GnRHa对化疗引起卵巢功能损害的保护作用的Meta分析

The protective effect of GnRHa for chemotherapy-induced ovarian dysfunction:a Meta analysis.

目的：系统评价化疗联合促性腺激素释放激素激动剂（GnRHa）对防止绝经前化疗妇女卵巢损伤的疗效和安全性。方法：通过计算机检索PubMed、Cochrane Library、EMbase、CBMdisc数据库,收集使用GnRHa对绝经前化疗妇女的卵巢功能保护的临床随机对照试验（RCT）。采用RevMan5.1软件分析卵巢功能早衰（POF）的发生率、月经恢复率、妊娠率、排卵率以及不良事件发生率等指标。结果：共纳入8篇文献,共670例患恶性疾病需化疗的绝经前妇女。Meta分析结果显示：（1）化疗联合GnRHa明显降低了POF发生率[RR=0.31,95%CI（0.15-0.64）,P=0.002],提高了停止化疗后的月经恢复率和排卵率[月经：RR=1.37,95%CI（1.06-1.77）,P=0.01;排卵：RR=2.50,95%CI（1.45-4.31）,P=0.001]。（2）GnRHa联合化疗与单独化疗患者的妊娠率及不良反应发生率均无显著差异[妊娠率：RR=0.64,95%CI（0.19-2.18）,P=0.48;不良反应发生率：RR=1.31,95%CI（0.97-1.76）,P=0.07]。结论：化疗联合GnRHa治疗,可防止化疗对卵巢功能的损害,降低POF的发生率,提高月经恢复率和排卵率,无明显的不良反应。

Objective：To assess the efficacy and safety of GnRH analogues given be-fore or in parallel to chemotherapy to prevent chemotherapy-related ovarian damage in premeno-pausal women. Methods ： Through computer searches of PubMed, Cochrame Library, EMbase, CBMdisc database randomized controlled trials （RCTs） were collected in all languages, which examined the effect of GnRH agonists for chemotherapy-induced ovarian failure in premenopa-usal women. The incidence of POF and menstrual recovery, pregnancy and ovulation rate, inci-dence of adverse events were collected. The Meta-analysis was performed with RevMan 5.1. Re-suit：Eight eligible RCTs involving 670 premenopausal women with malignant and non-malig-nant diseases which need chemotherapy were included in the Meta-analysis. The Meta-analysis showed that chemotherapy combined with GnRHa significantly reduced the incidence of prema-ture ovarian failure [ RR = 0. 31,95 % CI（0. 15 - 0. 64 ） , P = 0. 002 ], and GnRHa was effective in protecting menstruation and ovulation after chemotherapy [ menstrual ： RR = 1.37,95 % CI （1.06 - 1.77） ,P=0.01 ;ovulation：RR=2.50,95%Cl（1.45-4.31） ,P=0.001 ]. The preg-nancy rates and the incidence of adverse reactions were not significantly different between groups [ pregnancy rates RR = 0.64,95 % CI（0. 19 - 2.18 ）, P = 0.48 ] ; incidence of adverse re-actions [ RR = 1.31,95 % CI （0.97 - 1.76 ）, P = 0.07 ） ]. Conclusion： GnRHa therapy com-bined with chemotherapy can prevent the damage of chemotherapy on ovarian function, reduce the incidence of POF, improve recovery rate of menstruation and ovulation rate, and has no sig-nificant adverse reactions.