芳香化酶抑制劑用于不明原因不孕促排卵治療有效性和安全性的系統評價_《中國循證醫學雜志》

作者：

劉真 ^1,2 , 唐惠林 ² ,  翟所迪 ²

1. 首都醫科大學附屬北京婦產醫院（北京?100026）；2. 北京大學第三醫院（北京?100191）;

關鍵詞：

芳香化酶抑制劑不明原因不孕促排卵治療系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20110222

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目的　系統評價芳香化酶抑制劑對不明原因不孕患者促排卵治療的有效性和安全性。
方法　計算機檢索CNKI（1994～2011.6）、萬方數據庫（1982～2011.6）、PubMed（1966～2011.6）、Cochrane Library（2011年第6期），收集有關隨機對照試驗和半隨機對照試驗，由兩位研究者獨立進行文獻篩選、資料提取和方法學質量評價后，采用RevMan 5.0.1軟件進行Meta分析。
結果　共納入9個研究，均為英文文獻。方法學質量不高（僅1個B級，余為C級）。Meta分析結果顯示：芳香化酶抑制劑（AIs）和枸櫞酸氯米芬（CC）比較，在妊娠率［RR=1.02，95%CI（0.71，1.47）］、流產率［RR=1.00，95%CI（0.61，1.63）］、多胎妊娠率［RD= –0.02，95%CI（–0.07，0.03）］和不良事件發生率［RD=0.00，95%CI（–0.01、0.01）］上，兩組差異均無統計學意義；而AIs+促性腺激素（Gn）與CC+Gn比較，在妊娠率［RR=0.98，95%CI（0.68，1.42）］、流產率［RR=1.23，95%CI（0.70，2.15）］、多胎妊娠率［RD=0.00，95%CI（–0.10，0.10）］和不良事件發生率［RD=0.00，95%CI（–0.01、0.01）］上，兩組差異也均無統計學意義。
結論　對不明原因不孕的患者，芳香化酶抑制劑能否代替枸櫞酸氯米芬成為促排卵治療的一線促排卵藥物仍需開展大規模設計良好的隨機對照試驗和更長時間的隨訪來進一步驗證。

引用本文： 劉真,唐惠林,翟所迪. 芳香化酶抑制劑用于不明原因不孕促排卵治療有效性和安全性的系統評價. 中國循證醫學雜志, 2011, 11(11): 1327-1334. doi: 10.7507/1672-2531.20110222 復制

