Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Front Public Health. 2021 Aug 16;9:688264. doi: 10.3389/fpubh.2021.688264. eCollection 2021.
High-intensity focused ultrasound (HIFU) is an innovative non-invasive technology used for adenomyosis. Gonadotropin-releasing hormone agonist (GnRH-a) is a hormone commonly used for adenomyosis. We investigated and assessed the efficacy of HIFU combined with GnRH-a for adenomyosis. For this systematic review and meta-analysis, we searched Pubmed, Cochrane Library, Web of Science, Embase, CNKI, WanFang, and VIP databases for relevant articles published in Chinese or English that compared HIFU combined with GnRH-a vs. HIFU alone in patients with adenomyosis. The last literature search was completed on January 31, 2021. Two reviewers independently assessed study eligibility and assessed risk of bias. Another two reviewers extracted the data. The RevMan5.3 software was used for the data analysis. Changes in volume of the uterine and adenomyotic lesion were defined as the primary outcomes. The secondary outcomes were visual analog scale (VAS) scores for dysmenorrhea, menstrual volume scores, serum CA125 levels, and recurrence rate. This study is registered with PROSPERO (CRD42021234301). Three hundred and ninety potentially relevant articles were screened. Nine studies with data for 766 patients were finally included. Compared with the HIFU alone group, the HIFU combined with GnRH-a group had a higher rate of uterine volume reduction (MD 7.51, 95% CI 5.84-9.17, < 0.00001), smaller adenomyotic lesion volume (MD 4.11, 95% CI 2.93-5.30, < 0.00001), lower VAS score for dysmenorrhea (MD 1.27, 95% CI 0.54-2.01, = 0.0007) and menstrual volume score (MD 0.88, 95% CI 0.73-1.04, < 0.00001), and lower CA125 level (SMD 0.31, 95% CI 0.05-0.56, = 0.02) after the procedure. The recurrence rate in the HIFU combined with GnRH-a group was lower than that in the HIFU alone group (RR 0.28, 95% CI 0.10-0.82, = 0.02). Compared with HIFU treatment alone, HIFU combined with GnRH-a for the treatment of adenomyosis has greater efficacy in decreasing the volumes of the uterine and adenomyotic lesions and alleviating symptoms. However, since the number of the included studies was too small and most of them were written in Chinese, this conclusion needs to be referenced with caution. And the long-term evidence of its efficacy is still insufficient. : https://www.crd.york.ac.uk/prospero/ identifier [CRD42021234].
高强度聚焦超声（HIFU）是一种用于子宫腺肌病的创新的无创技术。促性腺激素释放激素激动剂（GnRH-a）是一种常用于子宫腺肌病的激素。我们研究并评估了 HIFU 联合 GnRH-a 治疗子宫腺肌病的疗效。 这项系统评价和荟萃分析检索了 Pubmed、Cochrane Library、Web of Science、Embase、CNKI、WanFang 和 VIP 数据库，以获取中文或英文发表的比较 HIFU 联合 GnRH-a 与 HIFU 单独治疗子宫腺肌病的相关文章。最后一次文献检索于 2021 年 1 月 31 日完成。两名审查员独立评估研究的纳入标准和评估偏倚风险。另外两名审查员提取数据。使用 RevMan5.3 软件进行数据分析。子宫和腺肌瘤体积的变化被定义为主要结局。次要结局为痛经的视觉模拟量表（VAS）评分、月经血量评分、血清 CA125 水平和复发率。本研究已在 PROSPERO（CRD42021234）注册。 共筛选出 390 篇潜在相关文章。最终纳入了 9 项研究，共 766 例患者的数据。与 HIFU 单独组相比，HIFU 联合 GnRH-a 组子宫体积缩小率更高（MD 7.51，95%CI 5.84-9.17，<0.00001），腺肌瘤体积更小（MD 4.11，95%CI 2.93-5.30，<0.00001），痛经的 VAS 评分更低（MD 1.27，95%CI 0.54-2.01，=0.0007）和月经血量评分（MD 0.88，95%CI 0.73-1.04，<0.00001），和更低的 CA125 水平（SMD 0.31，95%CI 0.05-0.56，=0.02）术后。HIFU 联合 GnRH-a 组的复发率低于 HIFU 单独组（RR 0.28，95%CI 0.10-0.82，=0.02）。 与单独使用 HIFU 相比，HIFU 联合 GnRH-a 治疗子宫腺肌病在减小子宫和腺肌瘤体积以及缓解症状方面具有更好的疗效。然而，由于纳入的研究数量太少，而且大多数研究都是中文的，因此这一结论需要谨慎参考。其疗效的长期证据仍然不足。
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