来曲唑和克罗米芬分别联合HMG治疗多囊卵巢综合征疗效的系统评价  

A meta-analysis of curative effect of letrozole versus clomiphene citrate combined with gonadotropins in women with PCOS

作　　者：王沛丽 王芳[2] 丁楠[2] 

机构地区：[1]甘肃省监狱管理局兰州医院,兰州730030 [2]兰州大学第二医院生殖医学中心,兰州730030

出　　处：《生殖医学杂志》2015年第8期626-633,共8页Journal of Reproductive Medicine

基　　金：国家自然科学基金(编号:81202959);中央高校重点培育项目(编号:lzujbky-2013-m04)

摘　　要：目的运用Meta分析的方法探究来曲唑(LE)与克罗米芬(CC)分别联合人绝经期促性腺激素(HMG)对多囊卵巢综合征(PCOS)患者的疗效,为临床用药提供一定的依据。方法拟定严格的文献纳入标准和排除标准,检索中知网、维普、万方、CBM、Pubmed、The cochrane library等数据库,提取出相关的随机对照试验(RCT)文献,对各文献进行质量评价后,采用RevMan5.3软件对各文献进行数据分析。结果 (1)共6篇文献纳入本研究中,包含658例PCOS患者,共746个周期;(2)将上述筛选后的文献进行Meta分析,得出LE+HMG组与CC+HMG组在HMG用量[0.67,95%CI(-0.66,2.00),P=0.33]、HCG日优势卵泡数[-0.47,95%CI(-1.01,0.07),P=0.08]、周期妊娠率[1.34,95%CI(0.88,2.04),P=0.17]、流产率[-0.11,95%CI(-0.38,0.16),P=0.43]、HCG日子宫内膜厚度[0.75,95%CI(-0.05,1.54),P=0.07]之间的差异均无统计学意义;而LE+HMG组不良事件发生率显著低于CC+HMG组[-0.05,95%CI(-0.08,-0.01),P=0.007]。结论 LE+HMG在PCOS患者促排卵方面有着与CC+HMG相似的效果,但可以降低不良事件的发生率,在临床上有一定的应用前景。Objective： To evaluate the clinical effect of letrozole（LE）or clomiphene citrate（CC）plus HMG in treatment of the patients with polycystic ovary syndrome（PCOS）. Methods： The databases as PUBMED, Cochrane Library, CNKI, CBMdisc, Wanfang and VIP were electronically searched for relevant randomized controlled trials（RCT）. Furthermore, we manually searched the relevant references which had been already published. The data were selected by two independent reviewers and evaluated for the quality. Meta-analysis was performed with the software of RevMan 5.3. Results： Six relevant RCT studies involving 658 women and 746 cycles were included in the study. The results of the meta-analysis showed that,when compared LE＋HMG with CC＋HMG, there were no significant difference in HMG dose used [0.67,95% CI（--0. 66,2.00） ,P=0.33] ,the number of dominant follicles [--0.47,95G CI（--1. 01,0. 07） ,P=0.08],the pregnancy rate [1.34,95% CI（0.88,2.04）,P= 0.17 ], the miscarriage rate [-- 0.11,95 % C I （ -- 0.38,0. 16）, P = 0.43 ], the endometrial thickness on the day of HCG [-0. 75,95% CI（ -- 0. 05 ,1. 54） , P = 0. 071. However, the adverse event incidence was significant lower in the LE＋ HMG than that in the CC＋ HMG [---0.05,95%CI（ -- 0. 08, --0.01）, P=0. 0071. Conclusions： It appears that LE＋HMG has similar effect for inducing ovulation in infertile women compared with CC＋ HMG, but lower adverse event incidence. This regimen has a certain application prospect in clinical practice.

关 键 词：多囊卵巢综合征 来曲唑 芳香化酶抑制剂 克罗米芬 人绝经期促性腺激素 Meta分析 

分 类 号：R[医药卫生]