1.	2 El-Toukhy T, Khalaf Y. Treatment of unexplained infertility. BMJ , 2008, 337(a772): 362-363.
2.	3 Bhattachrya S, Harrild K, Mollison S, et al . Clomifene citrate or intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial. BMJ , 2008, 337: a716.
3.	4 Holzer H, Casper R, Tulandi T. A new era in ovulation induction. Fertil and Steril , 2006, 85(2): 277-784.
4.	7 Sammour A, Biljan MM, Tan SL, et al . Prospective randomized trial comparing the effects of letrazole (LE) and clomiphene citrate (CC) on follicular development, endometrial thickness and pregnancy rate in patients undergoing super-ovulation prior to intrauterine insemination (IUI). Fertil and Steril , 2001, 76: (3 suppl 1): S110.
5.	8 Bayar Ü, Tanriverdi HA, Barut A, et al. Letrozole vs clomiphene citrate in patients with ovulatory infertility. Fertil and Steril , 2006, 85(4): 1045-1048.
6.	9 Wu HH, Wang AM, Cheng ML, et al . A randomized comparison of ovulation induction and hormone profile between the aromatase inhibitor anastrozole and clomiphene citrate in women with infertility. Gynecol Endocrinol , 2007, 23: 76-81.
7.	10 Badawy A, Elnashar A, Totongy M, et al . Clomiphene citrate or aromatase inhibitors for superovulation in women with unexplained infertility undergoing intrauterine insemination: a prospective randomized trial. Fertil and Steril , 2009, 92(4): 1355-1359.
8.	11 Badawy A, Skokeir T, Allam AF, et al . Pregnancy outcome after ovulation induction with aromatase inhibitors or clomiphene citrate in unexplained infertility. Octa Obstet et Gynecol , 2009, 88: 187-191.
9.	12 Barroso G, Menocal G, Felix H, et al . Comparison of the efficacy of the aromatase inhibitor letrozole and clomiphene citrate as adjuvants to recombinant follicle-stimulating hormone in controlled ovarian hyperstimulation: a prospective, randomized, blindedclinicaltrial. Fertil and Steril , 2006, 86(5): 1428-1431.
10.	13 Davar R, Asgharnia M, Tayebi M. Comparison of the success rate of letrozole and clomiphene citrate in women undergoing intrauterine insemination. J of Res in Med Sci , 2006, 11(6): 382-387.
11.	14 Badawy A, Elnashar A, Totongy M. Clomiphene citrate or aromatase inhibitors combined with gonadotropins for super ovulation in women undergoing intrauterine insemination: A prospective randomised trial. J Obstet and Gynaecol , 2010, 30(6): 617-621.
12.	15 Fouda UM, Sayed AM. Extended letrozole regimen versus clomiphene citrate for superovulation in patients with unexplained infertility undergoing intrauterine insemination: a randomized controlled trial. Reprod Biol Endocrinol , 2011, 9(1): 84.
13.	16 Dankert T, Kremer JA, Cohlen BJ, et al . A randomized clinical trial of clomiphene citrate versus low dose recombinant FSH for ovarian hyperstimulation in intrauterine insemination cycles for unexplained and male subfertility. Hum Reprod , 2007, 22: 792-797.
14.	17 Casper RF, Mitwally MF. Review: Aromatase inhibitors for ovulation induction. J Clin Endocrinol Metab , March 2006, 91(3): 760-771.
15.	18 Casper RF, Mitwally MF. Aromatase inhibitors improves ovarian response to follicle-stimulating hormone in poor responders. Fertil and Steril , 2002, 77(4): 776-779.
16.	19 Baruah J, Roy KK, Rahman SM, et al . Endometrial effects of letrozole and clomiphene citrate in women with polycystic ovary syndrome using spiral artery Doppler. Arch Gynecol Obstet , 2009, 279(3): 311-314.
17.	20 Polyzos NP, Tzioras S, Mauri D, et al . Treatment of unexplained infertility with aromatase inhibitors or clomiphene citrate: a systematic review and meta-analysis. Obstet Gynecol Surv , 2008, 63(7): 472-479.
18.	21 Polyzos NP, Tzioras S, Badawy AM, et al . Aromatase inhibitors for female infertility: a systematic review of the literature. Reprod Biomed Online , 2009, 19(4): 456-471.
19.	劉嘉茵. 不明原因不孕癥的診治. 實用婦產科雜志, 2005, 21(8): 457-459.
20.	郭鵲暉, 鄭志群. 來曲唑的促排卵及胚胎毒性的研究進展. 生殖與避孕, 2009, 29(2): 120-127.
21.	Cochrane Handbook for Systematic Reviews of Interventions Ver-sion 5. 0. 1[updated September 2008]. e Cochrane Collaboration, 2008. [www. cochrane-handbook. org/]. Accessed 10 March 2009.

