目的:采用循证医学方法评价曼月乐与孕三烯酮治疗子宫腺肌病的有效性及安全性.方法:计算机检索中国知网、万方等中文数据库及Pubmed、Cochrane Library等外文数据库,同时运用手工检索,全面搜集国内外相关文献,运用Rev-Man5.3软件进行Meta分析.结果:共纳入文献9篇,包括706例子宫腺肌病患者,实验组为曼月乐(n=359),对照组为孕三烯酮(n=347).观察痛经评分(VAS)、月经量、内膜厚度、子宫体积和不良反应.Meta分析结果显示:(1)曼月乐组VAS评分显著低于孕三烯酮组(MD=-l.43,95％CI:-1.65～-1.21,P＜0.000 01).(2)月经量:曼月乐组月经量明显少于孕三烯酮组(MD=-60.00,95％CI:-102.52～-17.47,P=0.006).(3)子宫内膜厚度:曼月乐组子宫内膜厚度明显薄于孕三烯酮组(MD=-1.08,95％ CI:-1.49～-0.66,P＜0.000 1).(4)子宫体积:曼月乐组子宫体积明显小于孕三烯酮组(MD=-18.05,95％ CI:-26.95～-9.15,P＜0.000 1).(5)不良反应:曼月乐组不良反应发生率明显低于孕三烯酮组(OR=0.45,95％ CI:0.29～0.69,P=0.000 3).结论:曼月乐治疗子宫腺肌病的疗效较孕三烯酮更为显著,且不良反应发生率更低;对于无曼月乐禁忌证且暂无备孕的患者,曼月乐可作为首选.%Objective:To evaluate the efficacy and safety of mirena and gestrinone in the treatment of adenomyosis by means of evidence-based medicine.Methods:China National Knowledge Infrastructure (CNKI),Wanfang Med Database,Pubmed,Cochrane Library,etc.were retrieved for controlled clinical trials (CCTs) and randomized controlled trials (RCTs) of mirena and gestrinone for adenomyosis.The extracted data was analyzed with the RevMan 5.3 software.Results:6 RCTs and 3 CCTs involving 706 patients met the inclusion criteria.The meta-analysis showed that in patients treated with mirena,the dysmenorrhea score (Visual Analogue Scale/ Score,VAS),menstrual blood volume,endometrial thickness,uterine volume and the incidence of adverse reactions were significantly decreased,compared to those treated with gestrinone (P＜0.05).Conclusion:The current evidence showed that mirena was safer and more effective than gestrinone in the treatment of adenomyosis.Mirena could be used as first choice for patients with no contraindications and no planning of pregnancy.
展开▼
