拮抗剂方案促排卵周期中黄体支持添加雌激素对临床结局影响的Meta分析  

Is it better to add estrogen for luteal support in fresh cycles of GnRH-antagonist protocols?A meta-analysis

作　　者：方骏涛 吴庚香[1] FANG Jun-tao;WU Geng-xiang(Reproductive Medical Center,Renmin Hospital of Wuhan University,Wuhan 430060)

机构地区：[1]武汉大学人民医院生殖医学中心,武汉430060

出　　处：《生殖医学杂志》2023年第5期747-754,共8页Journal of Reproductive Medicine

基　　金：武汉大学教学研究项目(2020JG073);武汉大学医学部教学研究项目(2021012)。

摘　　要：目的 采用Meta分析方法系统评价拮抗剂方案促排卵鲜胚移植周期中黄体支持时添加雌激素对患者临床结局的影响。方法 计算机检索中国知网、维普、万方、中国生物医学文献、Pubmed、Embase、Cochrane Library、Web of Science等数据库从建库至2022年8月有关拮抗剂方案促排卵周期中黄体支持时添加雌激素的随机对照试验和临床队列研究,制定纳入与排除标准,筛选符合标准的文献,以黄体支持中使用孕激素者为对照组,黄体支持使用孕激素+雌激素者为实验组。采用RevMan 5.3软件及STATA 17软件进行Meta分析。结果 共10篇文献(1 212个周期)被纳入本研究。Meta分析结果显示,实验组的临床妊娠率显著高于对照组[RR=1.23,95%CI(1.05,1.45),P=0.01],而两组的流产率[RR=1.17,95%CI(0.43,3.19),P=0.76]、持续妊娠率[RR=1.95,95%CI(0.69,5.52),P=0.21]、活产率[RR=1.15,95%CI(0.86,1.55),P=0.34]均无显著性差异。行Egger检验和Begg检验分析纳入文献的发表偏倚,结果显示无明显发表偏倚(P_(Egger)=0.203 4,PBegg=0.107 4)。结论 对于使用拮抗剂方案促排卵的患者,黄体支持中添加雌激素可以提高患者的临床妊娠率,对于持续妊娠率、流产率和活产率的影响还有待大样本的随机对照研究证据支持。Objective:To systematically evaluate the effect of estrogen supplementation for luteal support during ovulation and pregnancy assistance with antagonist protocol on the clinical outcome of patients by a meta-analysis.Methods:The randomized controlled trials and clinical cohort studies about adding estrogen for luteal support during ovulation induction with GnRH antagonist protocol and fresh embryo transfer cycle were searched in CNKI,Vip,Wanfang,Chinese Biomedical Literature,Pubmed,Embase,Cochrane library,Web of Science,etc.databases from the establishment of database to August 2022.The inclusion and exclusion criteria were formulated,and the literature meeting the criteria were screened.The patients who used progesterone in luteal support were included in the control group,and the patients who used progesterone+estrogen in luteal support were included in the experimental group.RevMan5.3 and STATA 17 software were used for meta-analysis.Results:There were 10 studies(1212 cycles)were included in the study.The meta-analysis results show that clinical pregnancy rate[RR=1.23,95%CI(1.05,1.45),P=0.01]of the experimental group was significantly higher than that in the control group,but there was no significant difference in the abortion rate[RR=1.17,95%CI(0.43,3.19),P=0.76],ongoing pregnancy rate[RR=1.95,95%CI(0.69,5.52),P=0.21]and live birth rate[RR=1.15,95%CI(0.86,1.55),P=0.34]between this two groups.Egger test and Begg test showed there was no publication bias(P_(Egger)=0.2034,P Begg=0.1074).Conclusions:Estrogen supplementation for luteal support can improve the clinical pregnancy rate of fresh cycles in patients with GnRH-antagonist protocols,but more evidence of randomized controlled trials are needed to support the effect on ongoing pregnancy rate,abortion rate and live birth rate.

关 键 词：拮抗剂方案 黄体支持 雌激素 META分析 

分 类 号：R711.6[医药卫生—妇产科学]