摘要
目的:探讨反向添加疗法对比单用促性腺激素释放激素激动剂(GnRH-a)在治疗子宫内膜异位症(EMT)中的疗效。方法:计算机检索1999～2012年Cochrane Database,Medline,Embase,CNKI和万方数据库。纳入GnRH-a联合反向添加疗法的随机对照试验(RCT),运用Rev-Man5.0软件进行Meta分析。结果:8个RCT(292例)纳入评价。治疗结束时反向添加治疗组腰椎骨密度下降明显减少(WMD=-0.05,95%CI-0.06～-0.04,P<0.01),随访第24个月反向添加治疗组腰椎骨密度变化值仍明显减少(WMD=-0.03,95%CI-0.05～-0.01,P=0.008),但在股骨颈骨密度变化值中两组比较,差异无统计学意义(WMD=-0.01,95%CI-0.02～0.01,P=0.28)。在Kupperman index评分量表中,反向添加组评分值也小于单用Gn-RH-a组(WMD=-5.13,95%CI-5.77～-4.48,P<0.01),而在改善EMT痛经、性交痛症状上与单用GnRH-a比较,差异无统计学意义(WMD=-0.82,95%CI-3.28～1.64,P=0.51;WMD=0.01,95%CI-0.56～0.58,P=0.97)。结论:治疗EMT时,反向添加治疗在不影响GnRH-a缓解痛经和性交痛疗效的同时,也能减轻GnRH-a药物致腰椎骨质的丢失和围绝经期症状的不良反应。
Objective： To compare the effectiveness of ＂Add-back＂ treatment and to endometriosis （EMT） to GnRH-a treatment alone. Methods：The RCT assessing the ＂add-back＂ treatment to EMT were searched from Cochrane library,Medline database, Embase, CNKI and Wanfang database. The meta analy- sis was analyzed by RevMan V5.0 software. Results：Eight RCT （n =292） were included. There were signif- icant difference between ＂add-back＂ trratment and GnRH-a treatment alone in bone mineral density of lum- ber spine after treatment weight mean difference（WMD） -0. 05 （95% CI -0.06 to -0.04）, and after 24 months treatment WMD - 0. 03 （95% CI - 0. 05 to - 0. 01 ）. But the BMD of femoral neck between two groups had no statistical significance. The WMD for kupperman index after treatment that assessed the effica- cy of ＂add-back＂ treatment was -5.13 （95%CI -5.77 to -4.48）. The ＂add-back＂ treatment did not ap- pear to reduce the efficacy of GnRH-a alone in dysmenorrheal score and dyspareunia score. Conclusions： The ＂add-back＂ treatment based on GnRH-a dose not reduce efficacy in the management of endometriosis syndrome. ＂add-back＂ treatment also reduces side effects of GnRH-a alone in osteoporosis and menopausal syndrome.
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2013年第1期25-29,共5页
Journal of Practical Obstetrics and Gynecology
