体外受精或卵胞浆内单精子显微注射的GnRH拮抗剂方案中应用rLH与rFSH的有效性及安全性Meta分析  被引量:3

Effectiveness and safety of rLH and rFSH in patients undergoing in vitro fertilisation/intracytoplasmic sperm microinjection applied GnRH antagonist protocol:A meta-analysis

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作  者:彭清妹 周志军 黄筱金[2] PENG Qing-mei;ZHOU Zhi-jun;HUANG Xiao-jin(Department of Medicine,Jinggangshan University,Ji′an,Jiangxi 343000,China;Department of Auxiliary Reproductive Medicine,First Affiliated Hospital of Nanchang University,Nanchang 330000,China)

机构地区:[1]井冈山大学医学部,江西吉安343000 [2]南昌大学第一附属医院辅助生殖科,南昌330000

出  处:《解放军医学杂志》2019年第11期958-963,共6页Medical Journal of Chinese People's Liberation Army

摘  要:目的比较在体外受精(IVF)或卵胞浆内单精子显微注射(ICSI)治疗的促性腺激素释放激素(GnRH)拮抗剂方案中应用重组促黄体生成素(rLH)与重组卵泡刺激素(rFSH)的有效性及安全性。方法计算机检索PubMed、Embase、CochraneLibrary、ClinicalTrials.gov、中国期刊全文数据库(CNKI)、万方数据库及维普数据库,收集在IVF或ICSI的GnRH拮抗剂方案中rLH联合rFSH与单独应用rFSH的随机对照试验(RCT),检索时限均为从建库至2018年12月。按Cochrane系统评价方法,由两位评价者按照纳入与排除标准独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入10个RCT研究1965例患者,其中rFSH+rLH组988例,rFSH组977例。Meta分析结果显示:与rFSH组比较,rLH+rFSH组在临床妊娠率(RR=1.02,95%CI 0.82~1.27,P=0.85)、持续妊娠率(RR=1.06,95%CI0.86~1.32,P=0.57)、流产率(RR=1.38,95%CI0.75~2.54,P=0.29)、因卵巢低反应取消的不良事件发生率(RR=0.90,95%CI 0.42~1.93,P=0.78)及因将发生卵巢过度刺激综合征而取消的不良事件发生率(RR=1.06,95%CI0.56~1.99,P=0.86)方面,差异均无统计学意义。结论与单独应用rFSH相比,rLH联合rFSH对临床妊娠率、持续妊娠率、流产率及因卵巢低反应、将发生卵巢过度刺激综合征而取消的不良事件发生率均无明显影响。但受纳入研究质量的限制,上述结论尚需开展更多高质量研究予以验证。Objective To compare the effectiveness and safety of recombinant luteinizing hormone(rLH) combined with recombinant follicle-stimulating hormone(rFSH) and rFSH alone in women undergoing in vitro fertilisation/intracytoplasmic sperm microinjection(IVF/ICSI) applied gonadotrophin-releasing hormone(GnRH) antagonist. Methods The databases including PubMed, Embase, Cochrane Library, ClinicalTrials.gov, CNKI, VIP and Wanfang Data were electronically searched to collect the randomized controlled trials(RCT) applied GnRH antagonist using rLH+rFSH or rFSH alone in IVF/ISCI cycles from inception to Dec. 2018. Following the Cochrane system evaluation and according to the criteria for inclusion and exclusion, two reviewers independently screened literature, extracted data and evaluated the bias risk for inclusion in studies, and then metaanalysis was conducted by RevMan 5.3 software. Results A total of 10 RCT studies involving 1965 patients were included, of them 988 cases in rFSH+rLH group and 977 cases in rFSH alone group. Meta-analysis showed no significant difference between rFSH alone group and rLH+rFSH group in clinical pregnancy rate(RR=1.02, 95%CI 0.82-1.27, P=0.85), ongoing pregnancy rate(RR=1.06, 95%CI 0.86-1.32, P=0.57), miscarriage rate(RR=1.38, 95%CI 0.75-2.54, P=0.29), incidence of adverse events canceled due to ovarian hyporesponsiveness(RR=0.90, 95%CI 0.42-1.93, P=0.78), and the incidence of adverse events canceled due to ovarian hyperstimulation syndrome(OHSS)(RR=1.06, 95%CI 0.56-1.99, P=0.86). Conclusions Current evidence shows that, compared with rFSH alone group, the rLH+rFSH group showed no effect on the clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, incidence of adverse events canceled due to ovarian hyporesponsiveness, and the incidence of adverse events canceled due to OHSS. The above conclusions need to be verified by more high quality research since the quality and quantity limited of included studies.

关 键 词:重组促黄体生成素 重组卵泡刺激素 体外受精 卵胞浆内单精子显微注射 系统评价 META分析 

分 类 号:R715.2[医药卫生—妇产科学]

 

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