二甲双胍与腹腔镜卵巢打孔治疗有克罗米芬抵抗的多囊卵巢综合征的系统评价  

The effectiveness of metformin and laparoscopic ovarian drilling treatment in women with clomiphene citrate-resistant polycystic ovary syndrome：A systematic review and meta-analysis

作　　者：吴莲芝[1] 贺漪[1] 

机构地区：[1]武汉市第一医院妇产科,武汉430022

出　　处：《中国生育健康杂志》2015年第4期298-303,311,共7页Chinese Journal of Reproductive Health

摘　　要：目的：系统评价二甲双胍与腹腔镜卵巢打孔两种方法治疗有克罗米芬抵抗的多囊卵巢综合征患者的临床效果。方法依据循证医学原则，用Cochrane系统评价方法，检索2002年1月—2014年6月期间Cochrane图书馆、PubMed、CNKI、CBM、万方和重庆维普数据库等，纳入二甲双胍与腹腔镜卵巢打孔治疗有克罗米芬抵抗的多囊卵巢综合征患者的随机对照试验，采用RevMan5．0进行Meta分析。结果共纳入了5篇符合要求的RCT文献，共计688例患者。Meta分析结果显示，采用二甲双胍药物治疗相比腹腔镜卵巢打孔手术治疗排卵率[（54．8％～71．9％vs．53．2％～68．3％）；OR＝1．04，95％CI：0．86～1．27]、妊娠率[（13．1％～18．6％vs13．4％～17．2％）；OR＝0．99，95％CI：0．77～1．27]、规律月经率[（49．2％～68．8％vs41．5％～76．4％）；OR＝0．83，95％CI：0．47～1．47]及流产率[（8．9％～18．2％vs9．5％～29．0％）；OR＝0．72，95％CI：0．36～1．44]比较，两组治疗方式差异均无统计学意义。结论尚不能认为腹腔镜卵巢打孔术在治疗有克罗米芬抵抗的PCOS患者在排卵率、妊娠率、规律月经率及流产率方面优于二甲双胍。Objective To evaluate the effectiveness of metformin and laparoscopic ovarian drilling （LOD）for ovulation induction in women with polycystic ovary syndrome （PCOS）after failure of clomiphene citrate （CC）treatment. Methods Based on the principles of evidence-based medicine,we used Cochrane systematic review method to retrieve randomized controlled trials （RCT）in Cochrane Library,PubMed,CNKI,CBM,and Wanfang,Chongqing VIP database published between 2002 and 201 4.These publications were mainly about metformin therapy and laparoscopic ovarian drilling in the treatment of women with polycystic ovary syndrome （PCOS）after failure of CC treatment. Results Five RCTs were included,with a total of 688 patients.The results show that ovulation rate in metformin group were similar to LOD group （54.8% -71 .9% vs.53.2% -68.3%）,resulting in an OR of 1 .04 （0.86 -1 .27）.The metformin group and the LOD group had similar pregnancy rate （1 3.1 % -1 8.6% vs.1 3.4% -1 7.2%）,regular cycles （49.2% -68.8% vs.41 .5% -76.4%）,and first trimester miscarriage rate （8.9% -1 8.2% vs.9.5% -29.0%）. Conclusion The findings from this meta-analysis do not indicate that LOD is superior to metformin for the treatment of PCOS after failure of CC treatment in ovulation rate,pregnancy rate,regular cycles,and first trimester abortion rate.Heterogeneity was a major confounder among studies.A large-scale randomized controlled trial is needed to further address this issue.

关 键 词：多囊卵巢综合征 二甲双胍 腹腔镜卵巢打孔 META 分析 

分 类 号：R4[医药卫生—临床医学]