激素治疗小儿隐睾的系统评价

Systematic Review of Hormone Treatment for Children with Cryptorchidism

目的 评价激素治疗隐睾的效果，为进一步的临床研究与实践提供参考。方法 制定原始文献的纳人标准、排除标准及检索策略，在美国医学索引MEDLINE（1966-2004）、荷兰医学文摘EMBASE（1974～2004）、Cochrane图书馆的图书馆临床对照试验资料库（2004年第4期）、中国生物医学文献光盘数据库CBMdisc（1978-2004）、中国期刊全文数据库（1994～2004）和万方数据库（1980-2004）内检索、收集激素治疗隐睾的相关随机对照试验（RCT），并手检相关参考文献，进行质量评价和资料提取。应用RevMan4．2版软件进行数据的Meta分析处理；本系统评价疗效资料均为分类变量，故以比数比或相对危险度（PetoOR或RR）及其95％可信区间（95％（21）表示效应量。结果 共检索到相关文献500篇，其中RCT29篇，排除18篇，符合纳人标准11篇进人Meta分析。结果2个研究组设立人绒毛膜促性腺激素（HCG）治疗组和对照组，其睾丸完全下降率分别为25．2％与5．48％，PetoOR值及其95％C1分别为4．67[2．94，7．43]；10个随机化组比较促性腺激素释放激素（GnRH）治疗组和对照组的效果，其睾丸完全下降率分别是17．2％与3．04％，PetoOR值及其95％（21分别为4．73[3．34，6．68]；3个组比较HCG治疗组和GnRH治疗组，其睾丸完全下降率分别为24．0％与13．1％，PetoOR值及其95％（21分别为2．11[1．38，3．21]；两组比较HCG或GnRH治疗单侧隐睾和双侧隐睾的效果，其睾丸完全下降率分别为25．0％与20．9％，其RR值及其95％（21分别为1．16[0．69．1．95]。结论 按照目前已有资料分析，HCG较GnRH治疗隐睾有效，GnRH较安慰剂有效；激素治疗双侧隐睾效果较单侧隐睾好。但由于这些试验RCT数量较少，且可能存在一定程度的偏倚，因此其结果只能供临床参考。

Objective To evaluate the curative effect of clinical use of hormone in cryptorchidism children. Methods We search MELINE（ 1966 - 2004）, EMBASE（ 1974 - 2004 ）, the Cochrane Controlled Trials Register （ issue 4,2004 ）, CBMdisc （ 1978 - 2004 ）, CNKI（ 1994- 2004） and Wangfang data（ 1980- 2004） for RCTs. We also had searched the relative references. The search strategy was made according to the Collaborative Review Group search strategy. Data were extracted by two reviewers using the designed extraction form. The software Rev Man was used to review management and data analysis. The results were expressed as Peto odds ratic （Peto OR ） or relative Hsk （ RR ） and 95 % confidence interoals （ CI ） for categorical outcomes. Results Five hundred relevant literatures were searched,of which 29 were RCTs and 11 were included and 18 were excluded. Two studies of cryptorchidism therapy compared human chorionic gonadotrophin（HCG） with placebo,with a complete testicular descent rate of 25.2% vs 5.48%, Peto OR and 95% CI were 4.67 [ 2.94,7.43 ], respectively. Ten studies compared intranasal, gonadotropin - releasing hormone （GnRH） with placebo, with complete testicular descent rates of 17.2 % vs 3.04 %, Peto OR and 95 % CI were 4.73 [ 3.34,6.68 ], respectively. Three studies compared HCG with GnRH, with complete testicular descent rates of 24.0 % and 13.1%, Peto OR and 95 % CI were 2.11 [ 1.38,3.21 ], respectively. Two studies compared unilateral cryptorchidism with bilateral, with complete testicular descent rates of 25.0 % vs 20.9 %. Peto OR and 95 % CI were 1. 16[0.69,1.95 ], respectively. Conclusions With the information analyzed until the present, the evidence in the treatment of cryptorchidism HCG is effective in the treatment of cryptorchidism, and GnRH is more effective than placebo, and hormonal treatment of bilateral cryptorchidisrn show advantages for unilateral, But this evidence is based on few trials,with small sample sizes and moderated risk of bias, this treatment cannot be recommended for everyone.