促性腺激素释放激素激动剂联合反向添加疗法治疗术后中重度子宫内膜异位症的 Meta 分析

摘要

Objective To evaluate the effect of gonadotropin-releasing hormone agonist (Gonadotrophin re-leasing hormone agonist,GnRHa)combined with add back therapy for moderate /severe endometriosis after conserva-tive surgery in China.Methods In addition to manually searching,Cochrane CentralRegister of Controlled Trials (CENTRAL),the Cochrane Library,PubMed,Medline,EMBASE,SCI,Chinese journal full-text database,Chinese bi-omedical literature database,Chinese sci-tech periodical full-text database,VIP Chinese Periodical Database and Wan-fang Chinese Periodical Database were electronically searched from the establsihment of the database till March 2013, and state was limit as China.A total of seven RCTs meet the criteria.The data was extracted and analyzed by two re-viewers independently using the RevMan5.1 software.Results ①The increase in serum estrogen (E2 )levels,P <0.01,decrease in levels of serum follicle-stimulating hormone (FSH)was observed in the add-back therapy group,P=0.006,there was no statistic difference in the levels of serum CA125 and LH between the add-back therapy group and the GnRHa group,P >0.05.②There was no significant difference in the VAS score between the add-back thera-py group and the GnRHa group,P =0.12.③The menopause symptom(Kupperman score)caused by GnRHa was re-lieved in the add-back therapy group,P =0.001,There was no statistic difference in the levels of serum BMD and BPG levels,P >0.05.Conclusions GnRHa combined with add-back therapy post operation for moderate /severe en-dometriosis can effectively reduce the the menopause symptoms caused by GnRHa,with no evidence of changes in bone density,pain symptoms and CA125 levels.%目的：评价促性腺激素释放激素激动剂（GnRHa）联合反向添加疗法用于我国中重度子宫内膜异位症患者术后疗效。方法检索 cochrane central Register of Controlled Trials（CENTRAL）、the cochrane Li-brary、PubMed、Medline、EMBASE、SCI、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库、维普数据库、万方数据资源，检索时间截止2013年3月，国家限制为中国，并辅以手工检索，根据入选标准选出 RCT 文献7篇，对其进行文献质量评价。采用 RevMan5．1软件进行 meta 分析。结果①反加疗法组较 GnRHa 组增加雌激素（E2）水平，P ＜0．01，降低卵泡刺激素（FSH）水平，P ＝0．006，两组差异均有统计学意义。反加组与 GnRHa 组间 CA125水平、黄体生成素（LH）水平差异无统计学意义。②在缓解疼痛 VAS 评分上反加疗法组与 GnRHa 组差异无统计学意义。③在药物不良反应中绝经症状严重程度（Kupperman 评分）上反加疗法组缓解了使用 GnRHa 造成的绝经症状，两组差异有统计学意义，P ＝0．001，在骨密度、骨钙素水平上，两组差异无统计学意义。结论保守手术后中重度子宫内膜异位症患者应用反加疗法，可以减少由GnRHa引起的低雌激素水平，但是未能对于骨密度水平和疼痛症状有显著地改善。