來曲唑促排卵治療有效性的系統性評價_《中國循證醫學雜志》

作者：

 肖勁松 , 陳雙隕 , 張春蓮

湖北省十堰市鄖陽醫學院附屬太和醫院婦產科（湖北十堰市 442000）;

關鍵詞：

來曲唑促排卵有效性系統性評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20100482

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目的　系統性評價來曲唑促排卵治療的有效性。
方法　計算機檢索CBM（1979～2009）、萬方數據庫（1994～2009）、CNKI（1994～2009）、VIP（1989～2009）、PubMed（1997～2009）、ProQust Medical Libraray （1997～2009）、外文生物醫學期刊文獻數據庫（2000～2009），并手工檢索相關雜志9種。納入來曲唑與氯米芬促排卵效果比較的隨機對照試驗和臨床對照試驗。評價納入研究的方法學質量，并提取有效數據而后采用RevMan 4.2.7軟件進行Meta分析。
結果　共納入10個研究，合計3 100例患者，其中A級5個，B級4個，C級1個。5個研究顯示絨毛膜促性腺激素（HCG）日子宮內膜厚度來曲唑組高于氯米芬組，兩組差異有統計學意義；1個研究顯示HCG日子宮內膜厚度來曲唑組低于氯米芬組，兩組差異有統計學意義；3個研究顯示兩組差異無統計學意義。4個研究顯示HCG日優勢卵泡數來曲唑組低于氯米芬組，兩組差異有統計學意義；1個研究顯示HCG日優勢卵泡數來曲唑組高于氯米芬組，兩組差異有統計學意義；2個研究顯示兩組差異無統計學意義。Meta分析結果顯示，與氯米芬比較，來曲唑單一用藥組妊娠率略低，但其差異無統計學意義［RR=1.03，95%CI（0.82，1.29）］；聯合用藥組妊娠率較高，且其差異有統計學意義［RR=1.73，95%CI（1.37，2.18）］；來曲唑組排卵率較高，其差異無統計學意義［RR=1.23，95%CI（0.97，1.57）］。
結論　來曲唑與氯米芬促排卵治療在子宮內膜厚度、優勢卵泡數、排卵率、妊娠率方面可能存在差異，但無統計學意義。臨床上來曲唑可彌補氯米芬促排卵治療的缺點，提供另外一種選擇。上述結論仍需更多設計嚴謹的多中心，大樣本隨機對照試驗來證實。

引用本文： 肖勁松,陳雙隕,張春蓮. 來曲唑促排卵治療有效性的系統性評價. 中國循證醫學雜志, 2010, 10(6): 718-723. doi: 10.7507/1672-2531.20100482 復制

