促性腺激素释放激素激动剂联合激素反向添加治疗子宫内膜异位症的系统评价

发布时间：2018-01-24 04:45

本文关键词： 子宫内膜异位症促性腺激素释放激素激动剂反向添加系统评价 Meta分析　出处：《广西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的应用循证医学方法对促性腺激素释放激素激动剂（GnRH-a）联合激素反向添加疗法治疗子宫内膜异位症的疗效及安全性进行评价，为子宫内膜异位症的临床治疗提供评价依据。方法计算机检索Cochrane图书馆，MEDLINE数据库，EMBase数据库，中国生物医学文献数据库（CBM）、中国知网（CNIK），维普期刊数据库及万方学位论文数据库，手工检索相关专业杂志，文章语种不限，检索时间截止至2014年3月，收集国内外GnRH-a联合反向添加治疗子宫内膜异位症的随机对照试验（RCTs）。由两名评价员独立选择研究，对纳入的研究提取资料，评价其方法学质量，提取资料及有效数据，用RevMan5.1统计软件进行Meta分析。结果共纳入符合标准的RCTs11个，共包括772例患者。其中10个RCTs为GnRH-a联合雌孕激素与GnRH-a联合安慰剂/单用GnRH-a的比较，1个RCT为GnRH-a联合替勃龙与联合安慰剂的比较。Meta分析结果显示：①联合反向添加组患者的腰椎骨质丢失低于联合安慰剂/单用GnRH-a组，差异有统计学意义（P＜0.05）。②联合反向添加组治疗后患者的腰椎骨密度高于联合安慰剂/单用GnRH-a组，差异有统计学意义（P＜0.0001）。③联合反向添加组患者的E2明显高于联合安慰剂/单用GnRH-a组，而FSH水平低于联合安慰剂/单用GnRH-a组，差异均有统计学意义（P＜0.05）。④联合反向添加组与联合安慰剂/单用GnRH-a组比较，盆腔痛症状缓解上差异无统计学意义（P=0.09）。反向添加组患者的失眠、潮热的发生率及Kupperman评分均较联合安慰剂/单用GnRH-a组低，，差异有统计学意义（P＜0.05）。⑤联合反向添加组患者的低密度脂蛋白和甘油三酯与联合安慰剂/单用GnRH-a组相比，差异无统计学意义（P＞0.05）。结论GnRH-a联合激素反向添加治疗在保持其治疗效果的同时，能够改善机体低雌激素状态，减轻和缓解围绝经期相关症状及骨质丢失，短期内对血脂代谢变化影响不大。
[Abstract]:Objective to evaluate the efficacy and safety of gonadotropin releasing hormone agonist (GnRH-a) combined with reverse hormone supplementation therapy in the treatment of endometriosis by evidence-based medicine (EBM). To provide the evaluation basis for the clinical treatment of endometriosis. Methods the Cochrane library was searched by computer in MEDLINE database, China Biomedical Literature Database (CBM), and China knowledge Network (CNI). WIP journal database and Wanfang thesis database, manual retrieval of related professional magazines, the language of the article is unlimited, the retrieval time to March 2014. A randomized controlled trial of GnRH-a combined with reverse supplementation in the treatment of endometriosis was collected at home and abroad. Two evaluators independently selected the study and extracted the data from the included study. The quality of methodology, data extraction and effective data were evaluated, and Meta analysis was carried out with RevMan5.1 statistical software. Results A total of RCTs11 were included. A total of 772 patients were included, 10 of whom were compared with GnRH-a combined with estrogen and progesterone and GnRH-a with placebo / GnRH-a alone. One RCT was a comparison of GnRH-a combined with tibolone and placebo. Meta-analysis showed that:. 1the lumbar bone loss in the combined reverse supplementation group was lower than that in the combined placebo / GnRH-a group. The difference was statistically significant (P < 0.05). 2 the BMD of lumbar vertebrae was higher in the combined placebo / GnRH-a group than that in the control group (P < 0.05). The difference was statistically significant (P < 0.0001t.3). The level of E _ 2 in the group of combined placebo and GnRH-a was significantly higher than that in the group of combined placebo / GnRH-a alone. However, the level of FSH was significantly lower in the combined placebo / single GnRH-a group than in the combined placebo / single GnRH-a group (P < 0.05). There was no significant difference in the remission of pelvic pain symptoms. The incidence of hot flashes and the Kupperman score were lower than those in the placebo / GnRH-a alone group. There was a significant difference in low density lipoprotein and triglyceride between the combined placebo / GnRH-a group and the reverse supplementation group (P < 0.05). The difference was not statistically significant (P > 0.05). Conclusion GnRH-a combined with reverse hormone supplementation therapy can improve the state of low estrogen and alleviate the symptoms of menopause and bone loss while maintaining the therapeutic effect. In the short term, the changes of blood lipid metabolism have little effect.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.71

【参考文献】