GnRH拮抗剂方案中雌激素预处理与正常反应患者临床结局的Meta分析  

Meta-analysis of estrogen pretreatment in ovarian stimulation with GnRH antagonists for IVF

作　　者：易思思[1] 梁新红[1] 丘映[1] 

机构地区：[1]广西医科大学第三附属医院,南宁市第二人民医院妇产科生殖中心,南宁530000

出　　处：《生殖医学杂志》2017年第4期345-350,共6页Journal of Reproductive Medicine

基　　金：广西科学研究与技术开发计划项目(桂科攻0993003A-32)

摘　　要：目的系统评价GnRH拮抗剂方案中应用口服雌激素预处理对正常反应患者体外受精胚胎移植临床结局的影响。方法以"estrogen"、"in vitro fertilization"、"GnRH antagonist"及其对应的中文词系统性检索PubMed/MEDLINE、EMBASE、Cochrane Library、Wiley Library、Web of Science、ScienceDirect databases及中国期刊全文数据库、万方数据库、维普数据库、中国生物医学文献数据库,时间限定为1984~2014,所有拮抗剂周期中雌激素预处理的随机对照实验。结果共纳入4篇随机对照实验。雌激素预处理的GnRH拮抗剂方案组与无预处理的GnRH拮抗剂对照组相比,促性腺激素使用时长增加[MD=0.87,95%CI:(0.55,1.19),P<0.01]及总量增加[MD=197.45,95%CI:(164.43,230.47),P<0.01],获卵数升高[MD=1.49,95%CI:(0.44,2.53),P<0.01]。两组患者的继续妊娠率[RR=0.90,95%CI:(0.71,1.16),P=0.43]、临床妊娠率[OR=0.90,95%CI:(0.65,1.25),P=0.54]、活产率[OR=0.8,95%CI:(0.54,1.20),P=0.28]、流产率[OR=0.82,95%CI:(0.42,1.60),P=0.56]均无统计学差异。结论雌激素预处理并不影响患者临床妊娠率、活产率、流产率,还能增加获卵数。在体外受精-胚胎移植的临床实践中,雌激素预处理是一种可选的便于生殖中心进行周期调控而不影响患者妊娠结局的方法。Objective： To conducted an updated meta-analysis of the efficacy of oral estrogen pretreatment on pregnancy outcome in GnRH antagonist cycles. Methods： All the estrogen pretreatment in GnRH antagonist regimen of randomized controlled trials from 1984 to 2014 were systematically searched with the terms of ＂estrogen＂, ＂in vitro fertilization＂ and ＂GnRH antagonist＂ from PubMed/MEDLINE, EMBASE, Cochrane Library, Wiley Library, Web of Science, ScienceDirect database, the Chinese Academic Journal, WanFang DATA, VIP database, Chinese Biomedical Literature Database. Results： Four randomized controlled trials were included. Compared with the GnRH antagonist group without estrogen pretreatment, the duration of gonadotropin [MD 0.87,95 % CI： （0.55,1.19） ], total doses of gonadotropin [MD 197.45,95% CI： （164.43,230.47）],and number of oocytes retrieved [MD 1.49, 95% CI： （0. 44,2.53）] were significantly increased （all P〈0.01） in the GnRH antagonist with estrogen pretreatment;while the ongoing pregnancy rate [RR=0.90,95% CI：（0.71,1.16）,P=0.431,clinical pregnancy rate [OR = 0.90,95% CI：（0.65,1.25）, P = 0. 541, live birth rate[OR = 0.8,95% CI： （0.54,1.20） ,P=0.281 and abortion rate EOR = 0.82,95% CI. （0.42,1.60）, P = 0.561 were not significantly different （P〉0.05）.Estrogen pretreatment does not affect the clinical pregnancy rate, live birth rate and abortion rate,but increase oocytes retrieved. The estrogen pretreatment is an optional method to facilitate cycle control without affecting pregnancy outcome.

关 键 词：体外受精-胚胎移植 GNRH拮抗剂 雌激素 临床结局 

分 类 号：R[医药卫生]