GnRH拮抗剂对体外受精-胚胎移植中多囊卵巢综合征患者有效性的系统评价_《中国循证医学杂志》

作者：

肖劲松 ¹ , 陈双陨 ¹ , 张春莲 ¹ ,  常双 ²

1. 湖北省十堰市湖北医药学院附属太和医院妇产科（十堰?442000）；2. 湖北省十堰市湖北医药学院附属太和医院肿瘤科（十堰?442000）;

关键词：

GnRH拮抗剂 GnRH激动剂多囊卵巢综合征体外受精-胚胎移植系统评价 Meta分析

DOI：

10.7507/1672-2531.20110139

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价GnRH拮抗剂用于多囊卵巢综合征（PCOS）患者体外受精-胚胎移植的有效性。
方法　计算机检索PubMed（1997～2010）、ProQust Medical Library（1997～2010）、外文生物医学期刊文献数据库（2000～2010）、CBM（1979～2010）、CNKI（1994～2010）、VIP（1989～2010）、万方数据库（1994～2010）和读秀学术搜索引擎，并手工检索相关中文杂志9种，查找比较GnRH拮抗剂与GnRH激动剂在体外受精-胚胎移植PCOS患者治疗中有效性的随机对照试验（RCT）。由两位研究者按纳入排除标准筛选文献、提取资料和评价质量后，采用RevmMan 4.2.7软件进行Meta分析。
结果　共纳入6篇RCT，合计699例患者。其纳入研究质量A级3篇，B级3篇。Meta分析结果显示：与GnRH激动剂组比较，GnRH拮抗剂组在刺激天数［WMD= –1.23（–2.76，–0.31）］、 Gn量［WMD= –4.87（–14.20，4.46）］、HCG日E2值［WMD= 31.37（–263.40，–326）］、获卵数［WMD= 1.34（–1.02，4.70）］、临床妊娠率［OR= 1.27（0.77，2.10）］和流产率［Peto OR= 0.67（0.38，1.18）］方面，两组差异均无统计学意义；仅GnRH拮抗剂组的 OHSS率较低，两组差异有统计学意义［Peto OR= 0.35（0.24，0.50）］。
结论　GnRH拮抗剂方案较之GnRH激动剂方案能减低OHSS发生，而在Gn量、获卵数、临床妊娠率方面，两种方案疗效相当。由于GnRH拮抗剂方案可缩短治疗时间，减少治疗费用，具有较好的安全性，对PCOS患者行体外受精-胚胎移植可能是较理想的选择。鉴于纳入研究存在质量和数量的不足以及方法学的差异，上述结论仅供临床参考，需要开展更多后效评价和不断更新。

引用本文： 肖劲松,陈双陨,张春莲,常双. GnRH拮抗剂对体外受精-胚胎移植中多囊卵巢综合征患者有效性的系统评价. 中国循证医学杂志, 2011, 11(7): 811-818. doi: 10.7507/1672-2531.20110139 复制

