宫腔内人工授精使用米索前列醇疗效与安全性的系统评价

目的评价宫腔内人工授精（IUI）时使用米索前列醇的疗效和安全性。方法计算机检索Cochrane图书馆（2009年第3期）、EMbase、MEDLINE、ScienceDirect、中国生物医学文献数据库、万方数字化期刊全文数据库、中国期刊全文数据库,收集IUI后使用米索前列醇与对照组比较的临床随机对照试验（RCT）。检索时限为建库至2009年10月。按纳入与排除标准选择研究,评价纳入RCT质量和提取资料,而后采用RevMan5.0软件进行Meta分析。结果共纳入5个RCT,合计546例患者、1？133个IUI周期。其中2个研究证据等级高,3个研究证据等级为中。Meta分析结果显示,400μg米索前列醇与安慰剂组相比,可提高IUI的妊娠率[RR=1.95,95%C（I1.19,3.19）]。400μg米索前列醇组比200μg米索前列醇组腹痛[RR=3.13,95%CI（1.86,5.26）]及阴道流血[RR=5.25,95%CI（2.08,13.21）]的发生率高。结论目前米索前列醇对IUI疗效及安全性的临床试验太少,IUI时使用米索前列醇的疗效与安全性尚难定论,还需要更多高质量、大样本的随机对照试验进一步验证。

Efficacy and Safety of Misoprostol for Intrauterine Insemination: A Systematic Review

Objectives To assess the efficacy and safety of misoprostol for intrauterine insemination （IUI）.Methods The Cochrane Library,EMbase,MEDLINE,SCIENCE Direct Database,CBM,Wangfang Data and CNKI were searched for collecting randomized controlled trials or controlled clinical trials published before October,2009.Statistical analysis was performed with RevMan 5.0 software.Results Five Randomized controlled trials （RCTs） were included according to the inclusion and exclusion criteria at last.Five RCTs involving 546 participants and 1 133 cycles are included.Meta-analysis showed that,compared with placebo group,400 μg misoprostol could increase pregnancy rate of IUI （RR=1.95,95%CI 1.19 to 3.19）;compared with 200 μg misoprostol group,400 μg misoprostol also has higher incidence rate of abdominal pain （RR=3.13,95%CI 1.86 to 5.26） and vaginal bleeding （RR=5.25,95%CI 2.08 to 13.21）.Conclusions Because of the limited studies,recommendation of using misoprostol in IUI cycles is not fully convinced,which has to be further proved by more randomized controlled trials in large sample with high quality.