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目的系统性评价脱氢表雄酮(DHEA)在辅助生殖技术中改善卵巢储备功能低下(DOR)患者妊娠结局的有效性。方法计算机检索中国知网、万方、维普等中文数据库及PUBMED、CBMDISC、MEDLINE、Elsevier等英文数据库中有关服用DHEA与不服用DHEA在辅助生殖技术中对DOR患者妊娠结局作用的临床随机对照试验(RCT),并同时检索纳入文献的相关参考文献。由2名研究者共同对文献进行筛选及质量评价,采用RevMan5.1软件对数据进行分析。结果共纳入5篇RCT,共532名患者。Mete分析结果显示:DOR患者在进入IVF周期前口服DHEA与不服用或者服用安慰剂相比,临床妊娠率较高,但无统计学差异[RR=1.32,95%CI(0.91,1.90),P=0.14];Gn总用量口服DHEA组明显少于对照组[MD=-528.58,95%CI(-992.59,-64.56),P=0.03],获卵数[MD=1.27,95%CI(0.26,2.29),P=0.01]差异也有统计学意义;然而周期取消率、HCG日E2值、HCG日子宫内膜厚度及移植胚胎数差异无统计学意义(P>0.05)。结论 DOR患者进入IVF周期前口服一定剂量的DHEA较不服用或者服用安慰剂者周期获卵数增加,促性腺激素(Gn)总用量较少,临床妊娠率未增加,并且周期取消率也未降低。提示:DOR患者联合应用DHEA不能改善其IVF的妊娠结局,但同时考虑到各组研究人群之间存在差异、样本量少以及在DHEA给予时间上也存在差异,所以DHEA能否提高IVF的妊娠结局,需要多中心、大样本的、设计科学严谨的前瞻性RCT证实。
Abstract：Objective:To systematically evaluate the effect of dehydroepiandrosterone(DHEA)as an adjuvant on IVF outcome in women with diminished ovarian reserve.Methods:The literatures about the effects of usage of DHEA before IVF on pregnancy outcome in women with diminished ovarian reserve were searched from PUBMED,CBMDISC,MEDLINE,Elsevier,Wanfang database and other database.The literatures were screened and evaluated by two independent researchers.Software of RevMan5.1was utilized to analyze the data.Results:This research enrolled 532 patients from 5randomized controlled trials(RCTs).The results of the meta-analysis revealed that there was no significant difference in clinical pregnancy[RR=1.32,95%CI(0.91,1.90),P=0.14]between he DHEA group and control group.The total dose of gonadotropin(Gn)used in DHEA group was significantly lower than control group[MD=-528.58,95%CI(-992.59,-64.56),P=0.03].There was also a significant difference in the number of oocytes retrieved [MD=1.27,95% CI(0.26,2.29),P=0.01].However,no significant differences were found in cycle cancellation rate,E2 levels,endometrial thickness on the day of HCG and transplant embryos between the two groups(P>0.05).Conclusions:The women with diminished ovarian reserve use DHEA as an adjuvant pre-IVF obtain more oocytes and use lower total dose of Gn.However,the clinical pregnancy rate is not increased,and the cycle cancellation rate is not decreased compared with the control group.It indicates that administration of DHEA in women with diminished ovarian reserve do not improve the pregnancy outcome of IVF.However,it needs more multicenter,large sample and high quality prospective RCTs to testify the effect of DHEA on IVF pregnancy outcome due to the individual differences,small sample size and the different duration of DHEA used.
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基本信息:
中图分类号:R714.8
引用信息:
[1]董娟,徐望明,董兰,等.IVF-ET前使用脱氢表雄酮对卵巢储备功能低下患者妊娠结局影响的系统评估[J].生殖医学杂志,2015,24(06):436-443.
2015-06-15
2015-06-15