芳香化酶抑制剂治疗男性不育症的系统评价

Aromatase inhibitors in treatment of male infertility: a systematic review

目的评价芳香化酶抑制剂(aromatase inhibitors,AIs)治疗男性不育症的疗效和安全性。方法采用Cochrane系统评价方法,系统、全面检索Pub Med、EMbase、The Cochrane Library、Web of Science、CBM、万方和CNKI数据库,纳入AIs治疗男性不育症的临床对照试验。由2名评价者根据Cochrane协作网偏倚风险评价工具共同评价纳入研究的质量,并提取其中有效的数据进行分析。结果共纳入4个临床对照研究的178名患者。由于纳入的研究异质性明显,未进行Meta分析,仅作描述性分析。(1)主要结局指标:Gregoriou等的研究显示,阿那曲唑在提高精子总数方面优于来曲唑。(2)次要结局指标:Clark等的研究表明,与安慰剂相比,睾内酯能够改善男性不育患者的内分泌状况(提高血清FSH、LH、游离T浓度)。Gregoriou等的研究显示,阿那曲唑在提高血清LH浓度方面优于来曲唑。(3)马伟等的研究显示,治疗组(来曲唑)的妊娠率显著高于对照组(复方玄驹胶囊)(9/39,23.08%vs 4/39,10.26%,P<0.05)。AIs副作用发生率低且轻微,安全性较好。结论目前有限的证据显示,应用睾内酯治疗男性不育症患者,较安慰剂更能改善患者的内分泌状况。阿那曲唑与来曲唑相比,在提高血清LH浓度和精子总数方面,阿那曲唑优于来曲唑。AIs治疗男性不育症的副作用发生率低、耐受性好。限于目前文献的局限性,尚不能充分肯定AIs对男性不育症的疗效。今后需要开展设计良好的大样本、多中心的随机对照试验,纳入同质性更好的研究对象,进一步验证AIs对男性不育症的疗效。

Objective To assess the efficacy and safety of aromatase inhibitors in the treatment of male infertility. Methods The Cochrane LilDrary, PubMed, EMbase, Web of Science, CBM, Wanfang database and CNKIwere searched for targeted clinical trials. Randomized controlled trials＂ RCT） and quasi-RCTs were identified and alyzed according to the Cochrane Handbook for Systematic Review^s of Interventions. Two reviewers evaluated thequality of trials included independently according to the Cochrane Collaboration’s tool for assessinthe randomized trials. Valid data were extracted for analysis. Results Four controlled clinical trials involving 178 patients were included. Meta-analysis was not performed because of heterogeneity and the data were summarized in a narrative format. The results showed that ＂ 1） Gregoriou et al reported that compared with letrozole, anastrazole pres-ented more benefits in improving sperm counts. （2 ） Claris et al reported that testolactone was more effective than pla-cebo in elevating the levels of serum FSH, LH and free T. Gregoriou et al reported that anastrazole presented more benefits compared with letrozole in elevating serumLH. （3） Wei Ma et al reported that ptreatment group＂ letrozole） was significantly higher than that in the control group＂ compound Xuanju capsule）（9/39, 23. 08% vs 4/39, 10. 26% 〈0. 05） . The incidence of side effects was low. Conclusion Limited evidence is a -vailable and it shows that, compared witli placebo, testosterone is more effective in imtration in infertile men. Anastrazole is more beneficial than letrozole in elevating the level of serum LH and sperm counts. AIs have lowside effects and good tolerability. However, the available evidence can not fi^lly afirm the efficacy of AIs on male infertility. More high quality trials with large-scale samples are needed.