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皮下植入物与左炔诺孕酮宫内节育器在育龄妇女中的效果：一项系统评价和荟萃分析

Subdermal implants vs. levonorgestrel intrauterine devices outcomes in reproductive-aged women: a systematic review and meta-analysis.

作者信息

Oliveira Juliana Almeida, Neves Gabriel Lage, Pinhati Matheus Eduardo Soares, de Oliveira Flávia Ribeiro, Filho Agnaldo Lopes da Silva

机构信息

Department of Gynecology and Obstetrics, Federal University of Minas Gerais, Av.A Pres. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, 31270-901, Brazil.

Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil.

出版信息

Arch Gynecol Obstet. 2025 Apr;311(4):1173-1180. doi: 10.1007/s00404-025-07943-6. Epub 2025 Mar 11.

DOI:10.1007/s00404-025-07943-6
PMID:40069520
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11985546/
Abstract

PURPOSE

We aimed to conduct a systematic review and meta-analysis comparing the outcomes of subdermal implants and levonorgestrel intrauterine system (LNG-IUS) in reproductive-aged women.

METHODS

In April 2024, we searched Pubmed, Embase and Cochrane trials using the search terms: "etonogestrel", "levonorgestrel" and "randomized controlled trials". We identified 2862 results comparing the LNG-IUS to subdermal implants. Randomized controlled trials (RCTs) were selected with no restrictions on language or year of publication.

RESULTS

We include six RCTs comprising 1503 patients. R Studio was used for statistical analysis. Subdermal implants were associated with a higher risk of dissatisfaction (OR 2.42; 95% CI 1.47-3.98), acne (OR 2.21; 95% CI 1.21-4.04), weight gain (OR 4.63; 95% CI 1.96-10.63), and device removal due to side effects (OR 2.02; 95% CI 1.20-3.41) compared to the LNG-IUS group. Subgroup analysis indicated that irregular bleeding may be influenced by gynecological conditions, and the risk of new ovarian cyst detection was lower in healthy women using subdermal implants. Norplant-2 was associated with an increased risk of irregular bleeding and a decreased risk of amenorrhea or infrequent bleeding. The leave-one-out analysis and heterogeneity were well distributed among studies for all evaluated outcomes.

CONCLUSIONS

Reproductive-aged women in use of subdermal implants experienced a higher rate of acne, weight gain, device removal due to side effects and dissatisfaction compared to those in use of LNG-IUS.

TRIAL REGISTRATION

PROSPERO ID: CRD42024516472.

摘要

目的

我们旨在进行一项系统评价和荟萃分析，比较皮下植入物和左炔诺孕酮宫内节育系统（LNG-IUS）在育龄妇女中的效果。

方法

2024年4月，我们使用检索词“依托孕烯”、“左炔诺孕酮”和“随机对照试验”在PubMed、Embase和Cochrane试验库中进行检索。我们共识别出2862项比较LNG-IUS与皮下植入物的结果。随机对照试验（RCT）的选择不受语言或发表年份的限制。

结果

我们纳入了6项RCT，共1503例患者。使用R Studio进行统计分析。与LNG-IUS组相比，皮下植入物与更高的不满意风险（比值比[OR] 2.42；95%置信区间[CI] 1.47 - 3.98）、痤疮风险（OR 2.21；95% CI 1.21 - 4.04）、体重增加风险（OR 4.63；95% CI 1.96 - 10.63）以及因副作用而取出装置的风险（OR 2.02；95% CI 1.20 - 3.41）相关。亚组分析表明，不规则出血可能受妇科疾病影响，使用皮下植入物的健康女性中新发卵巢囊肿的检出风险较低。Norplant-2与不规则出血风险增加以及闭经或出血不频繁风险降低相关。留一法分析和异质性在所有评估结局的研究中分布良好。

结论

与使用LNG-IUS的育龄妇女相比，使用皮下植入物的妇女痤疮、体重增加、因副作用取出装置以及不满意的发生率更高。

试验注册

PROSPERO标识符：CRD42024516472。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aaba/11985546/e87ed15e4ec6/404_2025_7943_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aaba/11985546/50f8b18f20b2/404_2025_7943_Fig1_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aaba/11985546/63600b8d4a84/404_2025_7943_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aaba/11985546/d0b40faf3707/404_2025_7943_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aaba/11985546/0a2cd9e0ec66/404_2025_7943_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aaba/11985546/e87ed15e4ec6/404_2025_7943_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aaba/11985546/50f8b18f20b2/404_2025_7943_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aaba/11985546/bfd3ec9a327d/404_2025_7943_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aaba/11985546/63600b8d4a84/404_2025_7943_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aaba/11985546/d0b40faf3707/404_2025_7943_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aaba/11985546/0a2cd9e0ec66/404_2025_7943_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aaba/11985546/e87ed15e4ec6/404_2025_7943_Fig6_HTML.jpg

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