卵巢低反应患者高孕激素状态下促排卵方案与拮抗剂方案临床应用效果对比的meta分析  

Comparison of the clinical efficacy of progestin-primed ovarian stimulation protocol and antagonist protocol in patients with poor ovarian response:a meta-analysis

作　　者：杨欣 曹金龙 潘惠娟 张春芳 李晓凤[1] 王芳[1] Yang Xin;Cao Jinlong;Pan Huijuan;Zhang Chunfang;Li Xiaofeng;Wang Fang(Center of Reproductive Medicine,the Second Hospital of Lanzhou University,Lanzhou 730030,China;Urology Institute of Lanzhou University Second Hospital,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院生殖医学中心,兰州730030 [2]兰州大学第二医院泌尿研究所,兰州730030

出　　处：《中华生殖与避孕杂志》2022年第4期379-387,共9页Chinese Journal of Reproduction and Contraception

基　　金：兰州大学第二医院人才引进项目(ynyjrckyzx2015-3-03);兰州大学第二医院“萃英科技创新”计划(CY2018-MS12)。

摘　　要：目的比较高孕激素状态下促排卵(progestin-primed ovarian stimulation, PPOS)方案与拮抗剂方案对卵巢低反应(poor ovarian response, POR)患者的临床应用效果。方法通过检索Pubmed、The Cochrane Library、Embase、Web of Science、CNKI、Wanfang Data、CBM数据库, 搜集PPOS方案与拮抗剂方案应用于POR患者的队列研究和随机对照试验(randomized controlled trials, RCT), 检索时限从建库至2020年5月。严格筛选文献和提取资料后, 队列研究使用改良纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale, NOS)系统评价方法、RCT研究使用Cochrane系统评价方法对文献进行质量评价, 并使用RevMan5.3软件进行meta分析。结果共纳入队列研究7篇, RCT文献3篇, 包括1977例POR患者, 其中PPOS方案组1053例, 拮抗剂方案924例。Meta分析结果显示, PPOS方案的促性腺激素(gonadotropin, Gn)使用时间延长(P=0.02), 但Gn总用量与拮抗剂方案相比差异无统计学意义(P>0.05);PPOS方案的直径≥14 mm卵泡数和获卵数与拮抗剂方案相比差异无统计学意义(P>0.05), MⅡ卵率和受精率显著高于拮抗剂方案(P=0.04, P<0.001), 但两组方案的优质胚胎率差异无统计学意义(P>0.05);PPOS方案的早发黄体生成素(luteinizing hormone, LH)峰发生率明显降低(P=0.04), 扳机日雌二醇、孕酮、卵泡刺激素、LH水平与拮抗剂方案相比差异均无统计学意义(均P>0.05);PPOS方案的临床妊娠率高于拮抗剂方案, 而流产率低于拮抗剂方案(P=0.03, P<0.001), 但周期取消率和出生率与拮抗剂方案相比差异均无统计学意义(均P>0.05)。结论 PPOS方案可明显降低POR患者促排卵中LH峰发生率, 提高MII卵率, 改善妊娠结局, 降低不良妊娠发生率, 可在POR患者中广泛安全使用。Objective To compare the clinical efficacy of progestin-primed ovarian stimulation(PPOS)protocol and gonadotropin-releasing hormone(GnRH)-antagonist protocol in patients with poor ovarian response(POR).Methods By retrieving Pubmed,the Cochrane Library,Embase,Web of Science,CNKI,Wanfang Data,and CBM databases,the cohort studies and randomized controlled trials(RCTs)of PPOS and antagonist protocols applied to POR patients were collect and the retrieval time period was from establishment of the database to May 2020.After rigorous literature screening and data extraction,the cohort study used Newcastle Ottawa Scale(NOS)system evaluation method,the RCT used Cochrane system evaluation method to evaluate the literature quality,and the RevMan5.3 software was used for meta-analysis.Results A total of 7 cohort studies and 3 RCTs were included,totally 1977 POR patients,including 1053 in the PPOS protocol group and 924 in the antagonist protocol.Meta-analysis showed that the duration of gonadotropin(Gn)used in PPOS protocol group was extended(P=0.02),but there was no significant difference in the total dosage of Gn used compared with the antagonist protocol(P>0.05).There were no significant differences in the number of follicles with a diameter≥14 mm and the number of retrieved oocytes between PPOS protocol group and antagonist protocol group(all P>0.05),the MⅡoocyte rate and the fertilization rate were significantly higher than those of antagonist protocol(P=0.04,P<0.001),but there were no significant differences in the rate of high-quality embryos between the two groups(P>0.05).The incidence of early onset luteinizing hormone(LH)peak significantly reduced with PPOS protocol(P=0.04),the levels of estrogen,progesterone,follicle-stimulating hormone(FSH)and LH on trigger day were not significantly different from those of antagonist protocol(all P>0.05).The clinical pregnancy rate of PPOS protocol was higher than that of the antagonist protocol,but the abortion rate was lower than that of the antagonist protocol(P=0.03,P<0.

关 键 词：高孕激素状态下促排卵 促性腺激素释放激素拮抗剂 控制性促排卵 卵巢低反应 META分析 

分 类 号：R714.8[医药卫生—妇产科学]