發(fā)布時(shí)間：2018-06-09 13:45

  本文選題：多囊卵巢綜合征 + 二甲雙胍�。� 參考：《廣西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：系統(tǒng)評(píng)價(jià)二甲雙胍和克羅米芬單獨(dú)或聯(lián)合用于多囊卵巢綜合征(Poly cystic ovary syndrome, PCOS)患者促排卵效果的比較。方法：計(jì)算機(jī)檢索Cochrane圖書館臨床對(duì)照試驗(yàn)資料庫(kù)(Central/CCTR)、PubMed、EMbase、CBMdisc, CNKI、VIP、萬(wàn)方數(shù)據(jù)庫(kù)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)及Clinical trials、Current controlled trials等臨床試驗(yàn)網(wǎng)站,手工檢索相關(guān)醫(yī)學(xué)專業(yè)雜志。查找建庫(kù)至2014年10月更新的MET,CC單獨(dú)或聯(lián)合用于PCOS患者的臨床隨機(jī)對(duì)照試驗(yàn)(RCT)的所有文獻(xiàn)。根據(jù)Cochrane系統(tǒng)評(píng)價(jià)方法的納入及排除標(biāo)準(zhǔn)篩選文獻(xiàn)、提取資料、對(duì)納入研究的進(jìn)行偏倚風(fēng)險(xiǎn)評(píng)估,提取相關(guān)有效數(shù)據(jù),對(duì)其應(yīng)用軟件RevMan5.2進(jìn)行Meta分析。結(jié)果：納入10個(gè)RCT,共1580例患者。其中5個(gè)RCT包含MET與CC的比較,共837例患者；9個(gè)RCT包含CC與CC+MET的比較,共1100例患者；4個(gè)RCT包含MET與MET+CC的比較,共741例患者。Meta分析結(jié)果顯示：①CC與MET比較：周期排卵率(RR=1.80,95%CI(1.42,2.27),P0.00001)CC組較MET組高,妊娠率(RR=1.10,95%CI(0.53,2.28),P=0.79)、活產(chǎn)率(RR=1.03,95%CI(0.82,1.31), P=0.78),流產(chǎn)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)兩組均無(wú)差異；② ET+CC與MET比較：周期排卵率(RR=1.86,95%CI(1.15,3.30),P=0.01) MET+CC組較MET組高；妊娠率(RR=1.83,95%CI(0.99,3.36),P=0.05)、活產(chǎn)率(RR=1.16,95%CI(0.88,1.52),P=0.29)、流產(chǎn)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)兩組均無(wú)差異。③ MET+CC與CC比較：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組較CC組高；活產(chǎn)率(RR=-0.04,95%CI(-0.17,0.08), P=0.49)、流產(chǎn)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)降低水平兩組均無(wú)差異。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組較CC組顯著。結(jié)論：二甲雙胍聯(lián)合克羅米芬治療PCOS患者在改善其胰島素代謝、降低血清雄激素和黃體生成素水平的同時(shí),可明顯提高克羅米芬的促排卵效果和妊娠率,同時(shí)不增加多胎妊娠及流產(chǎn)的風(fēng)險(xiǎn)。三種治療方案比較,克羅米芬聯(lián)合二甲雙胍用于PCOS患者的促排卵效果最佳。由于受研究人群的不同,用藥劑量、療程的不同和樣本量的影響,研究結(jié)果不盡相同。故今后還需要高質(zhì)量、多中心、大樣本的RCT來(lái)確定藥物劑量、療程及最優(yōu)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，

本文編號(hào)：1999925