羟乙基淀粉溶液预防卵巢过度刺激综合征的系统评价

摘要

目的:系统评价羟乙基淀粉溶液(HES)预防卵巢过度刺激综合征(OHSS)的有效性.方法:计算机检索Cochrane图书馆、MEDLINE、EMbase、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库、万方数据库,检索时限至2012年9月.纳入HES预防OHSS的随机对照试验,由两名评价员独立提取资料,并对其方法学质量进行评价.对符合纳入标准的研究用RevMan 5.0软件进行Meta分析.结果:共纳入4个随机对照研究,666例研究对象.结果显示:与对照组相比,HES组OHSS发生率显著降低[OR =0.18,95％CI(0.10,0.32),P =0.000],重度OHSS发生率亦显著降低[OR =0.15,95％CI(0.05,0.48),P=0.001]；HES组与对照组妊娠率比较,差异无统计学意义[OR=1.02,95％CI(0.60,1.73),P=0.94].结论:HES能降低OHSS发生率,特别是重度OHSS,且不影响妊娠率.由于纳入研究方法学质量、样本量所限,该结论尚需大样本、高质量的随机对照试验进一步证实.%Objective:To assess the effectiveness of intravenous hydroxyethyl starch (HES) administration for the prevention of ovarian hyperstimulation syndrome (OHSS).Methods:All randomized controlled trials (RCTs) on HES for the prevention of OHSS were retrieved from databases including Cochrane Library,MEDLINE,Embase,CBMdisc,CNKI,VIP and Wanfang databases update to Sep.2012.Information was collected by two researchers independently.The quality of included RCTs was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions,and the Cochrane Collaboration's software RevMan 5.0 was used for meta-analysis.Results:4 RCTs involving 666 patients were included.The incidence of OHSS and severe OHSS in the HES group (OR=0.18,95％CI 0.10 to 0.32,P=0.000,OR=0.15,95％ CI 0.05 to 0.48,P =0.001,respectively) was significantly reducted compared to the control group.The differences of the pregnancy rate between the two groups has no statiscal significance (OR =1.02,95％ CI 0.60 to 1.73,P =0.94).Conclusions:Current evidence shows that H ES markedly decreases the incidence of OHSS,especially the severe OHSS,and do not affect the pregnancy rate.However,considering the limitation of the methodological quality and sample size of the included studies,more high-quality,large-scale RCTs are still needed to confirm this conclusion.