{"paper_id":"9f13379a-2b70-4e55-ab68-6cb3355262a6","body_text":"中华妇幼临床医学杂志(电子版) ›› 2013, Vol. 09 ›› Issue (03) : 287 -294. doi: 10.3877/cma.j.issn.1673-5250.2013.03.004\n所属专题： 文献；\n论著\n两种降调节方案对体外受精胚胎移植中子宫内膜异位症不孕患者有效性的Meta分析\n- 1. 430060 武汉，武汉大学人民医院生殖中心\n- 1. Reproduction Center, Renmin Hospital of Wuhan University, Hubei 430060, Hubei Province, China\n目的\n系统评价超长方案和长方案降调节在体外受精胚胎移植(IVF-ET)子宫内膜异位症(EMs)不孕患者治疗中的有效性。\n方法\n计算机检索2000年1月至2012年6月中国生物医学文献数据库(CBMDisc)、万方数据库、中国学术期刊网专题全文数据库(CNKI)、维普数据库、Pubmed、外文生物医学期刊文献数据(FMJS)中有关超长方案和长方案应用促性腺激素(Gn)降调节在对IVF-ET的EMs不孕患者治疗中的有效性的随机对照试验(RCT)，同时检索纳入文献的参考文献。对纳入研究文献的质量，由3位研究者共同评价，对同质研究进行Meta分析。统计学分析采用RevmMan 5.1软件。\n结果\n文献检索结果为7篇文献符合本研究纳入标准，涉及受试者为593例，将其中采取超长方案降调受试者纳入超长方案组(n＝219)，长方案降调的受试者纳入长方案组(n＝374)。对其进行Meta分析的结果显示：两组的周期取消率比较，差异无统计学意义(WMD＝0.69，95%CI：0.32～1.51；P＝0.35)；两组IVF-ET中，应用促性腺激素释放激素激动剂(GnRHa)刺激的时间比较，差异无统计学意义(WMD＝0.12，95%CI：－0.04～0.28；P＝0.14)；超长方案组应用Gn总剂量高于长方案组，且差异有统计学意义(WMD＝311.25，95%CI：6.43～616.08；P＝0.05)；两组获卵数比较，差异无统计学意义(WMD＝－0.65，95%CI：－1.76～0.47；P＝0.25)；两组人绒毛膜促性腺激素(hCG)日血清雌激素(E2)水平比较，差异无统计学意义(WMD＝－499.71，95% CI：－1171.02～171.60；P＝0.14)；临床妊娠率比较超长方案组较长方案组高，且差异有统计学意义(WMD＝2.23，95%CI：1.49～3.33；P<0.0001)；两组自然流产率比较，差异无统计学意义(WMD＝1.31，95%CI：0.37～4.64；P＝0.68)。\n结论\nEMs导致的不孕患者在IVF-ET治疗中，超长方案较长方案可显著提高临床妊娠率。对EMs导致的不孕患者行IVF-ET可能是较理想的选择。鉴于本研究纳入文献存在质量和样本数量不足及方法学差异，上述结论仅供临床参考，对超长方案和长方案降调节在对IVF-ET的EMs不孕患者治疗的有效性，尚需开展更多后效评价和不断更新。\nObjective\nTo evaluate the effectiveness of two kinds of down regulation protocols used in vitro fertilization embryo transfer( IVF-ET) in infertile patients with endometriosis(EMs).\nMethods\nCBM disc, Wan fang, CNKI, VIP, Pubmed, PML, FMJS were searched for randomized controlled trails(RCTs) on the comparison between prolonged protocol and long protocol in IVF-ET in infertility patients with EMs. The bibliography of the included studies were searched, too. The duration of search was form January 2000 to June 2012.The quality of the included was evaluated by three evaluators. For the homogeneous studies we performed Meta analysis. The extracted data were analyzed by RenMan 5.1.\nResults\nSeven literatures with 593 participants were selected for Meta analysis based on our including standards. Which involving 219 cases with prolonged protocol and 374 cases with long protocol of gonadotrophins(Gn). Meta analyses showed that prolonged protocol compared with long protocol cancellation rates were no significant difference in two groups at WMD=0.69 and 95%CI: 0.32-1.51; gonadotrophin releasing hormone analogue(GnRHa) stimulation durations were no significant difference in two groups at WMD=0.12 and 95% CI: -0.04-0.28; doses of GnRHa in prolonged protocol group were higher at the WMD=-311.25 and 95%CI: 6.43-616.08, the differences were statistically significant; the number of oocytes retrieved was no significant difference between two group at the WMD=-0.65 and 95%CI: -1.76-0.47(P>0.05); the differences were statistically significant serum E2 levels on the day of human chorionic gonadotrophin(hCG) administration was no significant difference in two groups at the WMD=-499.71 and 95%CI: -1171.02-171.60(P>0.05); clinical pregnancy rates in prolonged protocol group were slightly higher at the WMD=2.23 and 95%CI: 1.49-3.33, the differences were statistically significant(P<0.05); spontaneous abortion rates were no significant difference in two groups at the WMD=1.31 and 95% CI: 0.37-4.64(P>0.05).\nConclusions\nIn EMs patients with infertility IVF-ET treatment, compared with long protocol, the prolonged protocol can obviously increase the clinical pregnancy rate, so the IVF-ET may be an ideal choice for EMs patients with infertility. 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