1.	Al-Fozan H, Al-Khadouri M, Tan SL, et al. A randomized trial of letrozole versus clomiphene citrate in women undergoing superovulation. Fertil Steril, 2004, 82(6): 1561-1563.
2.	Mitwally MFM, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril, 2001, 75(2): 305-309.
3.	Mitwally M, Biljan M, Casper R. Pregnancy outcome after the use of an aromatase inhibitor for ovarian stimulation. Am J Obstet Gynecol, 2005, 192(2): 381-386.
4.	Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. BMJ, 2001, 323(7303): 42-46.
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6.	Cochrane Reviewer’ Handbook 4.1. The Cochrane Collaboration, 2000.
7.	Schulz KF, Chalmers I, Hayes RJ, et al. Empirical evidence of bias.JAMA, 1995, 273(5): 408-421.
8.	Jee BC, Ku SY, Suh CS, et al. Use of letrozole versus clomiphene citrate combined with gonadotropins in intrauterine insemination cycles: a pilot study. Fertil Steril, 2006, 85(6): 1774-1777.
9.	Sh E, Nejad T, Abediasl Z, et al. Comparison of the efficacy of the aromatase inhibitor letrozole and clomiphen citrate gonadotropins in controlled ovarian hyperstimulation: a prospective, simply randomized, clinical trial. J Assist Reprod Genet, 2008, 25(5): 187-190.
10.	Badawy A, Abdel Aal I, Abulatta M. Clomiphene citrate or letrozole for ovulation inductionin women with polycystic ovarian syndrome:a prospective randomized trial. Fertil Steril, 2009, 92(3): 849-852.
11.	Ganesh A, Goswami SK, Chattopadhyay R, et al. Comparison of letrozole with continuous gonadotropins and clomiphene-gonadotrop in combination for ovulation induction in 1387 PCOS women after clomiphene citrate failure: a randomized prospective clinical trial. J Assist Reprod Genet, 2009, 26(1): 19-24.
12.	Atay V, Cam C, Muhcu M, et al. Comparison of Letrozole and Clomiphene Citrate in women with polycystic ovaries undergoing ovarian stimulation. J Int Med Res, 2006, 34(1): 73-76.
13.	Barroso G, Menocal G, Felix H, et al. Comparison of the efficacy of the aromatase inhibitor letrozole and clomiphene citrate as adjuvants to recombinant follicle-stimulating hormone in controlled ovarian hyperstimulation: a prospective, randomized, blinded clinical trial. Fertil Steril, 2006, 85(5): 1428-1431.
14.	Bayar ü, Basaran M, Kiran S, et al. Use of an aromatase inhibitor in patients with polycystic ovary syndrome: a prospective randomized trial. Fertil Steril, 2006, 82(5): 1447-1451.
15.	Begum M, Ferdous J, Begum A, et al. Comparison of efficacy of aromatase inhibitor andclomiphene citrate in induction of ovulation in polycystic ovarian syndrome. Fertil Steril, 2009, 92(3): 853-856.
16.	Sohrabvand F, Ansari Sh, Bagheri M. Efficacy of combined Metformin-Letrozole in comparison with Metformin-Clomiphene citrate in clomiphene-resistant infertile women with polycystic ovarian disease. Hum Reprod, 2006, 21(6): 1432- 1435.
17.	Cortinez I, De Carvalho D, Vantman F, et al. Hormonal profile and endometrial morphology in letrozole-controlled ovarian hyperstimulation in ovulatory infertile patients. Fertil Steril, 2005, 83(1): 110-115.
18.	Fisher SA, Reid RL, Van Vugt DA, et al. A randomized double-blind comparison of the effects of clomiphene citrate and the aromatase inhibitor letrozole on ovulatory function in normal women. Fertil Steril, 2002, 78(2): 280-285.
19.	Kistner RW. Induction of ovulation with clomiphene citrate (clomid). Obstet Gynecol Survey, 1965, 20(6): 873-900.
20.	Heard MJ, Pierce A, Carson SA, et al. Pregnancies following use of metformin for ovulation induction in patients with polycystic ovary syndrome. Fertil Steril, 2002, 77(4): 669-673.
21.	Nestler JE, Jakubowicz DJ, Evans WS, et al. Effects of metformin on spontaneous and clomiphene – induced ovulation in the polycystic ovary syndrome. N Engl J Med, 1998, 338(26): 1876-1880.
22.	FG Samani, L Farzadi, N Nezami, et al. Endometrial and follicular development following letrozole intervention in unexplained infertile patients failed to get pregnant with clomiphene citrate. Arch Gynecol Obstet, 2009, 280(2): 201-205.
23.	RF Casper. letrozole ovulation or superovulation? Fertil Steril, 2003, 80(2): 1335-1337.