1. 2 El-Toukhy T, Khalaf Y. Treatment of unexplained infertility. BMJ , 2008, 337(a772): 362-363.
2. 3 Bhattachrya S, Harrild K, Mollison S, et al . Clomifene citrate or intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial. BMJ , 2008, 337: a716.
3. 4 Holzer H, Casper R, Tulandi T. A new era in ovulation induction. Fertil and Steril , 2006, 85(2): 277-784.
4. 7 Sammour A, Biljan MM, Tan SL, et al . Prospective randomized trial comparing the effects of letrazole (LE) and clomiphene citrate (CC) on follicular development, endometrial thickness and pregnancy rate in patients undergoing super-ovulation prior to intrauterine insemination (IUI). Fertil and Steril , 2001, 76: (3 suppl 1): S110.
5. 8 Bayar Ü, Tanriverdi HA, Barut A, et al. Letrozole vs clomiphene citrate in patients with ovulatory infertility. Fertil and Steril , 2006, 85(4): 1045-1048.
6. 9 Wu HH, Wang AM, Cheng ML, et al . A randomized comparison of ovulation induction and hormone profile between the aromatase inhibitor anastrozole and clomiphene citrate in women with infertility. Gynecol Endocrinol , 2007, 23: 76-81.
7. 10 Badawy A, Elnashar A, Totongy M, et al . Clomiphene citrate or aromatase inhibitors for superovulation in women with unexplained infertility undergoing intrauterine insemination: a prospective randomized trial. Fertil and Steril , 2009, 92(4): 1355-1359.
8. 11 Badawy A, Skokeir T, Allam AF, et al . Pregnancy outcome after ovulation induction with aromatase inhibitors or clomiphene citrate in unexplained infertility. Octa Obstet et Gynecol , 2009, 88: 187-191.
9. 12 Barroso G, Menocal G, Felix H, et al . Comparison of the efficacy of the aromatase inhibitor letrozole and clomiphene citrate as adjuvants to recombinant follicle-stimulating hormone in controlled ovarian hyperstimulation: a prospective, randomized, blindedclinicaltrial. Fertil and Steril , 2006, 86(5): 1428-1431.
10. 13 Davar R, Asgharnia M, Tayebi M. Comparison of the success rate of letrozole and clomiphene citrate in women undergoing intrauterine insemination. J of Res in Med Sci , 2006, 11(6): 382-387.
11. 14 Badawy A, Elnashar A, Totongy M. Clomiphene citrate or aromatase inhibitors combined with gonadotropins for super ovulation in women undergoing intrauterine insemination: A prospective randomised trial. J Obstet and Gynaecol , 2010, 30(6): 617-621.
12. 15 Fouda UM, Sayed AM. Extended letrozole regimen versus clomiphene citrate for superovulation in patients with unexplained infertility undergoing intrauterine insemination: a randomized controlled trial. Reprod Biol Endocrinol , 2011, 9(1): 84.
13. 16 Dankert T, Kremer JA, Cohlen BJ, et al . A randomized clinical trial of clomiphene citrate versus low dose recombinant FSH for ovarian hyperstimulation in intrauterine insemination cycles for unexplained and male subfertility. Hum Reprod , 2007, 22: 792-797.
14. 17 Casper RF, Mitwally MF. Review: Aromatase inhibitors for ovulation induction. J Clin Endocrinol Metab , March 2006, 91(3): 760-771.
15. 18 Casper RF, Mitwally MF. Aromatase inhibitors improves ovarian response to follicle-stimulating hormone in poor responders. Fertil and Steril , 2002, 77(4): 776-779.
16. 19 Baruah J, Roy KK, Rahman SM, et al . Endometrial effects of letrozole and clomiphene citrate in women with polycystic ovary syndrome using spiral artery Doppler. Arch Gynecol Obstet , 2009, 279(3): 311-314.
17. 20 Polyzos NP, Tzioras S, Mauri D, et al . Treatment of unexplained infertility with aromatase inhibitors or clomiphene citrate: a systematic review and meta-analysis. Obstet Gynecol Surv , 2008, 63(7): 472-479.
18. 21 Polyzos NP, Tzioras S, Badawy AM, et al . Aromatase inhibitors for female infertility: a systematic review of the literature. Reprod Biomed Online , 2009, 19(4): 456-471.
19. 劉嘉茵. 不明原因不孕癥的診治. 實用婦產科雜志, 2005, 21(8): 457-459.
20. 郭鵲暉, 鄭志群. 來曲唑的促排卵及胚胎毒性的研究進展. 生殖與避孕, 2009, 29(2): 120-127.
21. Cochrane Handbook for Systematic Reviews of Interventions Ver-sion 5. 0. 1[updated September 2008]. e Cochrane Collaboration, 2008. [www. cochrane-handbook. org/]. Accessed 10 March 2009.

《中國循證醫學雜志》

芳香化酶抑制劑用于不明原因不孕促排卵治療有效性和安全性的系統評價

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《中國循證醫學雜志》

芳香化酶抑制劑用于不明原因不孕促排卵治療有效性和安全性的系統評價

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