促性腺激素释放激素激动剂联合激素反向添加治疗子宫内膜异位症的Meta分析  

Gonadotrophin-Releasing Hormone Agonist Combined with Hormone Applied to ‘Add-Back' Therapy for Endometriosis: A Meta-Analysis

作　　者：林丽娜[1] 徐红[1] 韦仕洋[1] 

机构地区：[1]广西医科大学第一附属医院妇科,南宁市530021

出　　处：《广西医学》2014年第5期618-623,630,共7页Guangxi Medical Journal

摘　　要：目的应用循证医学方法对促性腺激素释放激素激动剂(GnRH-a)联合激素反向添加治疗子宫内膜异位症的疗效及安全性进行评价。方法计算机检索Cochrane图书馆临床对照试验数据库、MEDLINE数据库、EMBase数据库、中国生物医学文献数据库、中国知网数据库、维普数据库及万方数据库并辅以手工检索,收集国内外GnRH-a联合激素反向添加治疗子宫内膜异位症的随机对照试验(RCTs)。对纳入的研究提取资料,根据Jadad量表评价其方法学质量,提取有效数据,用RevMan5.1软件进行Meta分析。结果共纳入符合标准的RCTs 11个,均为GnRH-a联合反向添加治疗与单独应用GnRH-a治疗的比较。Meta分析结果显示:(1)GnRH-a联合反向添加组腰椎骨质丢失量低于单用GnRH-a组(P<0.05);(2)GnRH-a联合反向添加组患者的雌二醇水平高于单用GnRH-a组(P<0.05),而卵泡刺激素水平低于单用GnRH-a组(P<0.05);(3)GnRH-a联合反向添加组盆腔痛症状缓解方面与单用GnRH-a组比较,差异无统计学意义(P>0.05);(4)GnRH-a联合反向添加组患者的失眠、潮热症状发生率均较单用GnRH-a的患者低(P<0.05);(5)GnRH-a联合反向添加组血清低密度脂蛋白、甘油三酯水平与单用GnRH-a组相比,差异无统计学意义(P>0.05)。结论GnRH-a联合激素反向添加治疗在保持其治疗效果的同时,能够改善机体低雌激素状态,减轻和缓解围绝经期相关症状及骨质丢失,短期内对血脂代谢变化影响不大。Objective To evaluate the effect and safety of ‘add-back ’ therapy with gonadotropin-releasing hormone agonist （ GnRH-a） plus hormone for endometriosis （ EMT） according to evidence-based medicine .Methods We searched the Cochrane Library , MEDLINE, EMBase, CBM, CNKI, VIP and Wanfang Database to collect the domestic and overseas RCTs of ‘add-back’ therapy with GnRH-a combined with hormone for endometriosis .The useful data were collected from the selected RCTs , and their methodological quality was assessed according to Jadad scale .A Meta-analysis was performed by using RevMan 5.1 software.Results Eleven RCTs were included,they were studies on the comparison of GnRH-a combined with ‘add-back’ therapy versus GnRH-a treatment alone.The results of the meta-analysis were as follows：①The patients in ‘add-back’ therapy group had a less lumbar spine bone loss compared with those in GnRH-a alone group after treatment（P〈0.05）.②The‘add-back’ therapy group showed a higher estradiol level and a lower follicle-stimulating hormone level compared with GnRH-a alone group （ P〈0 .05 ） .③ There were no significant differences in reducing pelvic pain symptoms between ‘add-back’ therapy group and GnRH-a alone group （P〉0 .05 ） .④ The patients in ‘add-back ’ therapy group had a lower incidence of sleepless and hot flushes compared with those in GnRH-a alone group（P〈0.05）.⑤There were no significant differences in the levels of low density lipoprotein and triglyceride between ‘add-back’ therapy group and GnRH-a alone group（P〉0.05）.Conclusion＆amp;nbsp;The“add-back”therapy with GnRH-a plus hormone can improve the hypoestrogenic symptom,relieve the peri-menopausal syndrome and bone loss ,and keep the therapeutic effect .It has little effect on blood lipid metabolism in the short term .

关 键 词：子宫内膜异位症 促性腺激素释放激素激动剂 反向添加 META分析 雌激素 孕激素 

分 类 号：R711[医药卫生—妇产科学]