芳香化酶抑制剂用于不明原因不孕促排卵治疗有效性和安全性的系统评价_《中国循证医学杂志》

作者：

刘真 ^1,2 , 唐惠林 ² ,  翟所迪 ²

1. 首都医科大学附属北京妇产医院（北京?100026）；2. 北京大学第三医院（北京?100191）;

关键词：

芳香化酶抑制剂不明原因不孕促排卵治疗系统评价 Meta分析随机对照试验

DOI：

10.7507/1672-2531.20110222

视频：

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目的　系统评价芳香化酶抑制剂对不明原因不孕患者促排卵治疗的有效性和安全性。
方法　计算机检索CNKI（1994～2011.6）、万方数据库（1982～2011.6）、PubMed（1966～2011.6）、Cochrane Library（2011年第6期），收集有关随机对照试验和半随机对照试验，由两位研究者独立进行文献筛选、资料提取和方法学质量评价后，采用RevMan 5.0.1软件进行Meta分析。
结果　共纳入9个研究，均为英文文献。方法学质量不高（仅1个B级，余为C级）。Meta分析结果显示：芳香化酶抑制剂（AIs）和枸橼酸氯米芬（CC）比较，在妊娠率［RR=1.02，95%CI（0.71，1.47）］、流产率［RR=1.00，95%CI（0.61，1.63）］、多胎妊娠率［RD= –0.02，95%CI（–0.07，0.03）］和不良事件发生率［RD=0.00，95%CI（–0.01、0.01）］上，两组差异均无统计学意义；而AIs+促性腺激素（Gn）与CC+Gn比较，在妊娠率［RR=0.98，95%CI（0.68，1.42）］、流产率［RR=1.23，95%CI（0.70，2.15）］、多胎妊娠率［RD=0.00，95%CI（–0.10，0.10）］和不良事件发生率［RD=0.00，95%CI（–0.01、0.01）］上，两组差异也均无统计学意义。
结论　对不明原因不孕的患者，芳香化酶抑制剂能否代替枸橼酸氯米芬成为促排卵治疗的一线促排卵药物仍需开展大规模设计良好的随机对照试验和更长时间的随访来进一步验证。

引用本文： 刘真,唐惠林,翟所迪. 芳香化酶抑制剂用于不明原因不孕促排卵治疗有效性和安全性的系统评价. 中国循证医学杂志, 2011, 11(11): 1327-1334. doi: 10.7507/1672-2531.20110222 复制

