来曲唑联合拮抗剂方案对体外受精-胚胎移植中低反应患者有效性的Meta分析  

Effectiveness of Letrozole Combined with GnRH Antagonist for IVF-ET in Poor Responders:A Meta-Analysis

作　　者：孙琴[1] 陈莉[1] 邵一丹[1] 姚兵[1] 梁元姣[1] 

机构地区：[1]南京军区南京总医院生殖医学中心,南京210000

出　　处：《中国循证医学杂志》2013年第11期1354-1360,共7页Chinese Journal of Evidence-based Medicine

基　　金：江苏省"六大人才高峰"D类资助项目(编号:2011年第7批)

摘　　要：目的系统评价来曲唑+促性腺激素释放激素拮抗剂方案对体外受精-胚胎移植(IVF-ET)中低反应患者促排卵的有效性。方法计算机检索VIP、CNKI、PubMed、EMbase和FMJS,收集有关来曲唑+拮抗剂方案对体外受精-胚胎移植低反应患者促排卵有效性的随机对照试验或临床对照试验。由2位评价员根据纳入与排除标准独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.0软件进行Meta分析。结果最终纳入6个研究,共977例患者。Meta分析结果显示:对体外受精-胚胎移植中低反应患者,来曲唑+拮抗剂方案与对照组相比,Gn用量[MD=–8.05,95%CI(–13.67,–2.43),P=0.005]、HCG日E2值[MD=–1 026.41,95%CI(–1 949.61,–103.20),P=0.03]均小于对照组;而两组获卵数[MD=–0.61,95%CI(–2.41,–1.19),P=0.51]和临床妊娠率[OR=1.03,95%CI(0.53,2.02),P=0.92]无明显差异。结论对IVF-ET低反应患者促排卵治疗的有效性而言,来曲唑+拮抗剂方案较对照组临床结局无明显改善,但能减少Gn用量,降低IVF治疗费用。来曲唑+拮抗剂方案为卵巢低反应患者提供了另一种临床选择。由于纳入文献存在质量和数量不足以及方法学差异,建议本研究结论仅作为临床分析的参考,尚需后效评价和不断更新。Objective To systematically review the effectiveness of letrozole combined with GnRH antagonist for in vitro fertilization-embryo transfer （IVF-ET） in poor responders. Methods Such databases as VIP, CNKI, PubMed, EM- base and FMJS were electronically searched for randomized controlled trials （RCTs） or quasi-RCTs on the effectiveness of letrozole combined with GnRH antagonist for IVF-ET. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.0 software. Results Six studies involving 977 patients were finally included. The results of meta-analysis showed that, for IVF-ET poor responders, compared with the control group, the letrozole combined with GnRH antago- nist group had less dosage of Gn （MD=-8.05, 95%CI -13.67 to -2.43, P=0.005）, and lower serum E~ value on the day of HCG administration （MD= -1 026.41, 95%CI -1 949.61 to -103.20, P=0.03）. However, no significant difference was found in the number of ocytes obtained （MD= -0.61, 95%CI -2.41 to -1.19, P=0.51） and clinical pregnancy rates （OR= 1.03, 95%CI 0.53 to 2.02, P=0.92） between the two groups. Conclusion As for the effectiveness of impelling-ovulation treat- ment for IVF-ET in poor responders, letrozole combined with GnRH antagonist is similar to the control scheme in clini- cal outcomes, but it reduces the dosage of Gn and treatment costs of IVF-ET, which provides another clinical option for poor responders. Due to the limited quantity and quality of the included studies as well as the difference in methodology, we suggest this above conclusion could be taken as a reference for clinical analysis which needs to be further evaluated in its effects.

关 键 词：来曲唑 GNRHA 卵巢低反应 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]