中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2013年
5期
338-343
,共6页
牛子儒%岳晓静%孔群钰%王元芬%姚元庆
牛子儒%嶽曉靜%孔群鈺%王元芬%姚元慶
우자유%악효정%공군옥%왕원분%요원경
促性腺素释放激素%雌激素类%子宫内膜异位症%骨密度%Meta分析
促性腺素釋放激素%雌激素類%子宮內膜異位癥%骨密度%Meta分析
촉성선소석방격소%자격소류%자궁내막이위증%골밀도%Meta분석
Gonadotropin-releasing hormone%Estrogens%Endometriosis%Bone density%Meta-analysis
目的 评价反加疗法在促性腺激素释放激素激动剂(GnRH-a)治疗内异症中减缓骨量流失的作用及有效性.方法 检索Medline数据库、Embase数据库、Cochrane图书馆数据库、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库,收集国内外应用GnRH-a及反加疗法治疗内异症开展的随机对照临床试验(RCT),对纳入的研究进行质量评价,提取数据,采用Stata 11.0软件对用药前后骨密度、生殖激素水平和疼痛视觉模拟评分法(VAS)评分进行荟萃分析.结果 排除不符合纳入标准、随访期或失访人数不明确、重复发表、文献质量过低的研究后,最终共纳入13项RCT研究,调查对象累积785例[反加组(GnRH-a联合雌激素):377例,单药组(单独使用GnRH-a)408例].荟萃分析显示:(1)与单药组相比,反加组可减少骨量流失[标准化均数差(SMD)=0.223,95％ CI:0.003 ～0.443,P=0.047]；(2)反加组与单药组对血清雌激素水平的影响不显著(SMD=-0.053,95％ CI:-0.479～0.373,P=0.807)；(3)两组治疗后VAS评分比较,差异无统计学意义(SMD=-0.157,95％ CI:-0.474～0.160,P=0.332).结论 应用GnRh-a联合雌激素的反加疗法对内异症患者疗效较好且可减缓骨量流失,优于单独应用GnRH-a.
目的 評價反加療法在促性腺激素釋放激素激動劑(GnRH-a)治療內異癥中減緩骨量流失的作用及有效性.方法 檢索Medline數據庫、Embase數據庫、Cochrane圖書館數據庫、中國知網(CNKI)、中國生物醫學文獻數據庫(CBM)、萬方數據庫,收集國內外應用GnRH-a及反加療法治療內異癥開展的隨機對照臨床試驗(RCT),對納入的研究進行質量評價,提取數據,採用Stata 11.0軟件對用藥前後骨密度、生殖激素水平和疼痛視覺模擬評分法(VAS)評分進行薈萃分析.結果 排除不符閤納入標準、隨訪期或失訪人數不明確、重複髮錶、文獻質量過低的研究後,最終共納入13項RCT研究,調查對象纍積785例[反加組(GnRH-a聯閤雌激素):377例,單藥組(單獨使用GnRH-a)408例].薈萃分析顯示:(1)與單藥組相比,反加組可減少骨量流失[標準化均數差(SMD)=0.223,95％ CI:0.003 ～0.443,P=0.047]；(2)反加組與單藥組對血清雌激素水平的影響不顯著(SMD=-0.053,95％ CI:-0.479～0.373,P=0.807)；(3)兩組治療後VAS評分比較,差異無統計學意義(SMD=-0.157,95％ CI:-0.474～0.160,P=0.332).結論 應用GnRh-a聯閤雌激素的反加療法對內異癥患者療效較好且可減緩骨量流失,優于單獨應用GnRH-a.
목적 평개반가요법재촉성선격소석방격소격동제(GnRH-a)치료내이증중감완골량류실적작용급유효성.방법 검색Medline수거고、Embase수거고、Cochrane도서관수거고、중국지망(CNKI)、중국생물의학문헌수거고(CBM)、만방수거고,수집국내외응용GnRH-a급반가요법치료내이증개전적수궤대조림상시험(RCT),대납입적연구진행질량평개,제취수거,채용Stata 11.0연건대용약전후골밀도、생식격소수평화동통시각모의평분법(VAS)평분진행회췌분석.결과 배제불부합납입표준、수방기혹실방인수불명학、중복발표、문헌질량과저적연구후,최종공납입13항RCT연구,조사대상루적785례[반가조(GnRH-a연합자격소):377례,단약조(단독사용GnRH-a)408례].회췌분석현시:(1)여단약조상비,반가조가감소골량류실[표준화균수차(SMD)=0.223,95％ CI:0.003 ～0.443,P=0.047]；(2)반가조여단약조대혈청자격소수평적영향불현저(SMD=-0.053,95％ CI:-0.479～0.373,P=0.807)；(3)량조치료후VAS평분비교,차이무통계학의의(SMD=-0.157,95％ CI:-0.474～0.160,P=0.332).결론 응용GnRh-a연합자격소적반가요법대내이증환자료효교호차가감완골량류실,우우단독응용GnRH-a.
Objective To evaluate the role and efficacy of preventing bone mineral loss in patients with endometriosis treated by gonadotrophin-releasing hormone analogues (GnRH-a) combined with addback therapy.Methods Prospective,randomized controlled studies of the use of GnRHa with add-back therapy in treatment of endometriosis were enrolled in this study from Medline,Embase,Cochrane library,China National Knowledge Internet (CNKI),Chinese Biological Medicine Disk (CBM) and Data Base of Wanfang.After quality assessment and data extraction,meta-analysis were conducted in the change of BMD,reproductive hormone (E2) and visual pain score (VAS) by Stata 11.0 software.Results A total of 785patients from 13 randomized controlled trail (RCT) studies enrolled in this study after exclude no following up,poor quality and repeat published studies.377 patients were in group of GnRH-a with add-back treatment and 408 patients were in group of GnRna alone.The findinds were showed in meta-analysis:(1) there was a significant difference in percentage change of bone mineral density (BMD) between two groups,the addback therapy was more effective in prevention of bone loss which was (SMD =0.223,95％ CI:0.003 to 0.443,P =0.047).(2) There was no significant difference in the level of reproductive hormone between two groups (SMD =-0.053,95％ CI:-0.479 to 0.373,P =0.807).(3) There was also no significant difference in the visual pain score between the two groups (SMD =-0.157,95％ CI:-0.474 to 0.160,P=0.332).Conclusions GnRH-a with add-back therapy have been shown to be more effective in preventing loss of BMD than GnRH-a treatment alone.However,the long term effect of preventing BMD should be studied.
