Comparative effectiveness of 9 ovulation-induction therapies in patients with clomiphene citrate-resistant polycystic ovary syndrome: a network meta-analysis.
Comparative effectiveness of 9 ovulation-induction therapies in patients with clomiphene citrate-resistant polycystic ovary syndrome: a network meta-analysis.
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9 种促排卵疗法对克罗米芬耐药性多囊卵巢综合征患者的疗效比较：网络荟萃分析
DOI：
10.1038/s41598-017-03803-9
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发表时间：
2017-06-19
影响因子：
4.6
通讯作者：
Sun Y
中科院分区：
文献类型：
--
作者：
Yu Y;Fang L;Zhang R;He J;Xiong Y;Guo X;Du Q;Huang Y;Sun Y
克罗米芬抵抗(CCR)多囊卵巢综合征(PCOS)患者的促排卵治疗的疗效还不是很清楚。因此，我们进行了网络荟萃分析，对这些治疗的生殖效果进行了排名。我们最终纳入了26项随机临床试验，共有2722名参与者和9种治疗方法：克罗米芬(CC)、二甲双胍、来曲唑、卵泡刺激素(FSH)、人绝经期促性腺激素(HMG)、单侧腹腔镜卵巢打孔术(ULOD)、双侧腹腔镜卵巢打孔术(BOD)、二甲双胍联合来曲唑(二甲双胍+来曲唑)以及二甲双胍联合CC(二甲双胍+CC)。网络Meta分析表明，HMG治疗的妊娠率高于BLOD、ULOD和CC治疗。二甲双胍+来曲唑组和FSH组的妊娠率、活产率和排卵率均显著高于CC组。二甲双胍+来曲唑组的流产率明显低于二甲双胍+CC组。排名概率表明，除了促性腺激素(FSH和HMG)外，二甲双胍+来曲唑在改善生殖结果方面也可能比其他疗法更有效。综上所述，由于证据质量较低和可信区间较宽，不能推荐对CCR多囊卵巢综合征患者进行促排卵治疗。
The comparative efficacies of ovulation-induction treatments in patients with clomiphene citrate-resistant (CCR) polycystic ovary syndrome (PCOS) are not well known. Therefore, we conducted a network meta-analysis to rank the reproductive efficacies of these treatments. We ultimately included 26 randomized clinical trials with 2722 participants and 9 types of therapies: clomiphene citrate (CC), metformin, letrozole, follicle stimulating hormone (FSH), human menopausal gonadotropin (hMG), unilateral laparoscopic ovarian drilling (ULOD), bilateral laparoscopic ovarian drilling (BLOD), the combination of metformin with letrozole (metformin+letrozole), and the combination of metformin with CC (metformin+CC). The network meta-analysis demonstrates that hMG therapy result in higher pregnancy rates than BLOD, ULOD and CC therapies. Pregnancy, live birth and ovulation rates are significantly higher in metformin+letrozole and FSH groups than CC group. The abortion rate in the metformin+letrozole group is significantly lower than that in the metformin+CC group. Ranking probabilities show that, apart from gonadotropin (FSH and hMG), metformin+letrozole is also potentially more effective in improving reproductive outcomes than other therapies. In conclusion, owing to the low quality of evidence and the wide confidence intervals, no recommendation could be made for the treatment of ovulation-induction in patients with CCR PCOS.