活性γ型与常见开放式宫内节育器比较的Meta分析

目的:运用循证医学系统评价方法比较活性γ型宫内节育器(IUD)与3种常用开放式IUD的避孕效果,为计划生育服务对象知情选择和政府采购避孕药具提供依据。方法:检索7种医学数据库和9种相关杂志,并追查参考文献。由2位评价员根据纳入排除标准筛查检索的文献,并进行Meta分析。结果:纳入12篇文献,8100例进行Meta分析。与TCu220CIUD比较,活性γ型IUD在使用1年时的累计脱落率更低,OR及95%CI为0.51(0.31～0.85)。累计因症取出率在使用1、2年时也更低,OR及95%CI分别为0.42(0.28～0.63)和0.42(0.30～0.59)。与MTL-Cu375IUD比较,二者带器妊娠和脱落率相似,但使用2、3年时活性γ型IUD的因症取出率更低。活性γ型IUD比TCu380AIUD的累计脱落率和因症取出率低,差异有统计学意义。结论:与TCu220c、MTLCu375及TCu380AIUD比较,活性γ型IUD的5年内累计脱落率及因出血和/或疼痛等引起的取出率低,值得推广使用。

Meta-analysis for Active γ- IUD and Other Common- using Open- model IUDs

Objective:To compare the contraception effects of active γ-IUD and three other common-using open-model IUDs,and provide evidences for the clients' informed-choice of contraception and the government purchase for contraceptive.Methods:Seven medical databases and nine related journals were searched,including CBM,CNKI,CMAC,CMCC,EMBASE,MEDLINE and Cochrane library.And references of original articles were investigated also.All literatures were screened according to the inclusion and exclusion criteria by two reviewers,and meta-analysis was performed.Results:Twelve literatures were brought into,and 8,100 cases were meta-analyzed.Compared with TCu220c,the 1-year-usage accumulative expulsion rate of active γ-IUD was lower(OR=0.51,95%CI:0.31-0.85).While the discontinue rate for medical reason of 1-and 2-year usage of active γ-IUD was significantly lower,with the OR and 95%CI were 0.42(0.28-0.63)and 0.42(0.30-0.59),respectively.And the pregnancy rate with IUD and expulsion rate of active γ-IUD were similar to those of MTLCu375IUD,but the 2-and 3-year-usage discontinue rate for medical reason was markedly lower,with OR and 95%CI were 0.19(0.08-0.48)and 0.17(0.05-0.54),respectively.The accumulative expulsion rate and the discontinue rate for medical reason of active γ-IUD were lower than those of TCu380A,and the differences was statistically significant.Conclusion:Compared with open-model IUDs such as TCu220c,MTLCu375 and TCu380A,active γ-IUD is worth using widely for its low 5-year-usage accumulative expulsion rate and discontinue rate for medical reason.