GnRH-a治疗子宫内膜异位症对骨密度影响的系统评价

The Effect of Gonadotrophin-Releasing Hormone Agonist on Bone Mineral Density in Endometriosis:A Systematic Review

目的:评价促性腺激素释放激素激动剂(GnRH-a)治疗子宫内膜异位症对骨密度影响。方法:检索Cochrane Library、MEDLINE、EMBASE、中国生物医学文献数据库、CBM、CNKI等。纳入GnRH-a治疗子宫内膜异位症的随机对照试验,对其方法学质量进行评价。用RevMan 4.2.10软件进行统计分析。结果:①GnRH-a组骨密度和骨丢失率明显大于反加疗法[RR=0.03,95%CI(0.01,0.06),P<0.05;RR=1.86,95%CI(1.11,2.61),P<0.01]。其余描述性研究支持上述结果,认为两组差异有统计学意义(P<0.05)。GnRH-a组骨密度减少大于孕激素组(P<0.05)。②GnRH-a组药物副反应比反加疗法组大(P<0.05),雌激素水平也比反加疗法组下降多(P<0.01),在缓解疼痛上与反加疗法组差异无统计学意义(P>0.05)。GnRH-a组在缓解疼痛、药物副反应方面同孕激素组差异均无统计学意义。结论:目前研究认为GnRH-a组与反加疗法组、孕激素组在缓解子宫内膜异位症疼痛上效果相同,GnRH-a组所致骨密度下降大于其余两组。反加疗法组能降低GnRH-a所致骨密度下降及潮热等副反应,为长期和反复治疗提供了一个较好方案。但纳入研究质量不高、样本量小,有必要设计和实施严密、科学的多中心、大样本、高质量的随机双盲临床对照试验研究来进一步验证。

Objective：To determine the effect of gonadotrophin-releasing hormone agonist（GnRH-a） on the bone mineral density in women with endometriosis. Methods： A search for relevant articles was run on Cochrane Ubrary, MEDLINE, EMBASE, CBM,CNKI et al database. Randomized controlled trials（RCTs） of patients with endornetricsis treated with GnRH-a were included. Meta-analysis was performed by RevMan 4.2.10 software. Results： ①The reduce of BMD and the rate of bone loss were higher in the GnRH-a group than these in the add-back therapy group [RR=0.03;95%Cl（0.01,0.06） P〈0.05],[RR= 1.86;95%Cl（1.11,2.61 ） P〈 0.01 ]. The remaining descriptive study supported these results which indicated there was significant statistic difference between these two groups （ P 〈 0.05）. The BMD was decreased in the GnRH-a group compared with progestagens group（ P 〈 0.05）. ②The side effect was more and the serum F-2 level was also declined in the GnRH-a group compared with the add-back therapy group（ P 〈 0.05）. There was no statistic difference in pelvic pain compared with the add-back therapy group （ P〉0.05）. There was no difference in the pelvic pain and the drug side effect in the GnRH-a group compared with progestagens group.Conclusions： In GnRH-a group, the effect which releasing pelvic pain in endometriosis is the same as in the add-back therapy group and progestagens group. The decrease of BMD is higher in GnRH-a group than that in progestagens group. Add-back therapy can alleviate the BMD decrease and hot flush induced by GnRH-a, which provide a favorable project to long-term and reduplicated therapy. The evidence is not strong because of the low quality and small sample in the selected studies. Much more large-scale, multi-canter, randomized, double-blinded, oontrolled clinical trials are required in the future.