来曲唑联合促性腺激素与单独使用促性腺激素用于PCOS患者促排卵治疗的临床效果系统评价

A meta-analysis of letrozole combined with human menopausal gonadotropin in subfertile women with Polycystic ovary syndrome

目的:系统评价来曲唑(LE)联合人绝经期尿促性腺激素(HMG)和单独HMG用于多囊卵巢综合征(PCOS)患者促排卵治疗的临床效果,为临床用药提供依据。方法:计算机检索中国知网、维普、万方、CBM、PubMed、The Cochrane Library等数据库,提取出相关的随机临床研究(RCT)文献进行质量评价,采用RevMan5.3软件分析文献。结果:1共有7篇文献纳入本研究中,包含601例PCOS患者,共计688个周期;2meta分析显示,LE+HMG组在HMG用量方面较HMG组低[MD=-3.64,95%CI(-7.20,-0.08),P=0.04];在优势卵泡数方面较HMG组低[MD=-1.33,95%CI(-2.33,-0.33),P=0.01];而在周期妊娠率、不良事件发生率及人绒毛膜促性腺激素(hCG)注射日子宫内膜厚度方面差异无统计学意义[RR=1.05,95%CI(0.74,1.50),P=0.78;RD=-0.03,95%CI(-0.07,0.02),P=0.22;-0.21,95%CI(-0.82,0.40),P=0.51]。结论:PCOS患者在临床促排卵治疗中,LE联合HMG与单用HMG相比,有着相似的妊娠率,并可有效地减少HMG用量,减轻患者的经济负担,具有一定的应用前景。

Objective： To evaluate the clinical outcomes of letrozolecombined with human menopausal gonadotropin（LE ＋ HMG）using for ovulation induction in patients with Polycystic ovary syndrome （PCOS）, and LE＋HMG was compare with HMC only. Methods： Database such as CNKI, VIP, Wanfang, CBMdisc, PubMed, and Cochrane Library were searched with no limited language and publication time. The relevant printed medical journals and periodicals were also hand searched. Only randomized controlled trials （RCT） were included for meta-analysis. Two reviewers searched and assessed articles quality independently. RevMan5.3 was used for analysis. Results： 7 RCTs were involved, which were including 601 women and 688 cycles. When compared LE＋ HMG with HMG only, The dosage of HMG when LE ＋HMG using was lower than that of HMG using only[MD=-3.64,95% CI（-7.20,-0.08）,P=0.04], and the number of dominant follicles were significant less of LEI-HMG than that of using HMG only, [-1.33,95 % CI （-2.33 ,-0.33）, P =0.01]. But there were no significant differences on pregnancy rate, adverse event incidence, and the endometrial thickness on the day of hCG injection,[RR= 1.05,95% CI（0.74,1.50） ,P=0.78] ;[-RD=-0.03,95%CI （-0.07,0.02）, P =0.22] ;[MD=-0.21,95%CI （-0.82,0.40）, P = 0.51]. Conclusion： LE＋ HMG not only had the similar pregnancy rate compared with that of HMG only, but also reduced the dosage of HMG it maybe relieve the economical burden of patients.