全球10种常用宫内节育器有效性的网状Meta分析

Efficacy of 10 common used intrauterine devices:a network meta-analysis

目的采用网状Meta分析系统评价10种常用宫内节育器(IUD)的有效性。方法计算机检索PubMed、The Cochrane Library、EMbase、Web of Science、POPLINE、CNKI、WanFang Data、SinoMed、CMCI、ChiCTR等数据库和网站,搜集有关10种常用IUD有效性的随机对照试验(RCT),检索时限均从建库至2019年12月31日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用WinBUGS 1.4.3和Stata13.0软件进行网状Meta分析。结果共纳入67个RCT,包括59991例研究对象。网状Meta分析结果显示,随访1年结果显示,GyneFix的意外妊娠率低于TCu220C、TCu380A、元宫300、活性金属环型165和MLCu375,其有效性在10种IUD中位列第二(SUCRA=77.1%);元宫200低于TCu220C,有效性位列第三(SUCRA=71.5%)。随访2年结果显示,GyneFix的意外妊娠率低于TCu220C、TCu380A和活性金属环型165,有效性在10种IUD中位列第一(SUCRA=92.1%);元宫200低于TCu220C、TCu380A、元宫300、活性金属环型165、宫铜200、活性γ型和MLCu375,有效性位列第二(SUCRA=81.2%)。结论现有证据表明,GyneFix和元宫200使用1年、2年时发生意外妊娠的风险较低,短期有效性更好。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the efficacy of 10 commonly used intrauterine devices(IUD)by network meta-analysis.Methods PubMed,The Cochrane Library,EMbase,Web of Science,POPLINE,CNKI,WanFang Data,SinoMed,CMCI,ChiCTR databases and websites were electronically searched to collect randomized clinical trials(RCTs)on efficacy of 10 IUDs from inception to December 31 st,2019.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies;then,network meta-analysis was performed by using WinBUGS 1.4.3 software and Stata 13.0 software.Results A total of 67 RCTs involving 59991 IUD users were included.The results of network meta-analysis indicated that after 1 year of use,GyneFix had a lower pregnancy rate than those of TCu220 C,TCu380 A,YCu300,OCu165 and MLCu375,and its effectiveness ranked second out of ten IUDs(SUCRA=77.1%).YCu200 had a lower pregnancy rate than that of TCu220 C,which ranked third(SUCRA=71.5%).After2 years of use,GyneFix had a lower pregnancy rate than those of TCu220 C,TCu380 A and OCu165,which had the highest probability to be the most effective intervention(SUCRA=92.1%).YCu200 had a lower pregnancy rate than those of TCu220 C,TCu380 A,YCu300,OCu165,GCu200,GammaCu and MLCu375,and its effectiveness ranked second(SUCRA=81.2%).Conclusions Current evidence shows that the risk of pregnancy of GyneFix and YCu200 are lower at 1 and 2 years of use,which suggests they possess superior short-term effectiveness.Due to limited quality and quantity of the included studies,more high quality studies are required to verify above conclusions.