子宫动脉栓塞术对卵巢储备功能的影响：系统评价和荟萃分析。
The impact of uterine artery embolization on ovarian reserve: A systematic review and meta-analysis.
机构信息
Derby Fertility Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.
West Middlesex University Hospital, London, UK.
出版信息
Acta Obstet Gynecol Scand. 2020 Jan;99(1):16-23. doi: 10.1111/aogs.13698. Epub 2019 Aug 26.
INTRODUCTION
Uterine artery embolization (UAE) has been gaining increasing popularity as an effective and minimally invasive treatment for uterine fibroids. However, there has been growing concern over the risk of unintended embolization of the utero-ovarian circulation, leading to reduction of ovarian blood supply with subsequent impairment of ovarian reserve. The purpose of this study was to investigate the impact of UAE on circulating anti-Müllerian hormone (AMH) and other markers of ovarian reserve.
MATERIAL AND METHODS
This meta-analysis included all published cohort, cross-sectional and case-control studies, as well as randomized trials that investigated the impact of UAE on circulating AMH. Data sources included MEDLINE, EMBASE, Dynamed Plus, ScienceDirect, TRIP database, ClinicalTrials.gov and the Cochrane Library from January 2000 to June 2019. All identified articles were screened, and articles were selected based on the inclusion and exclusion criteria. AMH and other data were extracted from the eligible articles and entered into RevMan software to calculate the weighted mean difference between pre- and post-embolization values. PROSPERO registration number: CRD42017082615.
RESULTS
This review included 3 cohort and 3 case-control studies (n = 353). The duration of follow up after UAE ranged between 3 and 12 months. Overall pooled analysis of all studies showed no significant effect of UAE on serum AMH levels (weighted mean difference -0.58 ng/mL; 95% CI -1.5 to 0.36, I = 95%). Subgroup analysis according to age of participants (under and over 40 years) and according to follow-up duration (3, 6 and 12 months) showed no significant change in post-embolization circulating AMH. Pooled analysis of serum follicle-stimulating hormone (FSH) concentrations (4 studies, n = 248) revealed no statistically significant change after UAE (weighted mean difference 4.32; 95% CI -0.53 to 9.17; I = 95%). Analysis of 2 studies (n = 62) measuring antral follicle count showed a significant decline at 3-month follow up (weighted mean difference -3.28; 95% CI -5.62 to -0.93; I = 94%).
CONCLUSIONS
Uterine artery embolization for uterine fibroids does not seem to affect ovarian reserve as measured by serum concentrations of AMH and FSH.
简介
子宫动脉栓塞术（UAE）作为一种治疗子宫肌瘤的有效且微创的方法，越来越受到关注。然而，人们越来越担心子宫-卵巢循环的意外栓塞会导致卵巢血供减少，进而损害卵巢储备功能。本研究旨在探讨 UAE 对循环抗苗勒管激素（AMH）和其他卵巢储备标志物的影响。
材料与方法
本荟萃分析纳入了所有已发表的队列研究、横断面研究和病例对照研究，以及探讨 UAE 对循环 AMH 影响的随机试验。数据来源包括 MEDLINE、EMBASE、Dynamed Plus、ScienceDirect、TRIP 数据库、ClinicalTrials.gov 和 Cochrane 图书馆，时间范围为 2000 年 1 月至 2019 年 6 月。对所有确定的文章进行筛选，并根据纳入和排除标准选择文章。从合格文章中提取 AMH 和其他数据，并输入 RevMan 软件计算栓塞前后加权均数差值。PROSPERO 注册号：CRD42017082615。
结果
本综述纳入了 3 项队列研究和 3 项病例对照研究（n=353）。UAE 后随访时间为 3 至 12 个月。所有研究的总体汇总分析显示，UAE 对血清 AMH 水平无显著影响（加权均数差值-0.58ng/ml；95%CI-1.5 至 0.36，I²=95%）。根据参与者年龄（<40 岁和≥40 岁）和随访时间（3、6 和 12 个月）进行的亚组分析显示，栓塞后循环 AMH 无显著变化。对 4 项研究（n=248）血清卵泡刺激素（FSH）浓度的汇总分析显示，UAE 后无统计学意义的变化（加权均数差值 4.32；95%CI-0.53 至 9.17；I²=95%）。对 2 项研究（n=62）测量的窦卵泡计数分析显示，3 个月时随访时明显下降（加权均数差值-3.28；95%CI-5.62 至-0.93；I²=94%）。
结论
子宫动脉栓塞术治疗子宫肌瘤似乎不会影响卵巢储备功能，可通过血清 AMH 和 FSH 浓度来衡量。
Zotero 插件