GnRH拮抗剂方案及GnRH-a短方案用于卵巢低反应患者助孕临床疗效Meta分析  

Clinical efficacy of GnRH antagonist protocol or GnRH agonist short protocol for patients with poor ovarian response in artificial assisted reproduction:a meta-analysis

作　　者：牛婷[1] 李爱斌[1] 曹景云[1] 陈力[1] 沈兰[1] 

机构地区：[1]武汉大学人民医院生殖中心,武汉430060

出　　处：《生殖医学杂志》2015年第4期281-288,共8页Journal of Reproductive Medicine

摘　　要：目的比较卵巢低反应(POR)患者行促性腺激素释放激素拮抗剂(GnRH-ant)及GnRH激动剂(GnRH-a)短方案的临床疗效。方法计算机检索PubMed、ProQuest Medical Library、Medline外文生物医学期刊文献数据库、中国生物医学文献数据库(CBM)、中国知网(CNKI)、中国科技期刊数据库(VIP)、万方数据库和读秀学术搜索引擎等。收集2000年至2014年10月发表的相关文献,比较POR患者行GnRH-ant及GnRH-a短方案的临床试验,按Cochrane系统评价方法提取有效数据,采用RevMan 5.2软件进行Meta分析。结果共纳入11篇文献,共855例(1 054个周期)POR患者,其中GnRHant组444例(549个周期),GnRH-a短方案组411例(505个周期);Meta分析结果显示:对于POR患者,两组间临床妊娠率[RR=1.25,95%CI(0.96,1.63),P=0.10]、促性腺激素(Gn)时间[WMD=-1.15,95%CI(-2.56,0.25),P=0.11]、Gn用量[WMD=63.54,95%CI(-59.08,186.17),P=0.31]、获卵数[WMD=0.16,95%CI(-0.66,0.98),P=0.70]、周期取消率[RR=1.07,95%CI(0.85,1.35),P=0.57]差异均无统计学意义,但临床妊娠率的结果偏向于拮抗剂组更优。结论对于POR患者,拮抗剂方案和GnRH-a短方案效果无统计学差异,但是拮抗剂组可能更有助于提高临床妊娠率,可以作为POR患者助孕的一个选择。Objective： To evaluate the clinical efficacy of GnRH antagonist protocol or GnRH agonist（GnRH-a） short protocol in patients with poor ovarian response in artificial assisted reproduction. Methods. The databases as PubMed, ProQuest Medical Library, Medline, CBM, CNKI, VIP, Wanfang Databases and Reading Show Academic Search Engine were electronically searched for the clinical trials on comparison of clinical efficacy between GnRH antagonist protocol and GnRH-a short protocol in patients with poor ovarian response from 2000 to October 2014. The data were selected by two independent reviewers using an extraction method of Cochrane system analysis. Meta-analysis was performed with the software of RevmMan 5.2. Results： Eleven articles met the inclusion criteria and included 855 patients（1054 cycles）. There were 444 patients（549 cycles）in the GnRH antagonist protocol group and 411 patients（505 cycles）in GnRH-a short protocol group. Meta-analysis showed that there were no statistical differences in the clinical pregnancy rate[RR= 1.25,95%CI（0.96,1.63） ,P= 0.10], the time of gonadotropin（Gn） used[WMD =--1. 15,95% CI（--2.56,0.25）,P=0. 11],the total Gn 186.17） ,P=0. 311, the number of retrieval oocytes[WMD =0.16,95%CI（--0.66,0.98）, P=0. 70] and the cycle cancellation rate [RR = 1.07,95% CI （0.85,1.35）, P = 0.57] between the GnRH antagonist protocol group and the GnRH-a short protocol group, but the clinical pregnancy rate in the GnRH antagonist protocol has better tendency than the GnRH-a short protocol.

关 键 词：卵巢低反应 促性腺激素释放激素激动剂短方案 促性腺激素释放激素拮抗剂 META分析 

分 类 号：R4[医药卫生—临床医学]