促性腺激素释放激素拮抗剂在体外受精-胚胎移植中有效性的系统性评价

目的系统性评价促性腺激素释放激素（GnRH）拮抗剂在体外受精-胚胎移植治疗中的有效性。方法计算机检索中国生物医学文献数据库（1979～2010）、万方数据库（1994～2010）、中国学术期刊网专题全文数据库（1994～2010）、中国生物医学期刊数据库（1989～2010）和PubMed（1997～2010）、ProQust MedicalLibrary（1997～2010）、外文生物医学期刊文献数据库（2000～2010）,并手检相关杂志,查找GnRH拮抗剂与GnRH激动剂比较在体外受精-胚胎移植治疗中有效性的随机对照试验。按照纳入与排除标准选择试验、评价质量后进行Meta分析。结果共纳入6个RCT,合计1208例患者,其方法学质量均为B级。Meta分析结果显示：与GnRH激动剂组相比,GnRH拮抗组刺激天数WMD=–1.07,95%CI（–1.38,–0.76）]和获卵数WMD=–1.80,95%CI（–2.48,–1.12）]均更低,差异有统计学意义;而在Gn量WMD=–0.49,95%CI（–1.63,0.66）]、HCG日子宫内膜厚度WMD=–0.09,95%CI（–0.42,0.24）]、妊娠率Peto OR=0.83,95%CI（0.65,1.05）]、OHSS率PetoOR=0.77,95%CI（0.35,1.72）]和流产率Peto OR=1.49,95%CI（0.79,2.82）]上,两组差异均无统计学意义。结论 GnRH拮抗剂较之GnRH激动剂刺激天数短,所需Gn量少,不明显影响妊娠率,同时可减少OHSS的发生,临床上使用相对灵活,具有较好的接受性,为体外受精-胚胎移植超促排卵治疗提供了另一种选择。受纳入研究质量和例数限制,上述结论尚需开展更多设计严谨的多中心、大样本随机对照试验予以证实和更新。

Effectiveness of GnRH Antagonist in Vitro Fertilization-Embryo Transfr (IVF):A Systematic Review

Objective To evaluate the effectiveness of GnRH antagonist on vitro fertilization-embryo transfer（IVF-ET）.Methods We searched CBMdisc（1979 to 2010）,Wanfang（1994 to 2010）,CNKI（1994 to 2010）,VIP（1989 to 2010）,PubMed（1997 to 2010）,PML（1997 to 2010）,FMJS（2000-2010）,and 9 related journals to identify randomized controlled trials（RCTs） on the comparison between GnRH antagonist（GnRHA） and GnRH agonist（GnRHa）.The quality of included trials was critically appraised.RevMan 4.2.7 software was used for statistical analysis.Results Six published RCTs involving 1 208 participants were included.Compared with the GnRHa group,stimulation duration in the GnRHA group was lower（WMD= –1.07,95%CI –1.38 to –0.76）,dose of gonadotrophins（Gns） in the GnRHA group was slightly lower（WMD= –0.49,95%CI –1.63 to 0.66）,endometrial thickness at the time of HCG administration was no significant difference in the two groups（WMD= –0.09,95%CI –0.42 to 0.24）,number of oocytes retrieved in the GnRHA group was lower（WMD= –1.80,95%CI –2.48 to –1.12）,OHSS rate in the GnRHA group was slightly lower（Peto OR= 0.77,95%CI 0.35 to 1.72）,pregnancy rate in the GnRHA group was slightly lower（Peto OR= 0.83,95%CI 0.65 to 1.05）,miscarraige rate as no significant difference in the two groups（Peto OR= 1.49,95%CI 0.79 to 2.82）.Conclusions Compared with GnRHa,GnRHA requires shorter stimulation duration and less Gn,less affected the pregnancy rate,and reduces the incidence of OHSS.The use of GnRHA in clinical practice is relatively flexible with good acceptability.GnRHA for the superovulation IVF-ET offers an alternative treatment.The above conclusion still needs more well-designed,multi-center,and large-scale RCTs to confirm and update.