發(fā)布時(shí)間：2018-01-24 04:45

  本文關(guān)鍵詞： 子宮內(nèi)膜異位癥 促性腺激素釋放激素激動(dòng)劑 反向添加 系統(tǒng)評(píng)價(jià) Meta分析　出處：《廣西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的應(yīng)用循證醫(yī)學(xué)方法對(duì)促性腺激素釋放激素激動(dòng)劑（GnRH-a）聯(lián)合激素反向添加療法治療子宮內(nèi)膜異位癥的療效及安全性進(jìn)行評(píng)價(jià)，為子宮內(nèi)膜異位癥的臨床治療提供評(píng)價(jià)依據(jù)。 方法計(jì)算機(jī)檢索Cochrane圖書館，MEDLINE數(shù)據(jù)庫(kù)，EMBase數(shù)據(jù)庫(kù)，中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)（CBM）、中國(guó)知網(wǎng)（CNIK），維普期刊數(shù)據(jù)庫(kù)及萬(wàn)方學(xué)位論文數(shù)據(jù)庫(kù)，手工檢索相關(guān)專業(yè)雜志，文章語(yǔ)種不限，檢索時(shí)間截止至2014年3月，收集國(guó)內(nèi)外GnRH-a聯(lián)合反向添加治療子宮內(nèi)膜異位癥的隨機(jī)對(duì)照試驗(yàn)（RCTs）。由兩名評(píng)價(jià)員獨(dú)立選擇研究，對(duì)納入的研究提取資料，評(píng)價(jià)其方法學(xué)質(zhì)量，提取資料及有效數(shù)據(jù)，用RevMan5.1統(tǒng)計(jì)軟件進(jìn)行Meta分析。 結(jié)果共納入符合標(biāo)準(zhǔn)的RCTs11個(gè)，共包括772例患者。其中10個(gè)RCTs為GnRH-a聯(lián)合雌孕激素與GnRH-a聯(lián)合安慰劑/單用GnRH-a的比較，1個(gè)RCT為GnRH-a聯(lián)合替勃龍與聯(lián)合安慰劑的比較。Meta分析結(jié)果顯示：①聯(lián)合反向添加組患者的腰椎骨質(zhì)丟失低于聯(lián)合安慰劑/單用GnRH-a組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。②聯(lián)合反向添加組治療后患者的腰椎骨密度高于聯(lián)合安慰劑/單用GnRH-a組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.0001）。③聯(lián)合反向添加組患者的E2明顯高于聯(lián)合安慰劑/單用GnRH-a組，而FSH水平低于聯(lián)合安慰劑/單用GnRH-a組，差異均有統(tǒng)計(jì)學(xué)意義（P＜0.05）。④聯(lián)合反向添加組與聯(lián)合安慰劑/單用GnRH-a組比較，盆腔痛癥狀緩解上差異無(wú)統(tǒng)計(jì)學(xué)意義（P=0.09）。反向添加組患者的失眠、潮熱的發(fā)生率及Kupperman評(píng)分均較聯(lián)合安慰劑/單用GnRH-a組低，，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。⑤聯(lián)合反向添加組患者的低密度脂蛋白和甘油三酯與聯(lián)合安慰劑/單用GnRH-a組相比，差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。 結(jié)論GnRH-a聯(lián)合激素反向添加治療在保持其治療效果的同時(shí)，能夠改善機(jī)體低雌激素狀態(tài)，減輕和緩解圍絕經(jīng)期相關(guān)癥狀及骨質(zhì)丟失，短期內(nèi)對(duì)血脂代謝變化影響不大。
[Abstract]:Objective to evaluate the efficacy and safety of gonadotropin releasing hormone agonist (GnRH-a) combined with reverse hormone supplementation therapy in the treatment of endometriosis by evidence-based medicine (EBM). To provide the evaluation basis for the clinical treatment of endometriosis. Methods the Cochrane library was searched by computer in MEDLINE database, China Biomedical Literature Database (CBM), and China knowledge Network (CNI). WIP journal database and Wanfang thesis database, manual retrieval of related professional magazines, the language of the article is unlimited, the retrieval time to March 2014. A randomized controlled trial of GnRH-a combined with reverse supplementation in the treatment of endometriosis was collected at home and abroad. Two evaluators independently selected the study and extracted the data from the included study. The quality of methodology, data extraction and effective data were evaluated, and Meta analysis was carried out with RevMan5.1 statistical software. Results A total of RCTs11 were included. A total of 772 patients were included, 10 of whom were compared with GnRH-a combined with estrogen and progesterone and GnRH-a with placebo / GnRH-a alone. One RCT was a comparison of GnRH-a combined with tibolone and placebo. Meta-analysis showed that:. 1the lumbar bone loss in the combined reverse supplementation group was lower than that in the combined placebo / GnRH-a group. The difference was statistically significant (P < 0.05). 2 the BMD of lumbar vertebrae was higher in the combined placebo / GnRH-a group than that in the control group (P < 0.05). The difference was statistically significant (P < 0.0001t.3). The level of E _ 2 in the group of combined placebo and GnRH-a was significantly higher than that in the group of combined placebo / GnRH-a alone. However, the level of FSH was significantly lower in the combined placebo / single GnRH-a group than in the combined placebo / single GnRH-a group (P < 0.05). There was no significant difference in the remission of pelvic pain symptoms. The incidence of hot flashes and the Kupperman score were lower than those in the placebo / GnRH-a alone group. There was a significant difference in low density lipoprotein and triglyceride between the combined placebo / GnRH-a group and the reverse supplementation group (P < 0.05). The difference was not statistically significant (P > 0.05). Conclusion GnRH-a combined with reverse hormone supplementation therapy can improve the state of low estrogen and alleviate the symptoms of menopause and bone loss while maintaining the therapeutic effect. In the short term, the changes of blood lipid metabolism have little effect.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R711.71

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