1. Al-Fozan H, Al-Khadouri M, Tan SL, et al. A randomized trial of letrozole versus clomiphene citrate in women undergoing superovulation. Fertil Steril, 2004, 82(6): 1561-1563.
2. Mitwally MFM, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril, 2001, 75(2): 305-309.
3. Mitwally M, Biljan M, Casper R. Pregnancy outcome after the use of an aromatase inhibitor for ovarian stimulation. Am J Obstet Gynecol, 2005, 192(2): 381-386.
4. Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. BMJ, 2001, 323(7303): 42-46.
5. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies epidemiology: a proposal for reporting. JAMA, 2000, 283(15): 2008-2012.
6. Cochrane Reviewer’ Handbook 4.1. The Cochrane Collaboration, 2000.
7. Schulz KF, Chalmers I, Hayes RJ, et al. Empirical evidence of bias.JAMA, 1995, 273(5): 408-421.
8. Jee BC, Ku SY, Suh CS, et al. Use of letrozole versus clomiphene citrate combined with gonadotropins in intrauterine insemination cycles: a pilot study. Fertil Steril, 2006, 85(6): 1774-1777.
9. Sh E, Nejad T, Abediasl Z, et al. Comparison of the efficacy of the aromatase inhibitor letrozole and clomiphen citrate gonadotropins in controlled ovarian hyperstimulation: a prospective, simply randomized, clinical trial. J Assist Reprod Genet, 2008, 25(5): 187-190.
10. Badawy A, Abdel Aal I, Abulatta M. Clomiphene citrate or letrozole for ovulation inductionin women with polycystic ovarian syndrome:a prospective randomized trial. Fertil Steril, 2009, 92(3): 849-852.
11. Ganesh A, Goswami SK, Chattopadhyay R, et al. Comparison of letrozole with continuous gonadotropins and clomiphene-gonadotrop in combination for ovulation induction in 1387 PCOS women after clomiphene citrate failure: a randomized prospective clinical trial. J Assist Reprod Genet, 2009, 26(1): 19-24.
12. Atay V, Cam C, Muhcu M, et al. Comparison of Letrozole and Clomiphene Citrate in women with polycystic ovaries undergoing ovarian stimulation. J Int Med Res, 2006, 34(1): 73-76.
13. Barroso G, Menocal G, Felix H, et al. Comparison of the efficacy of the aromatase inhibitor letrozole and clomiphene citrate as adjuvants to recombinant follicle-stimulating hormone in controlled ovarian hyperstimulation: a prospective, randomized, blinded clinical trial. Fertil Steril, 2006, 85(5): 1428-1431.
14. Bayar ü, Basaran M, Kiran S, et al. Use of an aromatase inhibitor in patients with polycystic ovary syndrome: a prospective randomized trial. Fertil Steril, 2006, 82(5): 1447-1451.
15. Begum M, Ferdous J, Begum A, et al. Comparison of efficacy of aromatase inhibitor andclomiphene citrate in induction of ovulation in polycystic ovarian syndrome. Fertil Steril, 2009, 92(3): 853-856.
16. Sohrabvand F, Ansari Sh, Bagheri M. Efficacy of combined Metformin-Letrozole in comparison with Metformin-Clomiphene citrate in clomiphene-resistant infertile women with polycystic ovarian disease. Hum Reprod, 2006, 21(6): 1432- 1435.
17. Cortinez I, De Carvalho D, Vantman F, et al. Hormonal profile and endometrial morphology in letrozole-controlled ovarian hyperstimulation in ovulatory infertile patients. Fertil Steril, 2005, 83(1): 110-115.
18. Fisher SA, Reid RL, Van Vugt DA, et al. A randomized double-blind comparison of the effects of clomiphene citrate and the aromatase inhibitor letrozole on ovulatory function in normal women. Fertil Steril, 2002, 78(2): 280-285.
19. Kistner RW. Induction of ovulation with clomiphene citrate (clomid). Obstet Gynecol Survey, 1965, 20(6): 873-900.
20. Heard MJ, Pierce A, Carson SA, et al. Pregnancies following use of metformin for ovulation induction in patients with polycystic ovary syndrome. Fertil Steril, 2002, 77(4): 669-673.
21. Nestler JE, Jakubowicz DJ, Evans WS, et al. Effects of metformin on spontaneous and clomiphene – induced ovulation in the polycystic ovary syndrome. N Engl J Med, 1998, 338(26): 1876-1880.
22. FG Samani, L Farzadi, N Nezami, et al. Endometrial and follicular development following letrozole intervention in unexplained infertile patients failed to get pregnant with clomiphene citrate. Arch Gynecol Obstet, 2009, 280(2): 201-205.
23. RF Casper. letrozole ovulation or superovulation? Fertil Steril, 2003, 80(2): 1335-1337.

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來曲唑促排卵治療有效性的系統性評價

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