1.	2 El-Toukhy T, Khalaf Y. Treatment of unexplained infertility. BMJ , 2008, 337(a772): 362-363.
2.	3 Bhattachrya S, Harrild K, Mollison S, et al . Clomifene citrate or intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial. BMJ , 2008, 337: a716.
3.	4 Holzer H, Casper R, Tulandi T. A new era in ovulation induction. Fertil and Steril , 2006, 85(2): 277-784.
4.	7 Sammour A, Biljan MM, Tan SL, et al . Prospective randomized trial comparing the effects of letrazole (LE) and clomiphene citrate (CC) on follicular development, endometrial thickness and pregnancy rate in patients undergoing super-ovulation prior to intrauterine insemination (IUI). Fertil and Steril , 2001, 76: (3 suppl 1): S110.
5.	8 Bayar Ü, Tanriverdi HA, Barut A, et al. Letrozole vs clomiphene citrate in patients with ovulatory infertility. Fertil and Steril , 2006, 85(4): 1045-1048.
6.	9 Wu HH, Wang AM, Cheng ML, et al . A randomized comparison of ovulation induction and hormone profile between the aromatase inhibitor anastrozole and clomiphene citrate in women with infertility. Gynecol Endocrinol , 2007, 23: 76-81.
7.	10 Badawy A, Elnashar A, Totongy M, et al . Clomiphene citrate or aromatase inhibitors for superovulation in women with unexplained infertility undergoing intrauterine insemination: a prospective randomized trial. Fertil and Steril , 2009, 92(4): 1355-1359.
8.	11 Badawy A, Skokeir T, Allam AF, et al . Pregnancy outcome after ovulation induction with aromatase inhibitors or clomiphene citrate in unexplained infertility. Octa Obstet et Gynecol , 2009, 88: 187-191.
9.	12 Barroso G, Menocal G, Felix H, et al . Comparison of the efficacy of the aromatase inhibitor letrozole and clomiphene citrate as adjuvants to recombinant follicle-stimulating hormone in controlled ovarian hyperstimulation: a prospective, randomized, blindedclinicaltrial. Fertil and Steril , 2006, 86(5): 1428-1431.
10.	13 Davar R, Asgharnia M, Tayebi M. Comparison of the success rate of letrozole and clomiphene citrate in women undergoing intrauterine insemination. J of Res in Med Sci , 2006, 11(6): 382-387.
11.	14 Badawy A, Elnashar A, Totongy M. Clomiphene citrate or aromatase inhibitors combined with gonadotropins for super ovulation in women undergoing intrauterine insemination: A prospective randomised trial. J Obstet and Gynaecol , 2010, 30(6): 617-621.
12.	15 Fouda UM, Sayed AM. Extended letrozole regimen versus clomiphene citrate for superovulation in patients with unexplained infertility undergoing intrauterine insemination: a randomized controlled trial. Reprod Biol Endocrinol , 2011, 9(1): 84.
13.	16 Dankert T, Kremer JA, Cohlen BJ, et al . A randomized clinical trial of clomiphene citrate versus low dose recombinant FSH for ovarian hyperstimulation in intrauterine insemination cycles for unexplained and male subfertility. Hum Reprod , 2007, 22: 792-797.
14.	17 Casper RF, Mitwally MF. Review: Aromatase inhibitors for ovulation induction. J Clin Endocrinol Metab , March 2006, 91(3): 760-771.
15.	18 Casper RF, Mitwally MF. Aromatase inhibitors improves ovarian response to follicle-stimulating hormone in poor responders. Fertil and Steril , 2002, 77(4): 776-779.
16.	19 Baruah J, Roy KK, Rahman SM, et al . Endometrial effects of letrozole and clomiphene citrate in women with polycystic ovary syndrome using spiral artery Doppler. Arch Gynecol Obstet , 2009, 279(3): 311-314.
17.	20 Polyzos NP, Tzioras S, Mauri D, et al . Treatment of unexplained infertility with aromatase inhibitors or clomiphene citrate: a systematic review and meta-analysis. Obstet Gynecol Surv , 2008, 63(7): 472-479.
18.	21 Polyzos NP, Tzioras S, Badawy AM, et al . Aromatase inhibitors for female infertility: a systematic review of the literature. Reprod Biomed Online , 2009, 19(4): 456-471.
19.	刘嘉茵. 不明原因不孕症的诊治. 实用妇产科杂志, 2005, 21(8): 457-459.
20.	郭鹊晖, 郑志群. 来曲唑的促排卵及胚胎毒性的研究进展. 生殖与避孕, 2009, 29(2): 120-127.
21.	Cochrane Handbook for Systematic Reviews of Interventions Ver-sion 5. 0. 1[updated September 2008]. e Cochrane Collaboration, 2008. [www. cochrane-handbook. org/]. Accessed 10 March 2009.