1.	1 Asunción M, Calvo RM, San LJ, et al . A prospective study of the prevalence of the polycystic ovary syndrome in unselected caucasian women from spain. J Clin Endocrinol Metab , 2000, 85(7): 2434-2438.
2.	2 Knochenhauer ES, Key TJ, Kahsar-miller M, et al . Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern united states: a prospective study. J Clin Endocrinol Metab , 1998, 83(9): 3078-3082.
3.	3 Tarlatzis BC, Fauser BC, Kolibianakis EM, et al . GnRH antagonists in ovarian stimulation for IVF. Hum Reprod Update , 2006, 12(4): 333-340.
4.	4 Hwang JL, Seow KM, Lin YH, et al . Ovarian stimulation by concomitant administration of cetrorelix acetate and HMG following diane-35 pre-treatment for patients with polycystic ovary syndrome:a prospective randomized study. Hum Reprod , 2004, 19(9): 1993-2000.
5.	5 Huirne YA, Homburg R, Lambalk CB. Are GnRH antagonists comparable to agonists for use in IVF? Hum reprod , 22(1): 2805-2813.
6.	6 MA DO, Barmat L, Liu HC, et al . Dual suppression with oral contraceptives and gonadotrophin releasing-hormone agonists improves in vitro fertilization outcome in high responder patients. Hum Reprod , 12(11): 2359-2365.
7.	7 Griesinger G, Diedrich K, Tarlatzis BC, et al . GnRH-antagonists in ovarian stimulation for IVF in patients with poor response to gonadotrophins, polycystic ovary syndrome, and risk of ovarian hyperstimulation: a meta-analysis. Reprod Biomed Online , 2006, 13(5): 628-638.
8.	8 Consensus RP. Revised 2003 consensus on diagnostic criteria and long-termhealth risks related to polycystic ovary syndrome. Fertil Steril , 2004, 81(1): 19-25.
9.	9 Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. BMJ , 2001, 323(7303): 42-46.
10.	11 Schulz KF, Chalmers I, Hayes RJ, et al . Empirical evidence of bias. JAMA , 1995, 273(5): 408-421.
11.	12 Hosseini MA, Aleyasin A, Saeedi H, et al . Comparison of gonadotropin-releasing hormone agonists and antagonists in assisted reproduction cycles of polycystic ovarian syndrome patients. J Obstet Gynaecol Res , 2010, 36(3): 605-610.
12.	13 Tehraninejad ES, Nasiri R, Rashidi B, et al . Comparison of GnRH antagonist with long GnRH agonist protocol after OCP pretreatment in PCOs patients. Arch Gynecol Obstet , 2010, 282(3): 319-325.
13.	14 Lainas TG, Sfontouris IA, Zorzovilis IZ, et al . Flexible GnRH antagonist protocol versus GnRH agonist long protocol in patients with polycystic ovary syndrome treated for IVF: a prospective randomised controlled trial (RCT). Hum Reprod , 2010, 25(3): 683-689.
14.	15 Kurzawa R, Ciepiela P, Baczkowski T, et al . Comparison of embryological and clinical outcome in GnRH antagonist vs. GnRH Agonist Protocols for in Vitro Fertilization in PCOS non-Obese Patients.a Prospective Randomized Study. J Assist Reprod Genet , 2008, 25(8): 365-374.
15.	16 Lainas TG, Petsas GK, Zorzovilis IZ, et al . Initiation of GnRH antagonist on day 1 of stimulation as compared to the long agonist protocol in PCOS patients. A Randomized Controlled Trial:Effect on Hormonal Levels and Follicular Development. Hum Reprod , 2007, 22(6): 1540-1546.
16.	17 Bahçeci M, Ulug U, Ben-shlomo I, et al . Use of a GnRH antagonist in controlled ovarian hyperstimulation for assisted conception in women with polycystic ovary disease:a randomized,prospective, pilot study. J Reprod Med , 2005, 50(2): 84-90.
17.	18 Garcia-velasco JA, Isaza V, Vidal C, et al . Human ovarian steroid secretion in vivo: effects of GnRH agonist versus antagonist (cetrorelix). Hum Reprod , 2001, 16(12): 2533-2539.
18.	19 Ortmann O, Weiss JM, Diedrich K. Embryo implantation and GnRH antagonists: ovarian actions of GnRH antagonists. Hum Reprod , 2001, 16(4): 608-611.
19.	20 Kahraman K, Berker B, Atabekoglu CS, et al . Microdose gonadotropin-releasing hormone agonist flare-up protocol versus multiple dose gonadotropin-releasing hormone antagonist protocol in poor responders undergoing intracytoplasmic sperm injection-embryo transfer cycle. Fertil Steril , 2009, 91(6): 2437-2444.
20.	21 Schoot DC, Harlin J, Shoham Z, et al . Recombinant human follicle-stimulating hormone and ovarian response in gonadotrophin-deficient women. Hum Reprod , 1994, 9(7): 1237-1242.
21.	22 Ludwig M, Finas DF, Al-hasani S, et al . Oocyte quality and treatment outcome in intracytoplasmic sperm injection cycles of polycystic ovarian syndrome patients. Hum Reprod , 1999, 14(2): 354-358.
22.	23 Antoine JM, Merviel P, Cornet D, et al . Therapeutic management of ovarian dystrophy and insufficiency in abortion disorders: recent data. Gynecol Obstet Fertil , 2000, 28(3): 205-210.
23.	Cochrane R. 1, 2000.

