曼月乐与孕三烯酮治疗子宫腺肌病疗效的Meta分析

Efficacy of Mirena versus gestrinone for treatment of adenomyosis:a meta-analysis

目的系统评价曼月乐与孕三烯酮治疗子宫腺肌病的疗效比较。方法计算机检索PubMed、MEDLINE、CNKI、CBM、WanFang Data数据库,查找国内外发表的关于比较曼月乐与孕三烯酮治疗子宫腺肌病的临床对照试验(CCT)报道,检索时限均为从建库至2014年12月,由2位评价者根据纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入7个研究,均为CCT,共计566例患者。Meta分析结果显示:曼月乐组与孕三烯酮组在减少子宫体积[MD=-10.24,95%CI(-21.93-1.44),P=0.09]、月经改善率[OR=6.15,95%CI(0.19-202.73),P=0.31]、不规则阴道流血不良反应发生率[OR=1.34,95%CI(0.57-3.18),P=0.05]和治疗12个月降低子宫内膜厚度[MD=-2.17,95%Cl(-4.66-0.33),P=0.09]等方面相比均无统计学差异;在痛经缓解率[OR=1.91,95%CI(1.03-3.53),P=0.04]和治疗6个月降低子宫内膜厚度[MD=-0.99,95%CI(-1.57--0.40),P=0.0009]方面相比均有统计学差异,其中曼月乐组的痛经缓解率显著提高。结论现有证据显示,曼月乐与孕三烯酮在减少子宫体积、月经改善率、不规则阴道流血不良反应发生率及长期降低子宫内膜厚度等方面的疗效差异无统计学意义,曼月乐较孕三烯酮在治疗子宫腺肌病患者痛经及短期降低子宫内膜厚度方面优势明显。受纳入研究的数量和质量所限,曼月乐的远期疗效仍需更多高质量、大样本随机对照试验(RCT)及CCT来加以验证。

Objective： To systematically review the efficacy of Mirena versus gestrinone in treatment of adenomyosis. Methods： PubMed,MEDLINE,CNKI,CBM and Wanfang database were searched from establishment database to December 2014 for explore the efficacy of Mirena versus gestrinone for treatment of adenomyosis. Two reviewers independently screened literatures according to the inclusion and exclusion criteria,extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed by using RevMan 5.2 software.Results： A total of 7 controlled clinical trails （CCTs） including 566 patients were included. Meta analysis results showed that there were no statistical differences in reducing uterine volume [MD = --10. 24,95%CI （-- 21. 93-1. 44） , P = 0. 09], menstrual improvement rate [OR=6.15,95%CI （0.19- 202.73） ,P= 0.31], irregular vaginal bleeding incidence [-OR = 1.34,95% CI（0. 57-3.18）, P = 0.05] and endometrial thickness reduction 12 months after treatment [MD=- 2.17,95%CI （--4.66-0. 33）, P= 0.09] between Mirena and gestrinone groups. The dysmenorrheal remission rate [OR = 1.91,95% CI （1.03-3.53） ,P=0. 04] and endometrial thickness reduction after 6 months treatment [MD=--0.99,95% CI（--1. 57-0. 40） ,P=0. 0009] were significantly different between the two groups. Conclusions： Current evidence shows that Mirena or gestrinone has similar effect on reducing uterine volume,menstrual improvement rate, improvement of irregular vaginal bleeding, long term reduction of endometrial thickness. Compared with gestrinone, Mirena has better effect in the treatment of uterine adenomyosis complicated with dysmenorrheal,and short period reduction of endometrial thickness. Due to limitation of the research quantity and quality, the long-term effect of Mirena still need to be verified by more high quality and RCTs ＆ CCTs.