【摘要】：目的:應(yīng)用meta分析評(píng)估左炔諾孕酮宮內(nèi)緩釋系統(tǒng)與口服孕激素治療子宮內(nèi)膜增生不伴不典型性的臨床療效。方法:使用計(jì)算機(jī)在Pub Med數(shù)據(jù)庫(kù)、中國(guó)知網(wǎng)(CNKI)、萬(wàn)方數(shù)據(jù)庫(kù)、維普數(shù)據(jù)庫(kù)(VIP)、CBMdisc(中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù))中檢索左炔諾孕酮宮內(nèi)緩釋系統(tǒng)與口服孕激素治療子宮內(nèi)膜增生不伴不典型性的隨機(jī)對(duì)照試驗(yàn)相關(guān)文獻(xiàn),制定嚴(yán)格的納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn),進(jìn)行文獻(xiàn)篩選,按Cochrane協(xié)作網(wǎng)偏倚風(fēng)險(xiǎn)評(píng)價(jià)工具對(duì)入選文獻(xiàn)進(jìn)行質(zhì)量評(píng)估,提取有效數(shù)據(jù),同時(shí)應(yīng)用Cochrane協(xié)作網(wǎng)提供的Review Manager 5.3軟件對(duì)相關(guān)數(shù)據(jù)進(jìn)行Meta分析。結(jié)果:根據(jù)本研究的納入與排除標(biāo)準(zhǔn),最終納入文獻(xiàn)11篇,其中英文7篇,中文4篇。Meta分析結(jié)果顯示:LNG-IUS與口服孕激素治療子宮內(nèi)膜增生不伴不典型性對(duì)比,LNG-IUS具有顯著的治療療效(組織病理學(xué)反應(yīng)),治療后3個(gè)月(OR=2.53,95%CI:[1.56,4.12],P=0.0002,7,I~2=0%,n=484)、治療后6個(gè)月(OR=4.07,95%CI:[2.16,7.67],P0.0001,5,I~2=0%,n=433)、治療后12個(gè)月(OR=8.73,95%CI:[4.48,16.99],P0.00001,3,I~2=53%,n=304)、治療后24個(gè)月(OR=7.46,95%CI:[2.55,21.78],P=0.0002,1,n=104)組織病理學(xué)反應(yīng)具有統(tǒng)計(jì)學(xué)差異;亞組分析:LNG-IUS與口服孕激素對(duì)比,LNG-IUS對(duì)子宮內(nèi)膜單純性增生有顯著治療療效(OR=2.68,95%CI:[1.25,5.73],P=0.01,7,I~2=0%,n=340);LNG-IUS對(duì)子宮內(nèi)膜復(fù)雜性增生有顯著治療療效(OR=4.30,95%CI:[2.23,8.29],P0.0001,5,I~2=0%,n=339);LNG-IUS與口服孕激素對(duì)比,LNG-IUS組顯著降低子宮切除率(OR=0.27,95%CI:[0.16,0.45],P0.00001,3,I~2=0%,n=324)。LNG-IUS與口服孕激素對(duì)比,兩者治療后陰道不規(guī)則流血率無(wú)統(tǒng)計(jì)學(xué)差異(OR=2.23,95%CI:[0.50,9.89],P=0.29,4,I~2=79%,n=270)。結(jié)論:LNG-IUS與口服孕激素相比,LNG-IUS治療子宮內(nèi)膜增生不伴不典型性具有顯著療效,提高了子宮內(nèi)膜逆轉(zhuǎn)率,同時(shí)降低子宮切除率,LNG-IUS可作為治療子宮內(nèi)膜增生不伴不典型性的一種安全、有效、適合不同群體的治療方案。
[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 鹵7.67]). P0. 0001 + 5 ~ (5) I ~ (2 +), 12 months after treatment (OR=8.73,95%CI: [4.48 鹵16.99], P 0.00001 ~ (3) I ~ (2 +), 24 months after treatment (OR=7.46,95%CI: [2. 55 鹵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 鹵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 鹵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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R711.74

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