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目的:系统评价促性腺激素释放激素激动剂(GnRH-a)联合反加疗法对子宫内膜异位症保守性手术后患者的临床疗效。方法:应用计算机检索Cochrane Database of Systematic Reviews、MEDLINE、National Technical Information Service(NTIS)、CNKI、VIP及万方数据库中关于反加疗法治疗子宫内膜异位症保守性手术后患者的随机对照试验(RCT)。检索时限均为从建库至2014年。根据Cochrane Handbook 5.0评价标准严格评价纳入文献,并用Rev Man 5.0软件对符合质量标准的文献进行分析。结果:共纳入11个RCT,包括3篇外文文献和8篇中文文献,共533例患者。Meta分析结果显示:1反加组骨密度减少低于GnRH-a组[WMD=0.03;95%CI:0.02~0.05;P=0.000 1]。2反加组雌激素下降水平低于GnRH-a组[WMD=3.24;95%CI:1.84~4.69;P<0.000 01]。3反加组与GnRH-a组在疼痛方面比较差异无统计学意义[WMD=0.01;95%CI:-0.20~0.22;P=0.92]。4反加组的副反应发生率比GRH-a组低、程度轻。结论:应用反加疗法治疗保守性手术后子宫内膜异位症患者在骨密度、雌激素水平及药物副反应方面的疗效明显优于单独使用GnRH-a,但由于纳入研究量较小且质量不高,故仍需开展大样本、多中心的研究,以进一步验证GnRH-a联合反加疗法治疗子宫内膜异位症保守性手术后患者的疗效。
Objective: To systematically evaluate the clinical efficacy of GnRH-a combined with anti-addictive therapy in patients with conservative surgery of endometriosis. METHODS: Randomized controlled trials (RCTs) were performed using Cochrane Database of Systematic Reviews, MEDLINE, National Technical Information Service (NTIS), CNKI, VIP and Wanfang database for the treatment of patients with conservative endometriosis surgery RCT). The search period is from the database to 2014. Strict reviews were included in the literature based on the Cochrane Handbook 5.0 evaluation criteria and the quality of the literature was analyzed using Rev Man 5.0 software. Results: A total of 11 RCTs were included, including 3 foreign literature and 8 Chinese literature, a total of 533 patients. The results of Meta analysis showed that the decrement of bone mineral density in anti-1 group was lower than that of GnRH-a group [WMD = 0.03; 95% CI: 0.02-0.05; P = 0.0001]. 2 anti-estrogen decreased less than the GnRH-a group [WMD = 3.24; 95% CI: 1.84 to 4.69; P <0.000 01]. There was no significant difference in pain between the 3-add group and the GnRH-a group [WMD = 0.01; 95% CI: -0.20-0.22; P = 0.92]. 4 adverse reaction group the incidence of side effects than GRH-a group of low, to a lesser extent. CONCLUSIONS: Antiarrhythmic treatment of patients with endometriosis after conservative surgery is significantly superior to GnRH-a alone in terms of bone mineral density, estrogen levels and side effects of drugs. However, due to the small study volume and quality Not high, it is still necessary to carry out large sample, multi-center study to further verify the GnRH-a combined anti-addictive treatment of patients with conservative treatment of endometriosis effect.