促性腺激素释放激素激动剂对绝经前化疗女性卵巢功能保护作用的Meta分析

Meta-analysis of GnRH agonist for ovarian protection in premenopausal women undergoing chemotherapy

目的系统评价促性腺激素释放激素激动剂(GnRH-a)对绝经前化疗女性卵巢功能保护的临床效果。方法检索Pubmed、Embase、the Cochrance Library、中国知网(CNKI)、中国生物医学文献数据库(CBM)和万方数据库,检索时限为建库至2020年4月30日,检索GnRH-a对绝经前女性化疗过程中卵巢功能保护性评价的随机对照试验(RCT)研究,单纯化疗组为对照组,GnRH-a联合化疗治疗组为研究组。结果纳入15篇RCT研究,共1478例绝经前女性患者,研究组736例,对照组742例。Meta分析结果显示:与对照组相比,研究组卵巢早衰(POF)发生率显著降低[RR=0.59,95%CI(0.45,0.78),P<0.001],月经复潮率显著提高[RR=1.34,95%CI(1.12,1.62),P=0.002]。两组患者的妊娠率、无病生存(DFS)事件发生率和总体生存(OS)事件发生率的差异均无统计学意义(P>0.05)。结论化疗联合GnRH-a可减轻化疗对绝经前女性卵巢功能的损害,降低POF发生率,提高月经复潮率,对患者的长期生存无不良作用;可将GnRH-a用于绝经前化疗女性以保护其卵巢功能。

Objective:To systematically evaluate of the clinical effects of GnRH agonist(GnRH-a)on the protection of ovarian function in premenopausal women undergoing chemotherapy.Methods:Pubmed,Embase,Cochrane Library,CBM,CNKI and WanFang databases were electronically search to collect randomized controlled trial(RCT)regarding the comparison of ovarian protection effect between GnRH-a combined with chemotherapy(research group)and chemotherapy alone(control group)in premenopausal women from building library to April 30,2020.Results:Fifteen RCTs literatures with 1478 premenopausal women(736 in the research group and 742 in the control group)were included in this study.The results of meta-analysis showed that compared with control group,research group significantly reduced the incidence of premature ovarian failure(POF)during chemotherapy[RR=0.59,95%CI(0.45,0.78),P<0.001],and significantly improved the menstrual recurrence rate[RR=1.34,95%CI(1.12,1.62),P<0.001].There were no significant differences in pregnancy rate,disease-free survival(DFS)events rate and overall survival(OS)events rate between the two groups(all P>0.05).Conclusions:GnRH-a combined with chemotherapy can reduce the damage of chemotherapy to ovarian function in premenopausal women,decrease the risk of POF incidence and improve the menstrual recurrence rate.GnRH agonist has no adverse effects on the long-term survival of patients,suggesting that GnRH-a can be used for ovarian protection in premenopausal women undergoing chemotherapy.