發(fā)布時間：2019-03-04 09:50

【摘要】：背景:絕經(jīng)前乳腺癌患者越來越關(guān)注化療期間導(dǎo)致的卵巢早衰及不孕不育。最新的卵巢功能保護(hù)策略就是化療聯(lián)合使用促性腺激素釋放激素激動劑(Gn RHa),但臨床療效不一,缺乏更全面關(guān)于保護(hù)卵巢及生育功能分析的數(shù)據(jù)。目的:研究絕經(jīng)前乳腺癌患者化療聯(lián)合GnRHa保護(hù)卵巢功能提高月經(jīng)復(fù)潮及生育功能,為臨床決策和實踐提供參考。方法:檢索EMBASE、Pubmed、中國知網(wǎng)、MEDLINE、萬方網(wǎng)及科技網(wǎng)等電子數(shù)據(jù)庫,收集并納入截至2016年12月份的使用促性腺激素釋放激素類似物預(yù)防或治療絕經(jīng)前乳腺癌患者化療期間卵巢功能保護(hù)及生育功能恢復(fù)方面的隨機(jī)對照試驗研究,僅限于中文和英文文獻(xiàn)。由兩名研究人員獨立操作完成文獻(xiàn)篩選、數(shù)據(jù)提取、文獻(xiàn)質(zhì)量評價等過程,采用RevMan5.0、Stata 11.0統(tǒng)計軟件進(jìn)行Meta分析。結(jié)果:9項隨機(jī)對照研究符合納入標(biāo)準(zhǔn),共858例絕經(jīng)前乳腺癌患者,其中化療聯(lián)合GnRHa組為442例,單純化療組為416例。化療聯(lián)合GnRHa組自然月經(jīng)復(fù)潮率高于單純化療組(OR=2.63,95%confidence interval(CI)=[1.50,4.63],P=0.0008)。但是,對于自然妊娠率來說,化療聯(lián)合GnRHa組和單純化療組結(jié)果沒有統(tǒng)計學(xué)意義(OR=1.77,95%CI=[0.92,3.40];P=0.09)。在40歲年輕乳腺癌患者中,使用GnRHa對月經(jīng)復(fù)潮有統(tǒng)計學(xué)意義(OR=2.26,95%CI=1.07,4.75;P=0.03)。而≥40歲乳腺癌患者則無統(tǒng)計學(xué)意義(OR=1.84,95%CI=0.78,4.35;P=0.16)。他莫昔芬聯(lián)合GnRHa亞組和僅用他莫昔芬亞組對于月經(jīng)復(fù)潮均無統(tǒng)計學(xué)意義,結(jié)果分別為(OR=1.45,95%CI=[0.90,2.33];P=0.12);(OR=1.44,95%CI=[0.91,2.30];P=0.12)。以蒽環(huán)類為基礎(chǔ)方案化療聯(lián)合GnRHa對月經(jīng)復(fù)潮有統(tǒng)計學(xué)意義(OR=2.49,95%CI=[1.06,5.89];P=0.04);以非蒽環(huán)類為基礎(chǔ)方案化療聯(lián)合GnRHa結(jié)果為(OR=1.72,95%CI=[0.60,4.96];P=0.31)差異無統(tǒng)計學(xué)意義。發(fā)生不良反應(yīng)亞組分析,化療聯(lián)合GnRHa組顯著增加潮熱發(fā)生,結(jié)果顯示(OR=1.92,95%CI=[1.26,2.93];P=0.002)。然而,對于陰道干澀、情緒改變及性欲下降在實驗組與對照組均無統(tǒng)計學(xué)意義,結(jié)果分別為(OR=1.46,95%CI=[0.69,3.10];P=0.32)、(OR=1.44,95%CI=[0.67,3.09];P=0.35)及(OR=1.55,95%CI=[0.68,3.53];P=0.29)。結(jié)論:GnRHa使絕經(jīng)前乳腺癌患者化療后月經(jīng)復(fù)潮率提高,提示能有效保護(hù)患者卵巢功能,但對患者自然妊娠能否獲益尚無法證實。仍需要進(jìn)行更多大樣本、多中心、高質(zhì)量、同質(zhì)性的隨機(jī)對照試驗來進(jìn)一步證實GnRHa安全性及有效性。
[Abstract]:Background: premenopausal breast cancer patients are increasingly concerned about premature ovarian failure and infertility during chemotherapy. The most recent protective strategy for ovarian function is the combination of chemotherapy with gonadotropin-releasing hormone agonist (Gn RHa), but the clinical efficacy is different. There is a lack of more comprehensive data on the analysis of ovarian protection and fertility function. Aim: to study the effects of chemotherapy combined with GnRHa on ovarian function in patients with premenopausal breast cancer, and to provide reference for clinical decision-making and practice. Methods: to search the electronic databases such as EMBASE,Pubmed, China knowledge Network, MEDLINE, Wanfang Network and Science and Technology Network, etc. To collect and incorporate randomized controlled trial studies to prevent or treat ovarian function protection and fertility recovery during chemotherapy in premenopausal breast cancer patients using gonadotropin-releasing hormone analogues as of December 2016, Only in Chinese and English. The process of literature screening, data extraction and document quality evaluation was performed by two researchers independently. Meta analysis was carried out with RevMan5.0,Stata 11.0 statistical software. Results: a total of 858 patients with premenopausal breast cancer were enrolled in 9 randomized controlled studies, including 442 cases in chemotherapy combined with GnRHa group and 416 cases in chemotherapy alone group. The rate of spontaneous menstrual regurgitation in chemotherapy combined with GnRHa group was higher than that in chemotherapy group (OR=2.63,95%confidence interval (CI) = [1.50,4.63], P < 0.0008). However, for the natural pregnancy rate, there was no significant difference between the chemotherapy combined with GnRHa group and the chemotherapy alone group (OR=1.77,95%CI= [0.92, 3.40]; P < 0.05). In 40-year-old young breast cancer patients, the use of GnRHa was statistically significant for menstrual regurgitation (OR=2.26,95%CI=1.07,4.75;P=0.03). There was no statistical significance (OR=1.84,95%CI=0.78,4.35;P=0.16) in patients with breast cancer 鈮，

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