来曲唑和枸橼酸氯米芬诱导多囊卵巢综合征患者排卵疗效分析

The Meta-Analysis for the Effects of Letrozole and Clomiphene Citrate for Ovulation Induction in Women with Polycystic Ovarian Syndrome

目的评价多囊卵巢综合征患者使用来曲唑和枸橼酸氯米芬诱导排卵的有效性。方法全面检索相关的中英文数据库,提取数据资料,应用系统评价专用处理软件RevMan4.2进行入选研究的同质性检验和数据的合并分析。结果共5篇文献被纳入。来曲唑组和枸橼酸氯米芬组妊娠率比较相对危险度1.46(0.87～2.44),P=0.15;排卵率相对危险度0.96(0.90～1.03),P=0.22,均无显著性差异;对枸橼酸氯米芬抵抗和反应不良的多囊卵巢综合征患者使用来曲唑妊娠率更高,相对危险度2.12(1.14～3.97),P=0.02,差异有显著性。来曲唑组注射绒毛膜促性腺素日雌二醇水平更低,差异有显著性(P=0.0003)。≥18mm卵泡数、注射绒毛膜促性腺素日子宫内膜厚度和流产率无显著性差异(P=0.43,P=0.43,P=0.66)。结论多囊卵巢综合征患者使用来曲唑和枸橼酸氯米芬诱导排卵的疗效没有显著差异,尚无充分证据证明来曲唑的疗效优于枸橼酸氯米芬,需要进行更多的临床研究。

Objective To evaluate the efficacy of Letrozole and Clomiphene Citrate （CC） for ovulation induction in women with polycystic ovarian syndrome （PCOS）. Methods Browsing the studies thoroughly, followed by taking up the data for recta-analysis. Results The pregnancy rate and ovulation rate in Letrozole group as compared with CC group did not show significant difference （RR1.46, 95%CI 0.87-2.44, P=0.15） and （RR 0.96, 95%CI 0.90-1.03, P=0.22）, whereas in PCOS patients with an inadequate response to CC, the pregnancy rate was higher in Letrozole group （RR 2.12, 95%CI 1.14-3.97, P=0.02）. The mean total estradiol level on day of HCG administration was significantly lower in Letrozole group （WMD -200.33, 95%CI -309.51-91.16 , P=0.000 3）. There was no statistical difference in number of follicles ≥ 18 mm in diameter, endometrial thickness on day of HCG administration and miscarriage rate （P=0.43, P=0.43, P=0.66）. Conclusion Letrozole is at least as effective as CC for inducing ovulation and achieving pregnancy in patients with PCOS. Not enough evidence is obtained to support the better efficacy of Letrozole over CC. It is hoped that further well designed clinical trials will be conducted on a large scale.