Keirse M J
Department of Obstetrics and Gynaecology, Leiden University, The Netherlands.
Br J Obstet Gynaecol. 1990 Feb;97(2):149-54. doi: 10.1111/j.1471-0528.1990.tb01740.x.
Two recently published meta-analyses of controlled trials of a wide variety of progestational agents, used in pregnancy (Daya 1989; Goldstein et al. 1989), prompted this third meta-analysis of placebo-controlled trials involving the prophylactic use of a single agent, 17 alpha-hydroxyprogesterone caproate. Of seven relevant published reports of controlled trials, six had involved women considered to be a high risk of miscarriage or preterm birth. This analysis provides no support for the view that 17 alpha-hydroxyprogesterone caproate protects against miscarriage, but suggests that it does reduce the occurrence of preterm birth. The latter effect was reflected in a reduced rate of low birthweight babies, but not in a statistically significant reduction in perinatal mortality and morbidity. The difference between this meta-analysis and the two earlier meta-analyses illustrates the problems both of selective sub-grouping and of comprehensive pooling of data from small trials.
近期发表的两项关于孕期使用多种孕激素制剂的对照试验的荟萃分析（戴亚，1989年；戈尔茨坦等人，1989年），促使进行了这第三项关于安慰剂对照试验的荟萃分析，该试验涉及单一制剂己酸17α-羟孕酮的预防性使用。在七篇已发表的相关对照试验报告中，有六篇涉及被认为有高流产或早产风险的女性。该分析不支持己酸17α-羟孕酮可预防流产的观点，但表明它确实能降低早产的发生率。后一种效果体现在低体重儿出生率降低，但围产期死亡率和发病率在统计学上没有显著降低。这项荟萃分析与前两项荟萃分析之间的差异说明了选择性亚组分析和对小型试验数据进行全面汇总所存在的问题。
