克罗米芬、来曲唑和二甲双胍对PCOS患者促排卵效果和妊娠结局的网状Meta分析  

A network meta-analysis of effects of clomiphene,letrozole and metformin on ovulation induction and pregnancy outcome in patients with polycystic ovary syndrome

作　　者：蒋玲洁 文亮 郎冉冉 罗珩 何玉萍 JIANG Ling-jie;WEN Liang;LANG Ran-ran;LUO Heng;HE Yu-ping(Outpatient Department of Reproductive Medicine Center,Second Affiliated Hospital of Air Force Military Medical University,Xi’an 710038;Graduate School of PLA General Hospital,Beijing 100089;Reproductive Ward of the Second Affiliated Hospital of Air Force Military Medical University,Xi’an 710038)

机构地区：[1]空军军医大学第二附属医院生殖医学中心门诊,西安710038 [2]解放军总医院研究生院,北京100089 [3]空军军医大学第二附属医院生殖病区,西安710038

出　　处：《生殖医学杂志》2022年第6期820-827,共8页Journal of Reproductive Medicine

摘　　要：目的应用网状Meta分析的方法研究来曲唑、克罗米芬和二甲双胍对多囊卵巢综合征(PCOS)患者促排卵效果和妊娠结局的影响。方法计算机检索The Cochrane Library、PubMed、Embase、Web of Science、中国知网(CNKI)、万方数据库(WanFang Data)、维普数据库(VIP)和中国生物医学文献数据库(CBM),纳入建库至2021年6月关于来曲唑、克罗米芬和二甲双胍对PCOS患者促排卵效果和妊娠结局的随机对照试验文献,由2位评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险,利用Stata 13.0软件进行网状Meta分析。结果本研究Meta分析纳入17篇文献,共1975例患者、4种药物干预措施(克罗米芬+二甲双胍、二甲双胍、克罗米芬、来曲唑)。网状Meta分析结果显示,在改善PCOS患者妊娠率方面,来曲唑、克罗米芬+二甲双胍与二甲双胍、克罗米芬相比均具有统计学差异(P<0.05),其优劣排序为克罗米芬+二甲双胍=来曲唑>克罗米芬>二甲双胍;在改善PCOS患者排卵率方面,来曲唑、克罗米芬+二甲双胍与二甲双胍、克罗米芬相比也均具有统计学差异(P<0.05),其优劣排序为克罗米芬+二甲双胍=来曲唑>克罗米芬>二甲双胍;而在改善PCOS患者流产率方面,二甲双胍、克罗米芬+二甲双胍、来曲唑与二甲双胍之间的比较均无统计学差异(P>0.05)。结论克罗米芬+二甲双胍和来曲唑能显著提高PCOS患者的排卵率和妊娠率,但有研究提示体质量指数(BMI)可能对干预结局存在影响,尚需更严谨的针对不同BMI亚组的临床对照研究。Objective:To evaluate the effects of letrozole,clomiphene and metformin on ovulation induction and pregnancy outcome in patients with polycystic ovary syndrome(PCOS)by using the network meta-analysis.Methods:Literature search was conducted in Cochrane Library,PubMed,Embase,Web of Science,China Journal Full-text Database(CNKI),WanFang Data,VIP Database(VIP)and China Biomedical Literature Database(CBM)from establishment of library to June 2021.The randomized controlled trials(RCTs)involved the effects of letrozole,clomiphene and metformin on ovulation induction and pregnancy outcome in patients with PCOS were included.Two evaluators independently screened the literature,extracted data,evaluated the risk of bias included in the study and used Stata 13.0 software for network meta-analysis.Results:This study included 17 RCTs with a total of 1975 patients,and 4 drug interventions(clomiphene plus metformin,metformin,clomiphene,letrozole).The results of the network meta-analysis showed that in terms of improving ovulation rate and the pregnancy rate of PCOS patients,letrozole and clomiphene plus metformin were statistically significant compared with clomiphene or metformin(P<0.05).The rank of pregnancy rate results showed that clomiphene plus metformin=letrozole>clomiphene>metformin.In improving the abortion rate of PCOS patients,there was no significant difference among metformin,clomiphene+metformin,letrozole and metformin(P>0.05).Conclusions:Current evidence shows that clomiphene plus metformin or letrozole can improve ovulation rate and pregnancy rate in PCOS patients.However,given some studies suggest that BMI may affect the pregnancy outcome,it is recommended to carry out more RCTs in different BMI subgroups to evaluate the effects.

关 键 词：多囊卵巢综合征 药物干预 网状Meta分析 

分 类 号：R711.6[医药卫生—妇产科学]