1. 1 Asunción M, Calvo RM, San LJ, et al . A prospective study of the prevalence of the polycystic ovary syndrome in unselected caucasian women from spain. J Clin Endocrinol Metab , 2000, 85(7): 2434-2438.
2. 2 Knochenhauer ES, Key TJ, Kahsar-miller M, et al . Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern united states: a prospective study. J Clin Endocrinol Metab , 1998, 83(9): 3078-3082.
3. 3 Tarlatzis BC, Fauser BC, Kolibianakis EM, et al . GnRH antagonists in ovarian stimulation for IVF. Hum Reprod Update , 2006, 12(4): 333-340.
4. 4 Hwang JL, Seow KM, Lin YH, et al . Ovarian stimulation by concomitant administration of cetrorelix acetate and HMG following diane-35 pre-treatment for patients with polycystic ovary syndrome:a prospective randomized study. Hum Reprod , 2004, 19(9): 1993-2000.
5. 5 Huirne YA, Homburg R, Lambalk CB. Are GnRH antagonists comparable to agonists for use in IVF? Hum reprod , 22(1): 2805-2813.
6. 6 MA DO, Barmat L, Liu HC, et al . Dual suppression with oral contraceptives and gonadotrophin releasing-hormone agonists improves in vitro fertilization outcome in high responder patients. Hum Reprod , 12(11): 2359-2365.
7. 7 Griesinger G, Diedrich K, Tarlatzis BC, et al . GnRH-antagonists in ovarian stimulation for IVF in patients with poor response to gonadotrophins, polycystic ovary syndrome, and risk of ovarian hyperstimulation: a meta-analysis. Reprod Biomed Online , 2006, 13(5): 628-638.
8. 8 Consensus RP. Revised 2003 consensus on diagnostic criteria and long-termhealth risks related to polycystic ovary syndrome. Fertil Steril , 2004, 81(1): 19-25.
9. 9 Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. BMJ , 2001, 323(7303): 42-46.
10. 11 Schulz KF, Chalmers I, Hayes RJ, et al . Empirical evidence of bias. JAMA , 1995, 273(5): 408-421.
11. 12 Hosseini MA, Aleyasin A, Saeedi H, et al . Comparison of gonadotropin-releasing hormone agonists and antagonists in assisted reproduction cycles of polycystic ovarian syndrome patients. J Obstet Gynaecol Res , 2010, 36(3): 605-610.
12. 13 Tehraninejad ES, Nasiri R, Rashidi B, et al . Comparison of GnRH antagonist with long GnRH agonist protocol after OCP pretreatment in PCOs patients. Arch Gynecol Obstet , 2010, 282(3): 319-325.
13. 14 Lainas TG, Sfontouris IA, Zorzovilis IZ, et al . Flexible GnRH antagonist protocol versus GnRH agonist long protocol in patients with polycystic ovary syndrome treated for IVF: a prospective randomised controlled trial (RCT). Hum Reprod , 2010, 25(3): 683-689.
14. 15 Kurzawa R, Ciepiela P, Baczkowski T, et al . Comparison of embryological and clinical outcome in GnRH antagonist vs. GnRH Agonist Protocols for in Vitro Fertilization in PCOS non-Obese Patients.a Prospective Randomized Study. J Assist Reprod Genet , 2008, 25(8): 365-374.
15. 16 Lainas TG, Petsas GK, Zorzovilis IZ, et al . Initiation of GnRH antagonist on day 1 of stimulation as compared to the long agonist protocol in PCOS patients. A Randomized Controlled Trial:Effect on Hormonal Levels and Follicular Development. Hum Reprod , 2007, 22(6): 1540-1546.
16. 17 Bahçeci M, Ulug U, Ben-shlomo I, et al . Use of a GnRH antagonist in controlled ovarian hyperstimulation for assisted conception in women with polycystic ovary disease:a randomized,prospective, pilot study. J Reprod Med , 2005, 50(2): 84-90.
17. 18 Garcia-velasco JA, Isaza V, Vidal C, et al . Human ovarian steroid secretion in vivo: effects of GnRH agonist versus antagonist (cetrorelix). Hum Reprod , 2001, 16(12): 2533-2539.
18. 19 Ortmann O, Weiss JM, Diedrich K. Embryo implantation and GnRH antagonists: ovarian actions of GnRH antagonists. Hum Reprod , 2001, 16(4): 608-611.
19. 20 Kahraman K, Berker B, Atabekoglu CS, et al . Microdose gonadotropin-releasing hormone agonist flare-up protocol versus multiple dose gonadotropin-releasing hormone antagonist protocol in poor responders undergoing intracytoplasmic sperm injection-embryo transfer cycle. Fertil Steril , 2009, 91(6): 2437-2444.
20. 21 Schoot DC, Harlin J, Shoham Z, et al . Recombinant human follicle-stimulating hormone and ovarian response in gonadotrophin-deficient women. Hum Reprod , 1994, 9(7): 1237-1242.
21. 22 Ludwig M, Finas DF, Al-hasani S, et al . Oocyte quality and treatment outcome in intracytoplasmic sperm injection cycles of polycystic ovarian syndrome patients. Hum Reprod , 1999, 14(2): 354-358.
22. 23 Antoine JM, Merviel P, Cornet D, et al . Therapeutic management of ovarian dystrophy and insufficiency in abortion disorders: recent data. Gynecol Obstet Fertil , 2000, 28(3): 205-210.
23. Cochrane R. 1, 2000.

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GnRH拮抗剂对体外受精-胚胎移植中多囊卵巢综合征患者有效性的系统评价

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《中国循证医学杂志》

GnRH拮抗剂对体外受精-胚胎移植中多囊卵巢综合征患者有效性的系统评价

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