来曲唑与枸橼酸氯米芬诱导排卵的临床效果系统评价

目的:系统性评价来曲唑与枸橼酸氯米芬在不孕症患者促排卵治疗中的疗效与安全性。方法:计算机检索国内外各主要数据库,手工检索相关中文杂志、会议论文集和所获文献的参考文献,收集国内外发表的来曲唑与枸橼酸氯米芬促排卵治疗不孕症的随机对照试验文献。两人独立进行文献筛选并进行方法学质量评价,采用RevMan4.2.10软件进行meta分析。结果:共纳入14个随机对照研究,包括1379例患者,2342个周期。根据是否有正常自然排卵周期分为多囊卵巢综合征(PCOS)亚组(纳入5个研究)和排卵正常亚组(纳入9个研究)进行分析。结果显示,来曲唑与枸橼酸氯米芬比较,两者在每周期妊娠率、每个患者妊娠率、排卵率、流产率方面差异无统计学意义,其RR(95%CI)分别为0.99(0.75～1.30)、1.21(0.92～1.58)、1.04(0.92～1.17)、0.55(0.23～1.29)。就人绒毛膜促性腺激素(hCG)日雌二醇(E2)水平,PCOS亚组有2个研究,排卵正常亚组有4个研究均显示来曲唑组低于氯米芬组(P<0.05)。关于子宫内膜厚度PCOS亚组有3个研究,排卵正常亚组有2个研究均显示来曲唑组高于氯米芬组(P<0.05)。结论:来曲唑促排卵治疗与氯米芬在hCG日E2水平、子宫内膜厚度、优势卵泡数、排卵率、妊娠率、流产率等方面未见统计学差异。目前的研究尚不能证明来曲唑可以代替氯米芬成为一线促排卵药。

Letrozole and clomiphene citrate for ovulation induction: A systematic review

Objective ： To evaluate the efficacy and safety of letrozole and clomiphene citrate for ovulation induction in infertile women. Methods： We searched paper databases such as PubMed （from 1966 to 2011 ）, EMBASE （from 1966 to 2011 ）, CB- Mdisc （ from 1978 to 2011 ）, CNKI （from 1994 to 2011 ） and VIP （from 1989 to 2011 ）. Relevant randomized controlled trials （RCTs） were selected for quality assessment according to Cochrane Reviewer＇s handbook 4.2.5 and meta- analysis with RevMan 4.2.10 software. Results ： Fourteen RCTs involving in 1 379 women and 2342 cycles were included. All data were divided into polycystic ovary syndrome （PCOS） and normal ovulation subgroups. The results of meta -analysis showed that no significant differences were found in the cycle pregnancy rate （ RR： 0.99, 95% CI ： 0.75 to 1.30）, pregnancy rate of each women （RR： 1.21,95% CI： 0.92 to 1.58 ）, ovulation rate （RR：I. 04, 95% C I： 0.92 to 1.17 ）, and miscarriage rate （ RR： 0.55, 95% CI： 0.23 to 1.29）. But serum estrodiol concentration on the day of human chorionic gonadotrophin （hCG） was significantly lower in the letrozole group in 2 RCTs of the PCOS subgroup and 4 RCTs of the normal ovulation subgroup （P 〈 0.05）. The endometrium on the day of hCG administration was significantly thicker in the letrozole group in 3 RCTs of the PCOS subgroup and 2 RCTs of the normal ovulation subgroup （ P 〈 0.05 ）. Conclusion ： Letrozole is at least as effective as clomiphene for inducing ovulation and achieving pregnancy in patients with infertility. Current research does not demonstrate that letrozole can replace clomiphene as a first -line medicine for ovulation induction in patients with infertility.