二甲双胍用于多囊卵巢综合征患者促排卵治疗有效性的系统性评价

目的:系统性评价二甲双胍对多囊卵巢综合征(PCOS)促排卵治疗的有效性。方法:计算机检索CBMDISC(中国生物医学文献数据库,1979～2011年)、万方(1994～2011年)、CNKI(中国学术期刊网专题全文数据库,1994～2011年)、维普(中国生物医学期刊数据库,1989～2011年),PubMed(1997～2011年)、ProQust Medical Libraray(PML,1997～2011年)、外文生物医学期刊文献数据库(FMJS,2000～2011年),读秀学术搜索(www.duxiu.com),并手检9种相关杂志。纳入二甲双胍与氯米芬用于PCOS促排卵治疗的随机对照试验,质量评价后进行Meta分析。结果:共纳入8篇RCT,合计1168例。Meta分析结果显示:与氯米芬组比较,二甲双胍组排卵率低于氯米芬组OR 0.48(0.26～0.87)],两组差异有统计学意义;妊娠率OR 0.94(0.26～3.43)],流产率OR 0.63(0.06～6.47)],活产率OR 0.90(0.11～7.32)],两组差异无统计学意义。氯米芬联合二甲双胍组妊娠率较高,与氯米芬组的差异有统计学意义Peto OR 1.56(1.16～2.08)];排卵率OR 1.54(0.96～2.49)],流产率Peto OR 1.40(0.79～2.48)],活产率Peto OR1.26(0.83～1.91)],两组差异无统计学意义。结论:较之氯米芬用于PCOS患者促排卵治疗,二甲双胍可能促进排卵、有利于妊娠,二甲双胍与氯米芬联合用药的治疗效果要好于单一用药。

The effectiveness of metformin ovulation induction treatment in patients with PCOS:a systematic review and meta analysis

Objective:To evaluate of metformin effectiveness of ovulation induction therapy in PCOS patients.Methods:CBMdisc(1979~2011),Wanfang(1994~2011),CNKI(1994~2011),VIP(1989~2011),PUBMED(1997~2011),PML(1997~2011)、FMJS(2000~2011),duxiu scholar seacher(www.duxiu.com) and 9 related journals were searched for randomized controlled trails(RCTs) on the comparison between metformin and clomiphene citrate used for PCOS patients.The quality of included trials was critically appraised.RevMan5.0 software was used for statistical analysis.Results:Seven pubished studies with 1,168 participants were included.The results of Meta-analyses showed that,compared with clomiphene citrate,ovulation rate in metformin group was lower with a significant difference.There was no significant difference in the metformin group about pregnancy rate,miscarraige rate,live birth rate.Pregnancy rate in combination of metformin and clomiphene group was higher with a significant difference Peto OR 1.56(1.16~2.08)].There was no significant difference in the metformin group about ovulation rate 、miscarraige ratePeto OR 1.40(0.79~2.48)],live birth ratePeto OR,1.26(0.83~1.91)].Conclusions:Metformin used for ovulation induction therapy in PCOS patients might promote ovulation induction and can increase pregnancy rates,the therapeutic effect of combination of metformin and clomiphene is better than a single drug use.