GnRH拮抗剂对体外受精-胚胎移植中多囊卵巢综合征患者有效性的系统评价  

Effectiveness of GnRH Antagonist In Vitro Fertilization-Embryo Transfer(IVF-ET) in PCOS Patients:A Systematic Review

作　　者：肖劲松[1] 陈双陨[1] 张春莲[1] 常双[2] 

机构地区：[1]湖北省十堰市湖北医药学院附属太和医院妇产科,十堰442000 [2]湖北省十堰市湖北医药学院附属太和医院肿瘤科,十堰442000

出　　处：《中国循证医学杂志》2011年第7期811-818,共8页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价GnRH拮抗剂用于多囊卵巢综合征(PCOS)患者体外受精-胚胎移植的有效性。方法计算机检索PubMed(1997～2010)、ProQust Medical Library(1997～2010)、外文生物医学期刊文献数据库(2000～2010)、CBM(1979～2010)、CNKI(1994～2010)、VIP(1989～2010)、万方数据库(1994～2010)和读秀学术搜索引擎,并手工检索相关中文杂志9种,查找比较GnRH拮抗剂与GnRH激动剂在体外受精-胚胎移植PCOS患者治疗中有效性的随机对照试验(RCT)。由两位研究者按纳入排除标准筛选文献、提取资料和评价质量后,采用RevmMan 4.2.7软件进行Meta分析。结果共纳入6篇RCT,合计699例患者。其纳入研究质量A级3篇,B级3篇。Meta分析结果显示:与GnRH激动剂组比较,GnRH拮抗剂组在刺激天数[WMD=–1.23(–2.76,–0.31)]、Gn量[WMD=–4.87(–14.20,4.46)]、HCG日E2值[WMD=31.37(–263.40,–326)]、获卵数[WMD=1.34(–1.02,4.70)]、临床妊娠率[OR=1.27(0.77,2.10)]和流产率[Peto OR=0.67(0.38,1.18)]方面,两组差异均无统计学意义;仅GnRH拮抗剂组的OHSS率较低,两组差异有统计学意义[Peto OR=0.35(0.24,0.50)]。结论 GnRH拮抗剂方案较之GnRH激动剂方案能减低OHSS发生,而在Gn量、获卵数、临床妊娠率方面,两种方案疗效相当。由于GnRH拮抗剂方案可缩短治疗时间,减少治疗费用,具有较好的安全性,对PCOS患者行体外受精-胚胎移植可能是较理想的选择。鉴于纳入研究存在质量和数量的不足以及方法学的差异,上述结论仅供临床参考,需要开展更多后效评价和不断更新。Objective To evaluate the effectiveness of GnRH antagonist in vitro fertilization-embryo transfer（IVF-ET） in polycystic ovary syndrome（PCOS） patients.Methods Such databases as PubMed（1997 to 2010）,PML（1997 to 2010）,FMJS（2000 to 2010）,CBMdisc（1979 to 2010）,CNKI（1994 to 2010）,VIP（1989 to 2010）,WanFang（1994 to 2010）,and duxiu scholar searcher（www.duxiu.com）,and nine relevant Chinese journals were searched for retrieving the randomized controlled trails（RCTs） on the effectiveness of GnRH antagonist versus GnRH agonist for IVF-ET in PCOS Patients.The studies were screened according to the inclusive and exclusive criteria by two reviewers independently,the data was abstracted and the quality was evaluated.The RevMan 4.2.7 software was used for Meta-analyses.Results Six grade-B studies involving 699 participants were included.The results of Meta-analyses showed that,compared with the GnRH agonist,there was no significant difference in the GnRH antagonist group about the stimulation duration（WMD= -1.23,95%CI -2.76 to -0.31）,dose of gonadotrophins（Gns）（WMD= -4.87,95%CI -14.20 to 4.46）,serum E2 value on the day of HCG administration（WMD= 31.37,95%CI -263.40 to 326）,number of oocytes retrieved（WMD= 1.34,95%CI -1.02 to 4.70）,clinical pregnancy rate（OR= 1.27,95%CI 0.77 to2.10）,and miscarraige rate（Peto OR= 0.67,95%CI 0.38 to1.18）.But the OHSS rate in the GnRH antagonist group was lower with a significant difference（Peto OR= 0.35,95%CI 0.24 to 0.50）.Conclusions Compared with the GnRH agonist protocol,the GnRH antagonist protocol can obviously reduce the incidence of OHSS,but has the same effect in Gn dose,retrieving oocytes and clinical pregnancy rate.Because the GnRH antagonist can decrease the treatment duration and cost,and has better safety,so it may be an ideal choice for PCOS patients to have IVF-ET therapy.For the quality and quantity limitation,and the methodology difference of the included studies,it is suggested that the conclusion from this

关 键 词：GNRH拮抗剂 GNRH激动剂 多囊卵巢综合征 体外受精-胚胎移植 系统评价 META分析 

分 类 号：R714.8[医药卫生—妇产科学] R711.75[医药卫生—临床医学]