑞林联合莉芙敏治疗子宫内膜异位症临床观察[J]. 中华实用诊断与治疗杂志, 2013, 27 (4): 383- 385 ZHANG Wenting , ZHANG Wei , ZHONG Yajuan . Combination clinical observation of Remifemin and leuprorelin acetate treatment on endometriosis patients[J]. Journal of Chinese Practical Diagnosis and Therapy, 2013, 27 (4): 383- 385

[8]	刘巍, 张丽丽, 刘红 . 醋酸亮丙瑞林联合莉芙敏治疗子宫内膜异位症的临床研究[J]. 中国当代医药, 2013, 20 (6): 103- 105 LIU Wei , ZHANG Lili , LIU Hong . Clinical research on the application of Remifemin and leuprorelin acetate treatment on endometriosis patients[J]. China Modern Medicine, 2013, 20 (6): 103- 105

[9]	赵小卫, 周建平 . 丙氨瑞林联合莉芙敏片对子宫内膜异位症患者p53、p21、MDM2蛋白表达及疗效的影响观察[J]. 中国药师, 2016, 19 (11): 2086- 2137 ZHAO Xiaowei , ZHOU Jianping . Effects of Alarelin and Remifemin treatment on the expression of p53, p21and MDM2 of the endometriosis patients[J]. China Pharmacist, 2016, 19 (11): 2086- 2137 doi: 10.3969/j.issn.1008-049X.2016.11.024

[10]	谷粒.黑升麻提取物改善子宫内膜异位症术后应用GnRH-a所致低雌激素症状的临床分析[D].大连: 大连医科大学, 2013. GU Li. Clinical analysis of the efficacy of black cohosh extracts in improving the low estrogen status of GnRH-a after surgery of endometriosis[D]. Dalian: Dalian Medical University, 2013. (in Chinese)

[11]	赵娜.莉芙敏对子宫内膜异位症术后GnRH-a治疗后围绝经症状及骨代谢标志物的影响[D].苏州: 苏州大学, 2016. DOI: CNKI:CDMD:2.1016.223780. ZHAO Na. Effect of Remifemin on peri-menopausal symptoms and bone metabolic markers in GnRH-a treatment of endometriosis after laparoscopic surgery abstract[D]. Suzhou: Soochow University, 2016. DOI: CNKI:CDMD:2.1016.223780.(inChinese)

[12]	KHARODE Y P , BODINE P V , MILLER C P et al. The pairingof a selective estrogen receptor modulator, bazedoxifene, with conjugated estrogens as a new paradigm for the treatment of menopausal symptoms and osteoporosis prevention[J]. Endocrinology, 2008, 149 (12): 6084- 6091 doi: 10.1210/en.2008-0817

[13]	RUHLEN R L , SUN G Y , SAUTERE R . Black cohosh:insights into its echanismof action[J]. Integr Med Insights, 2008, 3 (3): 21- 32 doi: 10.4137/117863370800300002

[14]	薛赛琴 . 希明婷片治疗女性更年期综合征364例[J]. 中国中西医结合杂志, 2006, 26 (10): 891 XUE Saiqin . Efficacy and safety of Ximingting tablets in the treatment of 364 cases of women with climacteric syndrome[J]. Chinese Journal of Integrated Traditional and Western Medicine, 2006, 26 (10): 891 doi: 10.7661/CJIM.2006.10.891

[15]	MU N L , JUN M S , KIM Y M et al. 7, 8-didehydrocimigenol from Cimicifugaerhizorma inhibits TNF-a induced VCAM-1 but not ICAM-1 expression through up-regulation of PPARγ in human endothelial cells[J]. Food Chem Toxicol, 2011, 49 (1): 166- 172 doi: 10.1016/j.fct.2010.10.012

[16]	MOON L , HA Y M , JANGH J et al. Isoimperalorin, eimiside E and 23-O-acetyl-shengmanol 3-xyloside from Cimicifugae Rhizome inhibit TNF-a-induced VCAM-1 expression in human endothelial cells:involvement of PPAR-upregulation and PI3K, ERK1/2, and PKC signal pathways[J]. J Ethnopharmacol, 2011, 133 (2): 33 doi: 10.1016/j.jep.2010.10.004

[17]	REBBECK T R , TROXEL A B , NORMAN S et al. A retrospective case control study of the use of hormone related supplements and association with breast cancer[J]. Int J Cancer, 2007, 120 (7): 1523- 1528 doi: 10.1002/ijc.22485

[1]	YU Ya,WEI Kai,YAO Qiuping,TIAN Shen,LIANG Kun,ZHOU Liming,WANG Liping,JIN Min. Controlled ovarian stimulation protocols in endometriosis patients: with antagonist or agonist?[J]. J Zhejiang Univ (Med Sci), 2019, 48(2): 165-173.

[2]	ZHANG Lifeng,ZHANG Xinmei. Research progress on roles of vitamin D in endometriosis[J]. J Zhejiang Univ (Med Sci), 2018, 47(4): 413-418.

[3]	HE Jiayi,ZHANG Xinmei. Research progress on oxidative stress in pathogenesis of endometriosis[J]. J Zhejiang Univ (Med Sci), 2018, 47(4): 419-425.

[4]	ZHU Tianhong, ZHANG Xinmei. Research progress on the role of epithelial-mesenchymal transition in pathogenesis of endometriosis[J]. J Zhejiang Univ (Med Sci), 2016, 45(4): 439-445.

[5]	LIN Kai-qing, ZHU Li-bo, ZHANG Xin-mei, LIN Jun. Role of mast cells in estrogen-mediated experimental endometriosis in rats[J]. J Zhejiang Univ (Med Sci), 2015, 44(3): 269-277.

[6]	XIN Liao-bing, JIANG Xiu-xiu, YE Xiao-lei, WU Rui-jin, XU Kai-hong, MA Jun-yan, LIN Jun. AQP5 gene silencing inhibits proliferation and migration of ectopic endometrial glandular epithelial cells in endometriosis[J]. J Zhejiang Univ (Med Sci), 2015, 44(3): 285-292.

[7]	ZHU Li-bo, LIN Kai-qing, ZHANG Xin-mei, LIN Jun. Sodium cromoglycate attenuates experimental endometriosis in rats by regulating mast cells[J]. J Zhejiang Univ (Med Sci), 2015, 44(3): 278-284.

[8]	ZHU Libo，ZHANG Xinmei. Research advances on the role of mast cells in pelvic pain of endometriosis[J]. J Zhejiang Univ (Med Sci), 2013, 42(4): 461-.

[9]	Zhang Xinmei, Wang Man. PROLACTIN PRODUCTION IN ECTOPIC AND EUTOPIC ENDOMETRIUM OF PATIENTS WITH ENDOMETRIOSIS[J]. J Zhejiang Univ (Med Sci), 1997, 26(2): 67-70.

Viewed

Full text

Abstract

Cited

Shared

Discussed