摘要
目的 系统评价地诺孕素用于子宫腺肌病(adenomyosis,AM)保守治疗的有效性与安全性。方法 计算机检索中英文数据库自建库至2023年8月相关的随机对照试验。采用偏倚风险评估工具评价文献质量,RevMan5.4软件进行分析。结果 纳入9篇随机对照试验,共654例AM患者,338例患者接受地诺孕素治疗,用药疗程3~6个月。Meta分析结果显示地诺孕素治疗腺肌病的总有效率(OR=6.70,95%CI:1.84~24.42,P=0.004)、血清糖类抗原125(carbohydrate antigen 125,CA125)降幅(MD=–6.89,95%CI:–12.84~–0.93,P=0.02)、子宫体积(MD=–26.49,95%CI:–37.86~–15.12,P<0.00001)、生活质量调查表评分(MD=6.12,95%CI:4.76~7.47,P<0.00001),均优于未使用地诺孕素者;疼痛改善情况(MD=–0.14,95%CI:–2.19~1.92,P=0.90)、子宫内膜厚度(MD=–0.54,95%CI:–3.66~2.59,P=0.74),差异无统计学意义;总体不良反应发生率(OR=0.51,95%CI:0.12~2.18,P=0.37)、阴道不规则出血发生率(OR=1.98,95%CI:0.25~15.59,P=0.52),差异无统计学意义。结论 地诺孕素可提高AM患者治疗的总有效率,一定程度上缩小子宫体积,缓解主观症状,改善患者的生活质量。
Objective To evaluate the efficacy and safety of dienogest in the conservative treatment of adenomyosis(AM).Methods The relevant randomized controlled trials were searched by computer from domestic and foreign electronic bibliographic databases to August 2023.Risk of bias tool was used to evaluate the literature quality,and RevMan 5.4 software was used for analysis.Results A total of 654 patients with AM were included in 9 randomized controlled trials.338 patients received dienogest for 3 to 6 months.Meta-analysis results showed that the total effective rate of dienogest in the treatment of adenomyosis(OR=6.70,95%CI:1.84–24.42,P=0.004)and serum carbohydrate antigen 125(CA125)reduction(MD=–6.89,95%CI:–12.84–0.93,P=0.02),uterine volume(MD=–26.49,95%CI:–37.86–15.12,P<0.00001),quality of life questionnaire score(MD=6.12,95%CI:4.76–7.47,P<0.00001),the difference was statistically significant.Pain improvement(MD=–0.14,95%CI:–2.19–1.92,P=0.90),endometrial thickness(MD=–0.54,95%CI:–3.66–2.59,P=0.74),the difference was not statistically significant.The overall incidence of adverse reactions(OR=0.51,95%CI:0.12–2.18,P=0.37)and the incidence of irregular vaginal bleeding(OR=1.98,95%CI:0.25–15.59,P=0.52),the difference was not statistically significant.Conclusion Dienogest improves overall response rates,reduces uterine volume in certain degree,relieves subjective symptoms,and improves quality of life in patients with adenomyosis.
作者
王金丹
桂涛
万贵平
WANG Jindan;GUI Tao;WAN Guiping(Department of Gynaecology and Obstetrics,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine,Nanjing 210028,Jiangsu,China;Department of Gynaecology and Obstetrics,Jiangsu Province Academy of Traditional Chinese Medicine,Nanjing 210029,Jiangsu,China)
出处
《中国现代医生》
2024年第3期70-77,共8页
China Modern Doctor
基金
国家中医临床研究基地开放课题(JD201814)。
