枸橼酸西地那非治疗子宫内膜生长不良疗效的系统评价

A systematic review of sildenafil citrate in treatment of poor endometrial development

目的:系统评价枸橼酸西地那非治疗子宫内膜发育不良的疗效。方法:检索Pub Med、EMbase、Medline(Ovid)、The Cochrane Library、CBM、CNKI、VIP和Wanfang数据库,查找有关枸橼酸西地那非治疗子宫内膜生长不良的随机对照试验(RCT),检索时限均为自建库至2014年12月。由2位研究者依据纳入和排除标准独立筛查文献、提取资料和评价纳入研究的方法学质量,采用Rev Man 5.3软件进行Meta分析。结果:最终纳入7篇RCT,共计538例患者。Meta分析结果显示:与对照组相比,子宫内膜厚度[MD=1.33,95%CI(0.46,2.21),P=0.003]、临床妊娠率[RR=3.20,95%CI(1.95,5.25),P<0.000 01]、子宫内膜螺旋动脉血流搏动指数(PI)[MD=–0.64,95%CI(–0.78,–0.51),P<0.000 01]、子宫内膜螺旋动脉血流阻力指数(RI)[MD=–0.17,95%CI(–0.21,–0.13),P<0.000 01]方面具有明显的差异,其差异具有统计学意义;而在子宫内膜形态、血雌二醇及血孕酮水平方面(均为单个研究)试验组疗效均优于对照组。结论:当前证据显示,枸橼酸西地那非治疗子宫内膜生长不良疗效显著,由于受纳入中文文献质量限制,尚需进一步开展高质量、大样本、多中心的研究予以验证。

Objective: To systematically review the efficacy of sildenafil citrate in treatment of poor endometrial development. Methods: The randomized controlled trials (RCTs) about sildenafil citrate used for poor endometrial development disease were searched in PubMed, EMbase, Medline (Ovid), The Cochrane Library, CBM, CNKI, VIP and Wanfang database from the date of their establishment to December, 2014. Two reviewers screened literature, extracted data independently according to the inclusion and exclusion criteria and assessed the methodological quality of pooled studies. Then meta-analysis was performed using RevMan 5.3. Results: A total of 7 RCTs involving 538 patients were included. The results of meta-analysis showed that the sildenafil citrate was superior to the control group in raising endometrial thickness [MD = 1.33, 95%CI(0.46, 2.21), P = 0.003],as well as clinical pregnancy rates [RR = 3.20, 95%CI(1.95, 5.25), P < 0.000 01], pulsation index (PI) of endometrial spiral artery blood flow [MD = – 0.64, 95%CI(– 0.78, – 0.51), P < 0.000 01], resistance index (RI) of endometrial spiral artery blood flow [MD = – 0.17, 95%CI(– 0.21, – 0.13), P < 0.000 01]. However, sildenafil citrate showed significant effect on endometrial morphology, blood estradiol level and blood progesterone level (single study only). Conclusion: Sildenafil citrate showed evident effect in poor endometrial development. Due to limited quality of the included studies, the above mentioned conclusion still needs to be verified by conducting more high quality blinding RCTs.