保守性手术后联合GnRH-a治疗子宫内膜异位症相关不孕有效性的系统评价

GnRH agonist treatment on endometriosis-associated infertility after conservative surgery:a systematic review.

目的:评价促性腺激素释放激素激动剂(GnRH-a)应用于子宫内膜异位症(EMs)相关不孕患者保守性手术后的临床疗效。方法:计算机检索PubMed、Embase、CB-MDISC、VIP、CNKI、万方数据库等,手工检索相关专业资料(包括期刊和会议论文),均检索至2011年12月,语种仅限汉语和英语。纳入GnRH-a治疗保守性手术后EMs相关不孕患者的随机对照试验(RCT),质量评价后,采用RevMan5.1软件进行Meta分析。结果:共纳入18篇RCT,共计1322例。Meta分析结果显示:与不用药组相比,GnRH-a组中Ⅰ～Ⅱ期患者的妊娠率无显著差异,而Ⅲ～Ⅳ期患者的妊娠率提高[Ⅰ～Ⅱ期:OR=1.08,95%CI(0.71,1.64),P=0.71;Ⅲ～Ⅳ期:OR=2.44,95%CI(1.69,3.52),P<0.00001]。GnRH-a组中随访1年内的妊娠率提高,而随访2～3年内的妊娠率无显著差异[随访1年:OR=1.97,95%CI(1.45,2.68),P<0.0001;随访2～3年:OR=0.74,95%CI(0.39,1.40),P=0.35]。GnRH-a能降低患者的复发率[OR=0.44,95%CI(0.25,0.79),P=0.006]。与孕三烯酮组比较,GnRH-a能提高患者的妊娠率[OR=1.93,95%CI(1.33,2.81),P=0.0006],降低患者的复发率[OR=0.44,95%CI(0.23,0.84),P=0.01]。结论:GnRH-a治疗提高Ⅲ～Ⅳ期EMs不孕患者行保守性手术后1年的妊娠率,降低EMs复发率。GnRH-a在降低复发率和提高妊娠率方面的疗效优于孕三烯酮。

Objective：To evaluate the effectiveness of postoperative GnRH agonist in patients with endometriosis-associated infertility. Methods： The cochrane systematic review method was used to evaluate the randomized controlled trial （RCT） of GnRH agonist in postoperative medical therapy for endometriosis-associated infertility. The searching strategy included： PubMed, Embase, CBMDISC, CNKI, VIP and WANFANG Database. Relevant journals were also hand searched. The search was conducted in Dec. 2011. Languages was restricted to Chinese and English. Two reviewers independently extracted the data and analyzed them in Revman Manager 5.1 software. Results： （1）Thirteen RCTs including 1322 patients were included. In GnRH-a compared with control group, there was a significantly higher rate of pregnancy of Ⅲ～ Ⅳ endometriosis-associated infertility[Ⅰ～Ⅱ ：OR = 1.08,95% CI （0.71,1.64）, P = 0.71 ;Ⅲ～Ⅳ ：OR=2.44,95% CI（1. 69,3. 52） ,P〈0.00001 ]. There was a significantly higher rate of pregnancy within one year of treatment [ 1 year： OR = 1.97,95% CI （ 1.45,2.68 ）, P 〈 0. 0001 ;2 ～ 3 years ： OR = 0.74,95 % CI （0.39,1.40）, P = 0.35 ]. Postoperative GnRH agonist for endometriosis-associated infertility could reduce recurrence rate [ OR = 0.44,95% CI（ 0.25, 0.79 ） , P = 0. 006 ]. In GnRH-a compared with gestrinone group, there was a significantly higher rate of pregnancy[ OR= l. 93,95% CI （ 1.33,2.81 ） ,P=O. 0006] and lower rate of recurrence [ OR=0.44,95% CI （0.23,0.84） ,P=0.01 ]. Conclusions： Postoperative GnRH agonist for Ⅲ ～ Ⅳ endometriosis-associated infertility can improve the pregnancy rate within one year of treatment and reduce the recurrence rate. Compared with gestrinone, there is a significantly higher rate of pregnancy and lower rate of recurrence.