左炔诺孕酮宫内缓释系统与口服孕激素治疗子宫内膜增生疗效的meta分析

发布时间：2018-06-06 21:28

本文选题：子宫内膜增生 + 左炔诺孕酮宫内缓释系统　；参考：《吉林大学》2017年硕士论文

【摘要】：【目的】:通过meta分析来评估左炔诺孕酮宫内缓释系统(LNG-IUS或者曼月乐)与口服孕激素治疗子宫内膜增生的有效性及安全性,为临床上需要保守治疗的子宫内膜增生患者提供治疗证据。【方法】:确定检索词及检索策略后检索以下数据库:万方数据库,中国生物医学文献数据库(CBM),维普数据库,中国知网数据库,Pubmed,Medline,Cochrane,Web of science,Embase等数据库,检索时间2000年1月-2016年12月1日,语言种类限定为中文和英文,按照纳入和排除标准纳入关于左炔诺孕酮宫内缓释系统与口服孕激素治疗子宫内膜增生的随机对照研究或非随机对照研究。对所纳入文献行质量评价后提取所需数据,采用Stata 12.1软件进行meta分析。【结果】:共纳入符合标准文献12篇,其中外文8篇,中文4篇。在12篇文献中,随机对照研究8篇,非随机对照研究4篇,共1068例患者,左炔诺孕酮宫内缓释系统组504例,口服孕激素组564例。其中有7篇文献研究的对象为无不典型子宫内膜增生患者,给予左炔诺孕酮宫内缓释系统和口服孕激素治疗随访3个月、6个月、12个月、24个月后对其有效性行meta分析,结果表明:治疗3个月后左炔诺孕酮宫内缓释系统组较口服孕激素组有效(RR=1.20,95%CI:1.07~1.34,z=3.13,P=0.002);治疗6个月后左炔诺孕酮宫内缓释系统组较口服孕激素组有效(RR=1.34,95%CI:1.20~1.50,z=5.20,P=0.000);治疗12个月后左炔诺孕酮宫内缓释系统组较口服孕激素组有效(RR=1.36,95%CI:1.20~1.54,z=4.80,P=0.000);治疗24个月后左炔诺孕酮宫内缓释系统组较口服孕激素组有效(RR=1.50,95%CI:1.23~1.83,z=4.05,P=0.000)。有3篇文献的研究对象为无不典型子宫内膜增生和子宫内膜不典型增生混合的患者,给予左炔诺孕酮宫内缓释系统和口服孕激素治疗末次随访的有效性行meta分析,结果表明:左炔诺孕酮宫内缓释系统组较口服孕激素组有效(RR=1.45,95%CI:1.25~1.68,z=4.94,P=0.000)。有4篇文献的研究对象为子宫内膜不典型增生的患者,给予左炔诺孕酮宫内缓释系统和口服孕激素治疗末次随访的有效性行meta分析,结果表明:左炔诺孕酮宫内缓释系统组较口服孕激素组有效(RR=1.33,95%CI:1.18~1.50,z=4.76,P=0.000)。【结论】:左炔诺孕酮宫内缓释系统在治疗子宫内膜增生的效果优于口服孕激素,有可能是子宫内膜增生患者保守治疗安全而有效的首选治疗方法。
[Abstract]:Objective: to evaluate the efficacy and safety of levonorgestrel intrauterine sustained release system (LNG-IUS or Manyue) and oral progesterone in the treatment of endometrial hyperplasia by meta analysis. To provide evidence for the treatment of endometrial hyperplasia patients who need conservative treatment in clinic. [methods] after determining the key words and searching strategies, the following databases were searched: Wanfang database, Chinese biomedical literature database (CBMN), Weip database, Chinese knowledge Network Database Pubmedan Medline, Cochraneof Web of Science Embase, etc., is available from January 2000 to December 1, 2016. The languages are limited to Chinese and English. According to the inclusion and exclusion criteria, randomized controlled or non-randomized controlled studies on the treatment of endometrial hyperplasia with levonorgestrel intrauterine release system and oral progesterone were included. The required data were extracted after the quality evaluation of the included literature, and meta analysis was carried out with Stata12.1 software. [results]: 12 articles were included, including 8 in foreign language and 4 in Chinese. Of the 12 articles, 8 were randomized controlled studies, 4 were non-randomized controlled trials, 504 patients were treated with levonorgestrel intrauterine sustained-release system, and 564 patients were treated with oral progesterone. Seven of them were treated with levonorgestrel intrauterine sustained release system and oral progesterone therapy for 3 months, 6 months, 12 months and 24 months after meta analysis. The results showed that the intrauterine sustained-release system of levonorgestrel was more effective than that of the oral progesterone group after 3 months of treatment, and that of the levonorgestrel intrauterine sustained-release system group was more effective than that of the oral progesterone group after 6 months, and that of the levonorgestrel intrauterine sustained-release system group was more effective than that of the oral progesterone group, and that of the levonorgestrel intrauterine sustained release system group was more effective than that of the oral progesterone group, and that of the levonorgestrel intrauterine sustained-release system group was more effective than that of the oral progesterone group; The intrauterine sustained-release system of progesterone was more effective than that of the oral progesterone group, and the RRN 1.5095% was more effective than that of the oral progesterone group (CI: 1.201.154) and the levonorgestrel intrauterine sustained-release system was 0.000g / kg after 24 months of treatment compared with the oral progesterone group (CI: 1.231.83z1 / 4.05). Three articles of study were conducted to study the efficacy of levonorgestrel intrauterine slow release system and oral progesterone therapy in the last follow-up of patients with nonatypical endometrial hyperplasia and endometrial atypical hyperplasia. The results showed that levonorgestrel intrauterine sustained-release system was more effective than that of oral progesterone group in RQ1.45 ~ (95) CI: 1.25 ~ (1.68) ~ 1.68 ~ (th) ~ (4.94) P ~ (+) 0.000 ~ (th). Patients with atypical endometrial hyperplasia received levonorgestrel intrauterine sustained-release system and oral progesterone for the last follow-up were analyzed by meta. The results showed that levonorgestrel intrauterine sustained-release system was more effective than oral progesterone group in the treatment of endometrial hyperplasia. [conclusion] the effect of levonorgestrel intrauterine sustained-release system on endometrial hyperplasia was better than that of oral progesterone. It may be a safe and effective first choice for the conservative treatment of endometrial hyperplasia.
【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】：R711.74

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