二甲双胍和克罗米芬单独或联合用于多囊卵巢综合征患者诱导排卵的meta分析

发布时间：2018-06-09 13:45

  本文选题：多囊卵巢综合征 + 二甲双胍　； 参考：《广西医科大学》2015年硕士论文

【摘要】：目的：系统评价二甲双胍和克罗米芬单独或联合用于多囊卵巢综合征(Poly cystic ovary syndrome, PCOS)患者促排卵效果的比较。方法：计算机检索Cochrane图书馆临床对照试验资料库(Central/CCTR)、PubMed、EMbase、CBMdisc, CNKI、VIP、万方数据库、中国生物医学文献数据库及Clinical trials、Current controlled trials等临床试验网站,手工检索相关医学专业杂志。查找建库至2014年10月更新的MET,CC单独或联合用于PCOS患者的临床随机对照试验(RCT)的所有文献。根据Cochrane系统评价方法的纳入及排除标准筛选文献、提取资料、对纳入研究的进行偏倚风险评估,提取相关有效数据,对其应用软件RevMan5.2进行Meta分析。结果：纳入10个RCT,共1580例患者。其中5个RCT包含MET与CC的比较,共837例患者；9个RCT包含CC与CC+MET的比较,共1100例患者；4个RCT包含MET与MET+CC的比较,共741例患者。Meta分析结果显示：①CC与MET比较：周期排卵率(RR=1.80,95%CI(1.42,2.27),P0.00001)CC组较MET组高,妊娠率(RR=1.10,95%CI(0.53,2.28),P=0.79)、活产率(RR=1.03,95%CI(0.82,1.31), P=0.78),流产率(RR=-0.02,95%CI (-0.25,2.20),P=0.85)、多胎妊娠率(RR=2.64,95%CI (0.56,12.58), P=0.22)两组均无差异；② ET+CC与MET比较：周期排卵率(RR=1.86,95%CI(1.15,3.30),P=0.01) MET+CC组较MET组高；妊娠率(RR=1.83,95%CI(0.99,3.36),P=0.05)、活产率(RR=1.16,95%CI(0.88,1.52),P=0.29)、流产率(RR=0.77,95%CI(0.46,1.29),P=0.32)、多胎妊娠率(RR=1.42,95%CI(0.21,9.71),P=0.72)两组均无差异。③ MET+CC与CC比较：周期排卵率(RR=1.39,95%CI(1.16,1.66),P=0.0004)、妊娠率(RR=1.55,95%CI(1.28,1.87),P0.00001) MET+CC组较CC组高；活产率(RR=-0.04,95%CI(-0.17,0.08), P=0.49)、流产率(RR=0.03,95%CI (-0.06,0.13),P=0.52)、多胎妊娠率(RR=0.30,95%CI (0.07,1.25), P=0.10、FSH值 (WMD=0.07,95%CI(-0.39,0.53),P=0.76)降低水平两组均无差异。FINS值(WMD=-5.21,95%CI(-5.97,-4.45),P0.00001)、 T值 (WMD=-1.18,95%CI(-1.33,-1.04),P0.00001)、LH值 (WMD=-2.47,95%CI(-3.24,-1.70),P0.00001)降低水平MET+CC组较CC组显著。结论：二甲双胍联合克罗米芬治疗PCOS患者在改善其胰岛素代谢、降低血清雄激素和黄体生成素水平的同时,可明显提高克罗米芬的促排卵效果和妊娠率,同时不增加多胎妊娠及流产的风险。三种治疗方案比较,克罗米芬联合二甲双胍用于PCOS患者的促排卵效果最佳。由于受研究人群的不同,用药剂量、疗程的不同和样本量的影响,研究结果不尽相同。故今后还需要高质量、多中心、大样本的RCT来确定药物剂量、疗程及最优的方案。
[Abstract]:Aim: to evaluate the effects of metformin and clomiphene alone or in combination on ovulation promotion in patients with polycystic ovary syndrome (PCOS). Methods: the clinical controlled trial database of Cochrane Library was searched by computer, and related medical journals were searched by hand, such as Central- / CCTRT PubMedbase (CBM discc), CNKI VIPs, Wanfang Database, Chinese Biomedical Literature Database and Clinical Trials current controlled trials. To find all the literatures of the clinical randomized controlled trial (RCTT) of METTCC for PCOS patients, which were built up to October 2014 and were updated in October 2014. According to the inclusion and exclusion criteria of Cochrane systematic evaluation, the literature was selected, the data was extracted, the bias risk was assessed, the relevant valid data were extracted, and the application software RevMan5.2 was analyzed by Meta-analysis. Results: 1580 patients were included in 10 RCTs. Five RCTs contained a comparison of met and CC in 837 patients, nine included a comparison of CC and CC met in 1100 patients, and four RCT included a comparison of met and met CC. 鍏，

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