来曲唑和克罗米芬对不明原因不孕症疗效对比Meta分析

Systematic review on letrozole and clomiphene for women with unexplained infertility:Meta-analysis

目的系统性评估和比较来曲唑和克罗米芬对改善生育功能的有效性,包括妊娠率、流产率、活产率、多胎妊娠率、子宫血流阻力、不良反应发生率。方法计算机检索MEDLINE(1997—2016)、EMBASE(医学文摘资料库1997—2016)、CENTRAL(生命科学科研文献1997—2016)、CNKI(中国学术期刊网专题数据库1994—2016)、万方(1997—2016)、维普(中国生物医学期刊数据库1989—2010)和CBMdisc(中国生物医学文献数据库1979—2016)等数据库。本研究纳入所有比较来曲唑和克罗米芬对于不明原因不孕患者疗效的随机对照试验,质量评估后,用Rev Man5.3软件进行Meta分析的数据分析。结果纳入的文献有8篇,经过Meta分析结果显示,在对不明原因不孕患者的妊娠率、流产率、多胎妊娠率、不良反应发生率、子宫动脉血流搏动指数(PI)和阻力指数(RI)值方面,来曲唑和克罗米芬的差异无统计学意义(P>0.05),克罗米芬活产率高于来曲唑,差异有统计学意义(P<0.05)。结论来曲唑在妊娠率、流产率、多胎妊娠率、不良反应发生率、子宫血流PI和RI值方面,对于不明原因不孕患者的疗效与克罗米芬相当,但活产率不及克罗米芬,因纳入研究数较少,仍需进一步的高质量的研究来对比来曲唑和克罗米芬对于不明原因不孕患者的综合治疗效果。

Objective To evaluate and compare the effectiveness of letrozole and clomiphene citrate （CC） for improving fertility outcomes, including pregnancy rate, miscarriage rate, live birth rate, multiple pregnancy rate, blood flow of uterus, and incidence rate of adverse events. Methods MEDI.INE（1997- 2016）, EMBASE （ 1997- 2016）, CENTRAl. （ 1997- 2016）, CNKI （ 1994- 2016）, Wanfang （1997-2016）, Vip database （1989-2010） and CBMdisc database （1979-2016） were searched up. Randomized controlled trials comparing letrozole with CC in women with unexplained infertility were included. The quality of the retrieved trials was critically appraised and meta-analyses were conducted using RevMan 5.3 software.Results Eight studies were included. Meta analysis revealed that there were no differences in the rates of pregnancy, miscarriage and multiple pregnancy, incidence rate of adverse events, pulsatility index （PI） and resistance index （RI） of the uterine blood flow in women with unexplained infertility between letrozole and CC regimens （P〉0.05）. The rate of live birth was higher in CC group than letrozole group, and the difference was statistically significant （P〈0.05）.Conclusion Letrozole is as effective as CC in rates of pregnancy, miscarriage and multiple pregnancy, incidence rate of adverse events, PI and RI of the uterine blood flow in women with unexplained infertility. The rate of live birth is higher in elomiphene group than that in letrozole group. Since the included studies are not many, further high-quality studies on effectiveness of letrozole and CC on unexplained infertility are needed.