Efficacy of Chinese herbal medicines combined with high-intensity focused ultrasound for patients with uterine fibroids: A meta-analysis with core herbs exploration

IF 6.7 1区医学 Q1 CHEMISTRY, MEDICINAL

Phytomedicine Pub Date : 2025-04-29 DOI:10.1016/j.phymed.2025.156811

Yu-Ting Huang , Meng-Chun Wang , Jian-An Liao , Wei-Chun Chen , Yu-Ting Chou , Wei-Jen Cheng

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引用次数: 0

Abstract

Background

Uterine fibroids (UFs) are prevalent benign tumours affecting women; they often present with symptoms such as excessive menstrual bleeding, pelvic discomfort, recurrent pregnancy loss, and infertility. High-intensity focused ultrasound (HIFU) has emerged as a non-invasive treatment option. Recent studies suggest that Chinese herbal medicines (CHMs) may enhance the efficacy of HIFU, but a comprehensive evaluation of their combined effects is lacking.

Aim

To evaluate the effectiveness of CHMs combined with HIFU for UFs through a meta-analysis on randomised controlled trials (RCTs) and identify core herbal patterns that may potentiate HIFU outcomes.

Materials and methods

English and Chinese databases were searched to identify relevant studies until May 2024. The risk of bias was evaluated using the Cochrane Risk of Bias 2 tool. A meta-analysis was performed using RevMan 5.4 software. The primary outcomes were changes in UF volume and clinical efficacy; secondary outcomes were changes in uterus volume, Traditional Chinese Medicine syndrome scores, incidence of recurrences and adverse reactions. Network analysis was performed to identify core herbs.

Results

Nineteen RCTs were included. The effects of reducing UFs volumes in the CHM group were more significant than those in the control group (SMD:0.34; 95 % CI:0.44 to -0.23, p < 0.001, I² = 0 %). The clinical effectiveness rate was higher in the CHM group than with HIFU therapy alone (risk ratio: 1.13; 95 % CI: 1.08 to 1.18; p < 0.001; I² = 37 %). Core pattern analysis revealed a total of 26 single herbs and 93 commonly used herbal combinations. Among these, Curcumae Rhizoma, Sparganii Rhizoma, Astragalus membranaceus, Poria cocos, Paeonia suffruticosa, and Trionyx sinensis were the most frequently utilized herbs.

Conclusions

This is the first meta-analysis to evaluate the clinical effectiveness of combining CHMs with HIFU for UFs, integrating both quantitative outcome and computational core herb pattern analyses to identify CHMs that may enhance the efficacy of HIFU. In addition to demonstrating superior clinical effectiveness, this study proposes a novel hypothesis: core CHMs may enhance HIFU efficacy through a dual-phase mechanism—promoting apoptosis during thermal ablation and modulating fibrotic and proliferative signaling pathways in the post-ablation phase. These findings provide an evidence-based foundation for developing integrated therapeutic strategies.

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中药联合高强度聚焦超声治疗子宫肌瘤疗效的meta分析及核心中药探索

子宫肌瘤（UFs）是影响女性的常见良性肿瘤；她们通常表现出月经过多、盆腔不适、反复流产和不孕等症状。高强度聚焦超声（HIFU）已成为一种非侵入性的治疗选择。最近的研究表明，中草药可以提高HIFU的疗效，但缺乏对其综合效果的综合评价。目的通过对随机对照试验（RCTs）的荟萃分析，评估中草药联合HIFU治疗UFs的有效性，并确定可能增强HIFU结果的核心草药模式。材料与方法检索中英文数据库，检索到2024年5月之前的相关研究。使用Cochrane risk of bias 2工具评估偏倚风险。采用RevMan 5.4软件进行meta分析。主要结局是UF体积和临床疗效的变化；次要观察指标为子宫体积变化、中医证候评分、复发率及不良反应。通过网络分析对核心药材进行鉴定。结果共纳入19项随机对照试验。中药组减少UFs体积的效果明显优于对照组(SMD:0.34；95% CI:0.44至-0.23,p <；0.001, i²= 0 %)。CHM组临床有效率高于单纯HIFU治疗组(风险比：1.13；95% CI: 1.08 ~ 1.18；p & lt;0.001;I2 = 37%)。核心模式分析显示，共有26种单一草药和93种常用草药组合。其中，姜黄、菝葜、黄芪、茯苓、赤芍和黄牛是最常用的药材。这是第一个评估中西医结合HIFU治疗UFs临床疗效的荟萃分析，结合定量结果和计算核心草药模式分析来确定可能增强HIFU疗效的中西医结合。除了表现出卓越的临床疗效外，本研究提出了一个新的假设：核心CHMs可能通过双阶段机制提高HIFU疗效-在热消融期间促进细胞凋亡和在消融后调节纤维化和增殖信号通路。这些发现为制定综合治疗策略提供了循证基础。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Phytomedicine 医学-药学

CiteScore

10.30

自引率

5.10%

发文量

670

审稿时长

91 days

期刊介绍： Phytomedicine is a therapy-oriented journal that publishes innovative studies on the efficacy, safety, quality, and mechanisms of action of specified plant extracts, phytopharmaceuticals, and their isolated constituents. This includes clinical, pharmacological, pharmacokinetic, and toxicological studies of herbal medicinal products, preparations, and purified compounds with defined and consistent quality, ensuring reproducible pharmacological activity. Founded in 1994, Phytomedicine aims to focus and stimulate research in this field and establish internationally accepted scientific standards for pharmacological studies, proof of clinical efficacy, and safety of phytomedicines.