1. 2 El-Toukhy T, Khalaf Y. Treatment of unexplained infertility. BMJ , 2008, 337(a772): 362-363.
2. 3 Bhattachrya S, Harrild K, Mollison S, et al . Clomifene citrate or intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial. BMJ , 2008, 337: a716.
3. 4 Holzer H, Casper R, Tulandi T. A new era in ovulation induction. Fertil and Steril , 2006, 85(2): 277-784.
4. 7 Sammour A, Biljan MM, Tan SL, et al . Prospective randomized trial comparing the effects of letrazole (LE) and clomiphene citrate (CC) on follicular development, endometrial thickness and pregnancy rate in patients undergoing super-ovulation prior to intrauterine insemination (IUI). Fertil and Steril , 2001, 76: (3 suppl 1): S110.
5. 8 Bayar Ü, Tanriverdi HA, Barut A, et al. Letrozole vs clomiphene citrate in patients with ovulatory infertility. Fertil and Steril , 2006, 85(4): 1045-1048.
6. 9 Wu HH, Wang AM, Cheng ML, et al . A randomized comparison of ovulation induction and hormone profile between the aromatase inhibitor anastrozole and clomiphene citrate in women with infertility. Gynecol Endocrinol , 2007, 23: 76-81.
7. 10 Badawy A, Elnashar A, Totongy M, et al . Clomiphene citrate or aromatase inhibitors for superovulation in women with unexplained infertility undergoing intrauterine insemination: a prospective randomized trial. Fertil and Steril , 2009, 92(4): 1355-1359.
8. 11 Badawy A, Skokeir T, Allam AF, et al . Pregnancy outcome after ovulation induction with aromatase inhibitors or clomiphene citrate in unexplained infertility. Octa Obstet et Gynecol , 2009, 88: 187-191.
9. 12 Barroso G, Menocal G, Felix H, et al . Comparison of the efficacy of the aromatase inhibitor letrozole and clomiphene citrate as adjuvants to recombinant follicle-stimulating hormone in controlled ovarian hyperstimulation: a prospective, randomized, blindedclinicaltrial. Fertil and Steril , 2006, 86(5): 1428-1431.
10. 13 Davar R, Asgharnia M, Tayebi M. Comparison of the success rate of letrozole and clomiphene citrate in women undergoing intrauterine insemination. J of Res in Med Sci , 2006, 11(6): 382-387.
11. 14 Badawy A, Elnashar A, Totongy M. Clomiphene citrate or aromatase inhibitors combined with gonadotropins for super ovulation in women undergoing intrauterine insemination: A prospective randomised trial. J Obstet and Gynaecol , 2010, 30(6): 617-621.
12. 15 Fouda UM, Sayed AM. Extended letrozole regimen versus clomiphene citrate for superovulation in patients with unexplained infertility undergoing intrauterine insemination: a randomized controlled trial. Reprod Biol Endocrinol , 2011, 9(1): 84.
13. 16 Dankert T, Kremer JA, Cohlen BJ, et al . A randomized clinical trial of clomiphene citrate versus low dose recombinant FSH for ovarian hyperstimulation in intrauterine insemination cycles for unexplained and male subfertility. Hum Reprod , 2007, 22: 792-797.
14. 17 Casper RF, Mitwally MF. Review: Aromatase inhibitors for ovulation induction. J Clin Endocrinol Metab , March 2006, 91(3): 760-771.
15. 18 Casper RF, Mitwally MF. Aromatase inhibitors improves ovarian response to follicle-stimulating hormone in poor responders. Fertil and Steril , 2002, 77(4): 776-779.
16. 19 Baruah J, Roy KK, Rahman SM, et al . Endometrial effects of letrozole and clomiphene citrate in women with polycystic ovary syndrome using spiral artery Doppler. Arch Gynecol Obstet , 2009, 279(3): 311-314.
17. 20 Polyzos NP, Tzioras S, Mauri D, et al . Treatment of unexplained infertility with aromatase inhibitors or clomiphene citrate: a systematic review and meta-analysis. Obstet Gynecol Surv , 2008, 63(7): 472-479.
18. 21 Polyzos NP, Tzioras S, Badawy AM, et al . Aromatase inhibitors for female infertility: a systematic review of the literature. Reprod Biomed Online , 2009, 19(4): 456-471.
19. 刘嘉茵. 不明原因不孕症的诊治. 实用妇产科杂志, 2005, 21(8): 457-459.
20. 郭鹊晖, 郑志群. 来曲唑的促排卵及胚胎毒性的研究进展. 生殖与避孕, 2009, 29(2): 120-127.
21. Cochrane Handbook for Systematic Reviews of Interventions Ver-sion 5. 0. 1[updated September 2008]. e Cochrane Collaboration, 2008. [www. cochrane-handbook. org/]. Accessed 10 March 2009.

《中国循证医学杂志》

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《中国循证医学杂志》

芳香化酶抑制剂用于不明原因不孕促排卵治疗有效性和安全性的系统评价

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