复方口服避孕药治疗原发性痛经的系统评价

Combined Oral Contraceptives in the Treatment of Primary Dysmenorrhea:a Systematic Review

目的:复方口服避孕药(COC)治疗原发性痛经是否有效尚缺乏大样本高质量的临床研究证实,本研究旨在通过循证医学方法评价COC治疗原发性痛经的安全性及有效性。方法:计算机检索Medline、EMbase、Cochrane Library、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库,检索时间从各数据库建立至2011年7月;同时辅助其他检索方法,所检索文献由两名系统评价者独立评价纳入研究并提取资料,并用RevMan5.1软件进行统计学分析。结果:共纳入8项研究,Meta分析结果显示:与安慰剂组相比,COC组可以降低患者McGill疼痛问卷(MDQ)评分(MD=2.7,95%CI:0.92～4.48,P=0.003)和目测类比疼痛(VAS)评分(MD=0.87,95%CI:0.54～1.21,P<0.000 01),2组不良反应发生率差异无统计学意义;第1、2代COC与第3代COC相比,患者疼痛缓解率差异无统计学意义(OR=1.13,95%CI:0.76～1.68,P=0.54)。结论:COC可缓解原发性痛经患者症状且不良反应发生率低,值得临床推广应用。鉴于目前研究样本量小,评价指标欠统一,COC治疗原发性痛经的有效性有待于更多高质量研究的进一步证实。

Objective：To evaluate the efficacy and safety of the combined oral contraceptive（COC） in the treatment of primary dysmenorrheal.Methods：Medline,Embase,The Chinese Biomedical Database（CJFD） and Chinese science and technology journal full-text database（CSJD）.All of the included studies were evaluated by Cochrane Handbook,homogenous studies were analyzed by Revman5.1.1 software.Results：Eight studies were included.Compared with placebo group,the COC group had a statistically significant in MDQ score（MD=2.7,95%CI：0.92-4.48,P=0.003） and VAS score（MD= 0.87,95%CI：0.54-1.21,P0.000 01）,The COC group has no statistically significant in adverse effect（OR=1.13,95%CI：0.76-1.68,P=0.54）.Conclusions： The COC can significantly reduce the pain score of the patients of primary dysmenorrheal,and it to be worthy of clinical application.But there is limited studies and the measure or index of these studies are different,so we look forward to more high quality studies to further prove the effectiveness of the COC.