TCu380A与其它常用宫内节育器效果比较的系统评价

Performance of TCu380A Compared with Other Common IUDs: A Systematic Review

目的系统评价TCu380A与其它常用宫内节育器(IUD)的有效性。方法计算机检索CBMdisc(1979～2005)、万方(1994～2005)、CNKI (1994～2005)、CMCC(1994～2005)、CMAC(1994～2005)和EMbase (1974～2004)、MEDLINE(1974～2004)、世界卫生组织生殖医学图书馆(WHO／RHL 2004～2005)、Cochrane图书馆(2004年第4期)、SCI(1985～2005)、POPLINE(1966～2003),并手检9种相关杂志。纳入TCu380A与其它常用IUD比较的随机对照试验(RCT)和临床对照试验(CCT),质量评价后进行Meta分析。结果共纳入15篇已发表研究,合计20 417例妇女。Meta分析结果显示,与TCu380A比较:①TCu220C累积脱落率较低,随访6个月及5年时差异有统计学意义[OR 0．36,95％CI(0．18,0．70);OR 0．44,95％CI(0．31,0．62)];累积妊娠率较高,随访10年时差异有统计学意义[OR 1．22(1．04,1．43)];累积因症取出率较低,随访6个月时差异有统计学意义[OR 0．59,95％CI(0．36, 0．97)]。②MLCu375累积脱落率较高,随访1年时差异有统计学意义[OR 2．17,95％CI(1．29,3．67)];累积妊娠率较高,随访1年和2年时其差异均有统计学意义[OR 1．66,95％CI(1．13,2．43);OR 1．26,95％CI(1．00, 1．58)]。③宫铜300累积脱落率较低,随访5年时差异有统计学意义[OR 0．38, 95％CI(0．27,0．56)]。④活性γ380累积因症取出率较低,随访1年时差异有统计学意义[OR 0．31,95％CI(0．14,0．70)]。结论与TCu380A比较,TCu220C长期使用(10年)的避孕效果略逊于TCu380A,但仍是一种性能优良的IUD;MLCu375临床综合效能与TCu380A类似;宫铜300具有低脱落率的特性;活性γ380能有效降低副反应发生率。但该结论还需开展多中心长随访时间的RCT加以证实。

Objective To evaluate the effectiveness of TCu380AIUD comparing with other common IUDs. Methods CBMDISC （1979 to 2005）, Wanfang （1994 to 2005）, CNKI （1974 to 2005）, CMCC （1979 to 2005）, CMAC （1994 to 2005）, EMbase （1974 to 2004）, MEDLINE （1974 to 2005）, WHO/RHL （2004 to 2005）, The Cochrane Library （Issue 4, 2004）, SCI （1985 to 2005）, POPLINE （1966 to 2003） and 9 relevant journals were searched for randomized controlled trials （RCTs） comparing TCu380AIUD with other common IUDs. The quality of included trials was criticaUy appraised. RevMan4.2.7 software was used for statistical analysis. Results Fifteen published studies involving 20 417 participants were included. The results of mcta-analyses were expressed with OR （cumulative expulsion rate, cumulative pregnancy rate, cumulative rate of removing for medical reasons） and 95% CI. Compared with TCu380A, TCu220C resulted in lower cumulative expulsion rate at 0.5 and l year of foUow-up [OR 0.36 （0.18 to 0.70）; 0.44 （0.31 to 0.62）, respectively], higher cumulative pregnancy rate at ten years of follow-up [1.22 （1.04 to 1.43）], lower cumulative rate of removing for medical reasons at 0.5 year of follow-up [0.59 （0.36 to 0.97）]; MLCu375 resulted in higher cumulative expulsion rate at l year of foUow-up [2.17 （1.29 to 3.67）], higher cumulative pregnancy rate at l and 2 years of follow-up [1.72 （l.18 to 2.50）; 1.28 （1.02 to 1.60）]; UCD300 resulted in lower cumulative expulsion rate at five years of follow-up [0.38 （0.27 to 0.56）]; Medicated Gamma 3801UD resulted in lower cumulative rate of removing for medical reasons at 1 year of foUow-up [0.31 （0.14 to 0.70）]. Conclusions Compared with TCu380A which is considered as a standard of IUDs, the pcrforrnancc of TCu220C is inferior in contraception, but TCu220C is also a good IUD in performance; The overall clinical performance of MLCu3751UD was as good as that ofTCu380A; UCD300 is of the characteristic of lower cumulative expulsion rate; Medicated Gamma 3801UD can decrease side effects effectively. However, larger multi-center randomized comparative trials with longer follow-up periods arc needed to confirm the conclusion