人绒毛膜促性腺激素治疗先兆流产有效性的meta分析

Meta-analysis of the efficacy of human chorionic gonadotrophin for threatened miscarriage

目的:系统评价人绒毛膜促性腺激素治疗先兆流产的有效性。方法:检索2018年2月前,发表于万方医学、中国知网、维普医学、中国生物医学、Medline、Embase、Cochrane和Clinical trails数据库的人绒毛膜促性腺激素治疗先兆流产的随机对照研究。纳入符合筛选标准的文献,对文献进行质量评价,提取数据后进行meta分析。结果:与安慰剂组(22.32%)相比,人绒毛膜促性腺激素治疗组流产率(11.00%)降低(MD=0.48,95%CI:0.30~0.76),Z=3.15(P=0.002)。纳入的英文文献中无不良反应报道,中文文献中发现用药组新生儿体重略高于对照组,且观测到2例先天性多囊肾的新生儿。归纳h CG相关文献,还有存在应用后出现注射局部红肿和肝酶一过性升高等轻度不良反应,以及卵巢过度刺激综合征、水肿和血栓等中重度不良反应的个案报道。结论:人绒毛膜促性腺激素在治疗先兆流产中疗效显著,但结合文献质量评价和不良反应报道,该药物应在严密监控下谨慎使用。

Objective： To systematically review the efficacy of human chorionic gonadotropin in the treatment of threatened abortion.Methods： Wanfang data, China National Knowledge Internet, VIP medical, China Biology Medicine disc, Medline, Embase, Cochrane and Clinical trials database were searched systematically for randomized controlled trials of human chorionic gonadotropin（h CG） in the treatment of threatened abortion published before February 2018. We selected the articles that accorded with all eligibility criteria and assessed the quality of the included studies. Rev Man 5.3 was used to perform meta-analysis after data extraction. Results： Compared with the abortion rate in the placebo group（22.32%）, that in the h CG treatment group（11.00%） was reduced（MD=0.48, 95%CI：0.30-0.76, Z=3.15, P=0.002）. No English trials reported any adverse effects of h CG on the mothers or fetuses. In the Chinese trials, the neonatal weight of the HCG group was slightly higher than that of the control group, and two newborns had congenital polycystic kidney disease. In the h CG related literature, some mild adverse reactions were reported such as local injection swelling and transient increase of liver enzymes, and there were also case reports of ovarian hyperstimulation syndrome, edema, and thrombosis. Conclusion： Human chorionic gonadotropin is effective for the treatment of threatened abortion. However, considering the literature quality and adverse reaction reports, the drug should be used with caution under monitoring.