LNG-IUS与口服孕激素治疗子宫内膜增生不伴不典型性疗效的Meta分析

发布时间：2018-11-27 16:18

【摘要】：目的:应用meta分析评估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不伴不典型性的临床疗效。方法:使用计算机在Pub Med数据库、中国知网(CNKI)、万方数据库、维普数据库(VIP)、CBMdisc(中国生物医学文献数据库)中检索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不伴不典型性的随机对照试验相关文献,制定严格的纳入标准及排除标准,进行文献筛选,按Cochrane协作网偏倚风险评价工具对入选文献进行质量评估,提取有效数据,同时应用Cochrane协作网提供的Review Manager 5.3软件对相关数据进行Meta分析。结果:根据本研究的纳入与排除标准,最终纳入文献11篇,其中英文7篇,中文4篇。Meta分析结果显示:LNG-IUS与口服孕激素治疗子宫内膜增生不伴不典型性对比,LNG-IUS具有显著的治疗疗效(组织病理学反应),治疗后3个月(OR=2.53,95%CI:[1.56,4.12],P=0.0002,7,I~2=0%,n=484)、治疗后6个月(OR=4.07,95%CI:[2.16,7.67],P0.0001,5,I~2=0%,n=433)、治疗后12个月(OR=8.73,95%CI:[4.48,16.99],P0.00001,3,I~2=53%,n=304)、治疗后24个月(OR=7.46,95%CI:[2.55,21.78],P=0.0002,1,n=104)组织病理学反应具有统计学差异;亚组分析:LNG-IUS与口服孕激素对比,LNG-IUS对子宫内膜单纯性增生有显著治疗疗效(OR=2.68,95%CI:[1.25,5.73],P=0.01,7,I~2=0%,n=340);LNG-IUS对子宫内膜复杂性增生有显著治疗疗效(OR=4.30,95%CI:[2.23,8.29],P0.0001,5,I~2=0%,n=339);LNG-IUS与口服孕激素对比,LNG-IUS组显著降低子宫切除率(OR=0.27,95%CI:[0.16,0.45],P0.00001,3,I~2=0%,n=324)。LNG-IUS与口服孕激素对比,两者治疗后阴道不规则流血率无统计学差异(OR=2.23,95%CI:[0.50,9.89],P=0.29,4,I~2=79%,n=270)。结论:LNG-IUS与口服孕激素相比,LNG-IUS治疗子宫内膜增生不伴不典型性具有显著疗效,提高了子宫内膜逆转率,同时降低子宫切除率,LNG-IUS可作为治疗子宫内膜增生不伴不典型性的一种安全、有效、适合不同群体的治疗方案。
[Abstract]:Objective: to evaluate the clinical efficacy of levonorgestrel intrauterine sustained release system and oral progesterone in the treatment of endometrial hyperplasia without atypical by meta analysis. Methods: using computer in Pub Med database, (CNKI), Wanfang database, (VIP), database CBMdisc (Chinese Biomedical Literature Database) was used to search the literature about levonorgestrel intrauterine sustained release system and oral progesterone in the treatment of endometrial hyperplasia without atypical randomized controlled trials, and to formulate strict inclusion criteria and exclusion criteria. According to the risk evaluation tool of Cochrane cooperation network bias, the quality of selected documents was evaluated, and valid data were extracted. At the same time, the relevant data were analyzed by Meta using Review Manager 5.3 software provided by Cochrane cooperation network. Results: according to the inclusion and exclusion criteria of this study, 11 articles were included, 7 of which were in English and Chinese, and 4 were in Chinese. The results of Meta analysis showed that LNG-IUS and oral progesterone were not associated with atypical endometrial hyperplasia. LNG-IUS showed significant curative effect (histopathological response), 3 months after treatment (OR=2.53,95%CI: [1.56n4.12], P0. 0002 + 7 Igna 2 + 484), 6 months after treatment (OR=4.07,95%CI: [2.16 卤7.67]). P0. 0001 + 5 ~ (5) I ~ (2 +), 12 months after treatment (OR=8.73,95%CI: [4.48 卤16.99], P 0.00001 ~ (3) I ~ (2 +), 24 months after treatment (OR=7.46,95%CI: [2. 55 卤21. 78], P = 0. 00021, P = 0. 001, P = 0. 00021, P < 0. 001, P = 0. 00021). The histopathological responses were statistically different. Subgroup analysis: compared with oral progesterone, LNG-IUS had a significant therapeutic effect on endometrial simple hyperplasia (OR=2.68,95%CI: [1.25v 5.73], OR=2.68,95%CI: 0.01 ~ (7) I ~ (2 +) compared with oral progesterone (P ~ (0.01), LNG-IUS had a significant therapeutic effect on endometrial simple hyperplasia (OR=2.68,95%CI: [1.25 卤5.73], P < 0.01). LNG-IUS was effective in the treatment of complex hyperplasia of endometrium (OR=4.30,95%CI: [2.238.29], P0.0001 / 5 ~ (2 +). Compared with oral progesterone, LNG-IUS significantly decreased the rate of hysterectomy in LNG-IUS group (OR=0.27,95%CI: [0.16 ~ 0.45], P0.00001 ~ (3 +) I ~ (2 +). LNG-IUS was compared with oral progesterone. There was no significant difference in the rate of irregular vaginal bleeding between the two groups after treatment (OR=2.23,95%CI: [0.50 卤9.89, P = 0.29, n = 29, n = 79, n = 270). Conclusion: compared with oral progesterone, LNG-IUS has a significant effect on endometrial hyperplasia without atypical type, and increases the rate of endometrial reversal and reduces the rate of hysterectomy. LNG-IUS can be used as a safe, effective and suitable treatment for endometrial hyperplasia without atypical.
【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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