雌激素不同给药方式替代治疗与绝经泌尿生殖道综合征相关性Meta分析

发布时间：2018-06-06 17:28

本文选题：雌激素替代治疗 + GSM　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:通过Meta分析方法评估雌激素替代治疗不同给药方式对绝经泌尿生殖道综合征的疗效,从而为临床工作中对于此类疾病治疗提供思路。方法:全面搜索Pubmed,Embase,Cochrane Library,Web of science,中国知网,中国生物医学文献数据库(CBM),万方中文数据库等,并结合手工检索图书馆等方法,搜集自1985年1月至2017年1月期间发表的相关中英文文献。根据之前所设计的纳入与排除标准,对符合标准的文献进行质量评价及数据提取,应用Rev Man5.3软件对数据进行Meta分析。结果:本次共纳入16项研究,全部为英文发表的随机对照研究(RCT)。根据雌激素替代治疗的不同给药方式进行分组,分别分析其与安慰剂对比治疗效果。经阴道给予雌激素替代治疗与安慰剂进行对比中,阴道VMI指数增加纳入3项研究分析,Meta分析结果显示:MD=15.82,95%CI(2.22,29.41),Z=2.28,P=0.020.05,提示两组差异有统计学意义。阴道PH值降低方面纳入3项研究,分析结果提示:MD=1.26,95%CI(1.10,1.43),Z=14.82,P0.00001。提示两组差异有统计学意义。阴道干涩情况改善方面纳入5项研究,分析结果提示:RR=2.74,95%CI(1.59,4.74),Z=3.61,P=0.0003,P0.05,考虑两组差异有统计学意义。压力性尿失禁方面纳入3项研究,分析结果提示:RR:3.93,95%CI(2.94,5.26),Z=9.20,P0.00001,两组差异有统计学差异。性交困难改善方面纳入5项研究,分析结果:RR:2.68,95%CI(1.67,4.29),Z=4.10,P0.0001。两组差异有统计学意义。经口服给予雌激素替代治疗与安慰剂进行对比中,阴道VMI指数增加纳入2项研究,结果显示:MD:16.84,95%CI(15.22,18.47),Z=20.33,P0.00001。两组差异有统计学意义。阴道PH降低方面纳入3项研究,结果显示:MD:0.33,95%CI(0.05,0.62),Z=2.27,P=0.02,两组差异有统计学意义。在泌尿系统症状的研究中,分析结果提示两组差异均无统计学意义。经皮给予雌激素替代治疗与安慰剂对比中,阴道PH降低方面,纳入3项研究,分析结果显示:MD=0.77,95%CI(0.49,1.04),Z=5.41,P0.00001,两组差异有统计学意义。结论:经阴道给予雌激素替代治疗GSM,与安慰剂对比,疗效显著。口服给予雌激素替代治疗在阴道VMI指数增加及阴道PH降低方面效果明显,经皮给予雌激素替代治疗在阴道PH降低方面效果明显。由于本研究纳入文献相对较少,未来仍需更多高质量,大样本的研究进一步分析,为临床工作提供证据支持。
[Abstract]:Objective: to evaluate the efficacy of estrogen replacement therapy in menopausal urogenital syndrome by meta-analysis. Methods: a comprehensive search was conducted for Pubmedus Embase Cochrane Library of Science, China knowledge Network, Chinese Biomedical Literature Database (CBMN), Wanfang Chinese Database, and other methods. The relevant Chinese and English literatures published from January 1985 to January 2017 were collected with the help of manual retrieval of libraries. According to the inclusion and exclusion criteria designed before, the quality evaluation and data extraction were carried out on the documents that met the criteria, and Meta-analysis of the data was carried out by using the software Rev Man5.3. Results: a total of 16 studies were included in this study, all of which were randomized controlled trials published in English. Estrogen replacement therapy was divided into groups and compared with placebo. In the comparison between vaginal estrogen replacement therapy and placebo, the increase of VMI index in vagina was included in three studies. Meta-analysis showed that the two groups had a significant difference between the two groups. The results of meta-analysis showed that the VMI index of the two groups was 2.222.28 and 29.41%, indicating that there was a significant difference between the two groups. Three studies were carried out on the reduction of vaginal PH value. The results showed that 1. 1. 26% CIQ of 1. 1010 1. 43% of the vagina PH value was 14. 82% (P 0. 0001). The results suggest that the difference between the two groups is statistically significant. In the aspect of improving the dry and astringent condition of vagina, five studies were included, and the results showed that the two groups had significant difference. The results showed that the ratio of the two groups was 2.74-95% (CI 1.59) and 4.74% (P < 0.05), and the difference between the two groups was statistically significant considering the difference between the two groups. Stress urinary incontinence was included in three studies. The results showed that the two groups had significant differences. The results showed that the two groups had a significant difference between the two groups. The improvement of sexual intercourse difficulty was included in five studies, and the results of the analysis were as follows: 1: RR: 2.68 / 95: CI1.67 / 4.29 / P 0.0001. The difference between the two groups was statistically significant. After oral estrogen replacement therapy compared with placebo, the vaginal VMI index was increased in two studies, and the results showed that: MD16.84% 95 CI15.22 18.47% 20. 33% P0.00001.The results showed that the VMI index of the vagina was increased after oral estrogen replacement therapy compared with the placebo, and the results showed that the VMI index of the vagina was increased in two studies. The difference between the two groups was statistically significant. Three studies were carried out on the reduction of vaginal PH. The results showed that there was a significant difference between the two groups. In the study of urinary system symptoms, the results showed that there was no significant difference between the two groups. Three studies were carried out on the reduction of vaginal PH in the comparison between percutaneous estrogen replacement therapy and placebo. The results of analysis showed that there was a significant difference between the two groups. Conclusion: transvaginal estrogen replacement therapy with GSM is more effective than placebo. Oral estrogen replacement therapy was effective in increasing VMI index and decreasing vaginal PH. Due to the relatively few literatures included in this study, more high quality is needed in the future. Large samples of research are further analyzed to provide evidence for clinical work.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.75

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