不同方式促排卵对多囊卵巢综合征疗效的网状Meta分析

A network Meta-analysis of the efficacy of different modes of ovulation induction on polycystic ovary syndrome

目的:采用贝叶斯网状Meta分析评价不同方式促排卵对多囊卵巢综合征(Polycystic Ovary Syndrome, PCOS)的有效性及安全性。方法:计算机检索中国期刊全文数据库、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Cochrane Library及Embase等中外文数据库,检索时间截至2021年11月,纳入不同方式促排卵对PCOS疗效的随机对照临床试验,采用Cochrane评价工具对纳入研究进行质量评价,2名研究者独立进行数据提取和质量评价,采用RevMan 5.3、Stata 17.0软件进行网状Meta分析。结果:纳入50项随机对照试验研究,共计患者4 938例,涉及中药、西药、手术、中药+西药、中药+手术、西药+手术、中药+西药+手术等7种干预措施,其中在妊娠率、排卵率,升高卵泡刺激素含量,降低总睾酮含量方面,中药+西药+手术联合模式效果最佳,降低黄体生成素含量以及黄体生成素与卵泡刺激素比值方面,西药效果最佳。结论:多模式联合治疗对比单纯西药促排卵在治疗PCOS中更具有优势,其中中药+西药+手术联合模式成为最优选择的可能性最大。但受纳入研究质量所限,存在发表偏倚,该结论仍需开展高质量研究进一步验证。

Objective:To evaluate the efficacy and safety of different methods of ovulation induction on polycystic ovary syndrome by Bayesian hetwork Meta-analysis.Methods:Computer was used to retrieve literature in CNKI,Wanfang database,Weipu database,Chinese biomedical literature database,PubMed,Cochrane Library and Embae and other Chinese and foreign language databases,and the search time was up to November 2021,randomized controlled clinical trials on the efficacy of ovulation induction on polycystic ovary syndrome in different ways were selected,and the quality of the included studies was evaluated by Cochrane evaluation tool,and two investigators independently conducted data extraction and quality evaluation.RevMan 5.3 and Stata 17.0 software were used for a network Meta-analysis.Results:A total of 4938 patients were enrolled in 50 RCT studies,involving 7 interventions including TCM medicine,western medicine,surgery,TCM medicine plus western medicine,TCM medicine plus surgery,western medicine plus surgery,TCM medicine plus western medicine and surgery,among which in terms of pregnancy rate and ovulation rate,the combination mode of TCM medicine plus western medicine and surgery was the best,and the effect of western medicine was the best in terms of reducing the content of luteinizing hormone and the ratio of luteinizing hormone to follicle stimulating.Conclusion:Multi-mode combination therapy has more advantages than western medicine for promoting ovulation in the treatment of polycystic ovary syndrome,of which the combination mode of TCM medicine plus western medicine and surgery is the most likely to become the optimal choice.However,due to the quality of the included studies,there is publication bias,and this conclusion still needs to be further validated by highquality studies.