促性腺激素释放激素抑制剂与促性腺激素释放激素激动剂用于IVF-ET中正常反应患者的系统性评价及Meta分析

Comparisons of GnRH antagonist versus GnRH agonist protocol in normal ovarian responders undergone IVF:a systematic review and meta-analysis

目的系统性评价促性腺激素释放激素拮抗剂(GnRH-ant)与促性腺激素释放激素激动剂(GnRH-a)长方案用于体外受精-胚胎移植(IVF-ET)中正常反应患者促排卵治疗的有效性及安全性。方法计算机检索6种数据库,时间截止至2014年12月底。纳入GnRH-ant与GnRH-a用于卵巢正常反应患者治疗的随机对照试验(RCT),采用Revman5.1软件进行Meta分析。结果 24篇RCT符合纳入标准。刺激天数(MD:-0.70,95%CI:-1.08^-0.32)、Gn用量(MD:-2.94,95%CI:-4.9^-0.97)、HCG日E2值(MD:-353.75,95%CI:-530.60^-176.90)、获卵数(MD:-1.32,95%CI:-2.00^-0.64)、临床妊娠率(OR:0.87,95%CI:0.75~1.00)、OHSS率(OR:0.57,95%CI:0.41~0.79)GnRH-ant组显著低于GnRH-a长方案组(P<0.05),但是HCG日子宫内膜厚度(MD:-0.07,95%CI:-0.25~0.12)、持续妊娠率(OR:0.88,95%CI:0.75~1.03)、活产率(OR:0.90,95%CI:0.70~1.17)、流产率(OR:1.18,95%CI:0.86~1.62)、周期取消率(OR:1.10,95%CI:0.89~1.35)两组差异无统计学意义(P>0.05)。结论在正常反应患者行IVF-ET治疗中,GnRHant方案较之GnRH-a标准的长方案显著降低卵巢过度刺激综合征(OHSS)发生率,持续妊娠率、活产率相似。

Objective：To evaluate the effectiveness and safety of GnRH antagonist and GnRH agonist in supposed normal ovarian responders undergone IVF.Methods：The data from 6databases were retrieved for this study.The random control trials（RCTs）of GnRH agonist and GnRH antagonist used during IVF-ET therapy for patients with supposed normal ovarian response were included.A meta-analysis was performed with Revman 5.1software.Results： Twenty-four RCTs met the inclusion criteria.The number of stimulation days（mean difference（MD）：-0.70,95% confidence interval（CI）：-1.08to-0.32）,gonadotropin amount（MD：-2.92,95% CI：-4.9to-0.97）,E2 values on the HCG day（MD：-353.75,95% CI：-530.60to-176.90）,number of oocytes retrieved（MD：-1.32,95% CI：-2.00to-0.64）,clinical pregnancy rate（odds ratio OR）：0.87,95% CI：0.75 to 1.00）,and ovarian hyperstimulation syndrome（OHSS）incidence（OR：0.57,95% CI：0.41 to 0.79）were significantly lower in GnRH antagonist protocol than those in GnRH agonist protocol.However,the endometrial thickness on the HCG day（MD：-0.07,95% CI：-0.25 to 0.12）,the ongoing pregnancy rate（OR：0.88,95% CI：0.86 to 1.62）,live birth rate（OR：0.90,95%CI：0.70 to 1.17）,miscarriage rate（OR：1.18,95%CI：0.86 to 1.62）,and cycle cancellation rate（OR：1.10,95% CI：0.89 to 1.35）did not significantly differ between the two groups（P〉0.05）.Conclusions：During IVF treatment for patients with supposed normal responses,the incidence of OHSS is significantly lower,whereas the ongoing pregnancy and live birth rates are similar in the GnRH antagonist compared with the standard long GnRH agonist protocols.