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系统评价和荟萃分析辅助促性腺激素释放激素激动剂（GnRH-a）对保守手术后子宫内膜异位症患者妊娠结局的影响。

Systematic review and meta-analysis on the effect of adjuvant gonadotropin-releasing hormone agonist (GnRH-a) on pregnancy outcomes in women with endometriosis following conservative surgery.

机构信息

Department of Obstetrics and Gynecology, Southwest Medical University, Luzhou, Sichuan, 646000, China.

Department of Obstetrics and Gynecology, Qingbaijiang District People's Hospital, Chengdu, Sichuan, 610300, China.

出版信息

BMC Pregnancy Childbirth. 2024 Apr 4;24(1):237. doi: 10.1186/s12884-024-06430-1.

DOI:10.1186/s12884-024-06430-1
PMID:38575880
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10993455/
Abstract

BACKGROUND

Endometriosis frequently results in pain and infertility. While conservative surgery offers some relief, it often falls short of ensuring satisfactory pregnancy outcomes. Adjuvant GnRH-a is administered post-surgery to mitigate recurrence; however, its impact on pregnancy outcomes remains debated. This study endeavors to assess the efficacy of adjuvant GnRH-a in enhancing pregnancy outcomes post-conservative surgery in endometriosis patients.

METHODS

Databases including PubMed, Embase, the Cochrane Library, Medline (Ovid), Web of Science, and Scopus were rigorously searched up to 02 August 2023, without linguistic constraints. Identified articles were screened using strict inclusion and exclusion criteria. Evaluated outcomes encompassed pregnancy rate, live birth rate, miscarriage rate, ectopic pregnancy rate, multiple pregnancy rate, mean postoperative pregnancy interval, recurrence rate, and adverse reaction rate. The Cochrane risk of bias tool and the Jadad score evaluated the included studies' quality. Subgroup and sensitivity analysis were implemented to analyze the pooled results. A meta-analysis model expressed results as standardized mean difference (SMD) and Risk ratio (RR).

RESULTS

A total of 17 studies about 2485 patients were assimilated. Meta-analysis revealed that post-surgery, the GnRH-a cohort experienced a marginally elevated pregnancy rate (RR = 1.20, 95% CI = 1.02-1.41; P = 0.03) and a reduced mean time to conceive (RR = -1.17, 95% CI = -1.70- -0.64; P < 0.0001). Contrarily, other evaluated outcomes did not exhibit notable statistical differences.

CONCLUSIONS

Incorporating adjuvant GnRH-a following conservative surgery may be deemed beneficial for women with endometriosis, especially before Assisted Reproductive Technology (ART). Nonetheless, owing to pronounced heterogeneity, subsequent research is warranted to substantiate these potential advantages conclusively.

REGISTRATION NUMBER

CRD42023448280.

摘要

背景

子宫内膜异位症常导致疼痛和不孕。虽然保守手术提供了一些缓解，但往往无法确保满意的妊娠结局。手术后给予辅助 GnRH-a 以减轻复发；然而，其对妊娠结局的影响仍存在争议。本研究旨在评估辅助 GnRH-a 在增强子宫内膜异位症患者保守手术后妊娠结局方面的疗效。

方法

我们严格检索了包括 PubMed、Embase、Cochrane 图书馆、Medline（Ovid）、Web of Science 和 Scopus 在内的数据库，检索时间截至 2023 年 8 月 02 日，无语言限制。使用严格的纳入和排除标准筛选确定的文章。评估的结果包括妊娠率、活产率、流产率、宫外孕率、多胎妊娠率、平均术后妊娠间隔、复发率和不良反应率。使用 Cochrane 偏倚风险工具和 Jadad 评分评估纳入研究的质量。进行亚组和敏感性分析以分析汇总结果。Meta 分析模型以标准化均数差（SMD）和风险比（RR）表示结果。

结果

共纳入了 17 项关于 2485 名患者的研究。Meta 分析显示，手术后 GnRH-a 组妊娠率略有升高（RR=1.20，95%CI=1.02-1.41；P=0.03），受孕时间缩短（RR=-1.17，95%CI=-1.70- -0.64；P<0.0001）。然而，其他评估结果没有显示出显著的统计学差异。

结论

在保守手术后联合辅助 GnRH-a 可能对子宫内膜异位症患者有益，尤其是在辅助生殖技术（ART）之前。然而，由于存在显著的异质性，需要进一步的研究来明确这些潜在的优势。

注册号

CRD42023448280。

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本文引用的文献

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Cochrane Database Syst Rev. 2023 Jun 21;6(6):CD014788. doi: 10.1002/14651858.CD014788.pub2.
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Concomitant Autoimmunity in Endometriosis Impairs Endometrium-Embryo Crosstalk at the Implantation Site: A Multicenter Case-Control Study.子宫内膜异位症中的伴随自身免疫损害着床部位的子宫内膜-胚胎相互作用：一项多中心病例对照研究。
J Clin Med. 2023 May 19;12(10):3557. doi: 10.3390/jcm12103557.
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Comparison of the efficacy of dienogest and GnRH-a after endometriosis surgery.
比较内异症手术后地诺孕素与 GnRH-a 的疗效。
BMC Womens Health. 2023 Feb 24;23(1):85. doi: 10.1186/s12905-022-02118-w.
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Endometriosis-associated infertility: From pathophysiology to tailored treatment.子宫内膜异位症相关不孕：从病理生理学到个体化治疗。
Front Endocrinol (Lausanne). 2022 Oct 26;13:1020827. doi: 10.3389/fendo.2022.1020827. eCollection 2022.
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Pathophysiology, diagnosis, and management of endometriosis.子宫内膜异位症的病理生理学、诊断和治疗。
BMJ. 2022 Nov 14;379:e070750. doi: 10.1136/bmj-2022-070750.
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