来曲唑对多囊卵巢综合征促排卵治疗有效性的系统性评价

Efficacy of Letrozole for Ovulation Induction in Patients with Polycystic Ovary Syndrome:A Systematic Review

目的:系统性评价来曲唑对多囊卵巢综合征(pcos)促排卵治疗有效性。方法:计算机检索CBMDISC(中国生物医学文献数据库1979—2010)、万方(1994—2010)、CNKI(中国学术期刊网专题全文数据库1994—2010)、维普(中国生物医学期刊数据库1989—2010);PUBMED(1997—2010)、ProQust Medical Libraray(简称PML)(1997—2010)、《外文生物医学期刊文献数据库》英文缩写FMJS(2000—2010),读秀学术搜索(www.duxiu.com),并手检相关杂志9种。纳入来曲唑与氯米芬用于多囊卵巢综合征促排卵治疗的随机对照试验,质量评价后进行Meta分析。结果:共7篇已发表研究符合纳入标准,合计1 818例。Meta分析结果显示,与氯米芬比较,刺激天数2组差异无统计学意义[WMD:1.22(-2.38～4.8)];HCG日子宫内膜厚度来曲唑组较高,敏感性分析2组差异有统计学意义[WMD:1.63(0.15～3.12)];优势卵泡数来曲唑组低于氯米芬组,2组差异无统计学意义[WMD:-0.63(-1.36～0.10)];排卵率来曲唑组高于氯米芬组,敏感性分析2组差异有统计学意义[Peto OR:2.11(1.39～3.21)];妊娠率2组差异无统计学意义[Peto OR:1.09(0.84～1.41)];流产率2组差异无统计学意义[Peto OR:1.59(0.56～4.46)]。结论:较之氯米芬,来曲唑用于多囊卵巢综合征患者促排卵治疗,有利于子宫内膜发育、促进单卵泡生长及排卵,妊娠率及流产率相似,临床上可弥补氯米芬促排卵治疗的缺点,提供另外一种选择。上述结论仍需设计严谨、多中心、大样本的随机对照试验的证实和更新。

OBJECTIVE： To conduct a systemic review on the efficacy of letrozole for ovulation induction in patients with polycystic ovarian syndrome（PCOS）.METHODS： We retrieved the databases including CBMdisc（1979-2009）,Wanfang（1994-2009）,CNKI（1994-2009）,VIP（1989-2009）,PUBMED（1997-2009）,PML（1997-2009）,FMJS（2000-2009）,duxiu scholar searcher（www.duxiu.com） and 9 related journals for collecting randomized controlled trials（RCTs） on letrozole vs.clomiphene citrate used for PCOS patients.A Meta-analysis was performed followed quality evaluation on the included trials.RESULTS： A total of seven published studies involving 1 818 cases meeting our inclusion criteria were included.Meta-analysis results showed no significant difference in stimulation duration between those treated with letrozole and those with clomiphene citrate（WMD：1.22,95% CI：-2.38 to 4.8）.As compared with those treated with clomiphene citrate,the patients treated with letrozole had higher endometrial thickness at the time of HCG administration,showing statistically significant differences between the two groups via sensitivity analysis（WMD：1.63,95% CI：0.15 to 3.12）,less dominant follicles,showing no statistically significant difference between the two groups（WMD：-0.63,95% CI：-1.36 to 0.10）,higher ovulation rate,showing statistically significant differences between the two groups via sensitivity analysis（Peto OR：2.11,95% CI： 1.39 to 3.21）,however,no statistically significant differences were noted between the two groups in both pregnancy rate（Peto OR： 1.09,95% CI： 0.84 to 1.41） and miscarraige rate（Peto OR： 1.59,95% CI： 0.56 to 4.46）.CONCLUSION： Compared with clomiphene citrate,letrozole for ovulation induction in PCOS patients facilitates endometrial development,promotes single follicular growth and ovulation,yet with similar pregnancy rate and miscarraige rate.Moreover,letrozole clinically can offset shortcomings of clomiphene ovulation induction therapy and serve as another choice.The above conclusions remain to be confirmed and updated by strictly-designed,multi-center,large sample randomized controlled trials.