GnRH-a对国内宫颈癌术后卵巢保护作用Meta分析

Meta-analysis of Ovarian Protection of GnRH-a After Cervical Cancer Surgery in China

目的使用Stata 15.0进行Meta分析,系统评价国内应用促性腺激素释放激素激动剂(Gn RH-a)在保留卵巢的宫颈癌根治术后的应用价值,探讨其对化疗过程中卵巢的保护作用。方法系统检索CNKI中国知网、维普及万方等数据库,按照本研究设定的纳入和排除标准,收集国内2014年1月-2019年1月公开发表关于宫颈癌保留卵巢后行辅助化疗时应用Gn RH-a治疗的随机对照研究,使用Stata 15.0对纳入研究资料进行Meta分析。结果共纳入4篇中中文文献,共计579名保留卵巢的宫颈癌术后受试者,均规范化行4~6个疗程的TP方案化疗,患者b FSH、b E2、AMH、b AFC分析结果为b FSH [SMD=-3.01,95%CI(-3.34,-2.67),P <0.001]、b E2 [SMD=-8.9,95%CI(-1.13,-0.65),P <0.001]、AMH [SMD=-1.17,95%CI(-0.41,-1.35-1.92),P <0.001]、b AFC [SMD=-1.2,95%CI(-2.07,-0.33),P <0.001],差异有统计学意义。结论在应用宫颈癌的化疗中配合促性腺激素释放激素激动剂,对TP化疗方案后患者的卵巢功能起到显著的保护作用。

Objective To evaluate the application value of gonadotropin-releasing hormone agonist(GnRH-a) after radical resection of cervical cancer with ovarian preservation by Meta-analysis with Stata 15.0. To explore its protective effect on ovaries during chemotherapy. Methods A systematic search of CNKI,Vepsa, Wan Fang and other databases was carried out according to the inclusion and exclusion criteria set in this study. A randomized controlled study was conducted in China from January 2014 to January 2019. A randomized controlled study of GnRH-a therapy for cervical cancer with ovarian preservation after adjuvant chemotherapy was conducted. The inclusion data were analyzed by Meta with Stata 15.0. Results A total of 579 patients with cervical cancer after operation were enrolled in 4 Chinese literatures. All patients were standardized for 4 ~ 6 courses of TP regimen chemotherapy, and the patients were treated with bFSH, bE2, AMH and bAFC. The results of bAFC analysis were as follows. bFSH [SMD =-3.01, 95% CI(-3.34,-2.67), P < 0.001], bE2 [SMD =-8.9, 95% CI(-1.13,-0.65), P < 0.001)], AMH [SMD =-1.17, 95% CI(-0.41,-1.35-1.92), P < 0.001], bAFC [SMD =-1.2, 95% CI(-2.07,-0.33), P < 0.001)], and bAFC [SMD =-1.2, 95% CI(-2.07,-0.33), P < 0.001]. The difference was statistically significant. Conclusion Combined with gonadotropin-releasing hormone agonist in the chemotherapy of cervical cancer, it can significantly protect the ovarian function of patients after TP chemotherapy.