摘要
目的评价孕激素在先兆流产患者中的治疗效果,并探索不同制剂、用药途径是否存在差异。方法检索数据库MEDLINE、EMBASE、Cochrane Database of Clinical Trials、ClinicalTrials.gov,检索时间为建库至2020年5月,比较了先兆流产患者中孕激素组与对照组(安慰剂或未治疗组)妊娠结局指标的所有随机对照试验(RCT)。两位研究者独立进行数据提取及分析,应用RevMan5.3软件对孕激素组和对照组患者的妊娠结局进行Meta分析。结果共检索到85篇文章,其中符合纳入标准的有11篇,共计5076例先兆流产患者被纳入Meta分析。(1)与对照组相比,孕激素组先兆流产患者的流产率显著降低(P<0.05)。不同孕激素制剂亚组分析显示,地屈孕酮和黄体酮均显著降低了先兆流产患者的流产率(P<0.05);不同给药途径亚组分析显示,口服孕激素在降低流产率方面显著优于对照组(P<0.05),而经阴道应用孕激素与对照组无统计学差异(P>0.05)。不同地区和不同研究规模的亚组分析显示,孕激素组与对照组相比,先兆流产患者的流产率均显著降低(P<0.05)。(2)与对照组相比,孕激素组的活产率显著提高(P<0.05)。不同孕激素制剂亚组分析显示,与对照组相比,地屈孕酮亚组的活产率显著提高(P<0.05),而黄体酮亚组无统计学差异(P>0.05);不同给药途径亚组分析显示,与对照组相比,口服孕激素显著提高活产率(P<0.05),而经阴道应用孕激素与对照组无统计学差异(P>0.05)。(3)孕激素组与对照组在新生儿先天性异常及低体重的发生率方面均无统计学差异(P>0.05)。结论孕激素可以降低先兆流产患者的流产率,提高活产率,且未增加新生儿相关不良结局的发生;但不同孕激素制剂和给药途径的治疗效果存在差异。口服地屈孕酮治疗可降低先兆流产患者的流产率并提高活产率,值得临床推荐应用。
Objective:To evaluate the therapeutic effect of progesterone in patients with threatened abortion,and explore whether there are differences in different preparations and administration routes.Methods:All published papers were searched in MEDLINE,EMBASE,Cochrane Database of Clinical Trials and ClinicalTrials.gov,and the retrieval time was from the establishment of the database to May 2020.All randomized controlled trials that compared the pregnancy outcomes between progesterone groups and control groups(placebo or untreated groups)in patients with threatened abortion were enrolled.Data were extracted and evaluated independently by two reviewers.Meta-analysis of pregnancy outcomes between progesterone groups and control groups was carried out using RevMan5.3 software.Results:A total of 85 papers were retrieved,in which 11 studies met the inclusion criteria and 5076 patients of threatened abortion were included in the meta-analysis.The results showed that the progesterone significantly reduced the miscarriage rate in patients with threatened abortion compared with control groups(P<0.05).Subgroup analysis of different progesterone preparations indicated that both dydrogesterone and progesterone significantly reduced the miscarriage rate(P<0.05).Subgroup analysis of different administration routes revealed that oral progesterone group was significantly better than the control group in reducing the rate of miscarriage(P<0.05),while vaginal application of progesterone had no significant difference compared with control group(P>0.05).Subgroup analysis in different regions and different study sizes showed that the miscarriage rate of patients with threatened abortion was significantly decreased in the progesterone groups compared with control groups(P<0.05).The incidence of live birth of progesterone group was increased compared with control group(P<0.05).The subgroup analysis of different progesterone preparations showed that the live birth rate of the dydrogesterone subgroup was significantly increased compared with the control group(P<0.05),while the progesterone subgroup had no significant difference(P>0.05).Subgroup analysis of different administration routes showed that oral progesterone significantly increased the live birth rate compared with the control group(P<0.05),while the vaginal application of progesterone had no significant difference with the control group(P>0.05).There was no significant difference in the incidence of neonatal congenital abnormalities and low weight between the progesterone groups and the control groups(P>0.05).Conclusions:Progesterone can reduce the miscarriage rate and increase the live birth rate in patients with threatened abortion,and it does not increase the incidence of adverse outcomes in newborn.However,different progesterone preparations and administration routes may have different therapeutic effects.Oral dydrogesterone may significantly reduce the miscarriage incidence and increase the live birth rate in patients of threatened abortion,which is worthy of clinical recommendation.
作者
曹金翔
吴洁
CAO Jin-xiang;WU Jie(Department of Obstetrics&Gynecology,the First Affiliated Hospital of Nanjing Medical University,Jiangsu Province Hospital,Nanjing 210036)
出处
《生殖医学杂志》
CAS
2020年第12期1612-1620,共9页
Journal of Reproductive Medicine
基金
江苏省医学创新团队(CXTDA2017004),江苏省妇幼保健重点学科(FXK201701)。
关键词
孕激素
先兆流产
地屈孕酮
流产率
活产率
新生儿相关结局
Progesterone
Threatened abortion
Dydrogesterone
Miscarriage rate
Live birth rate
Neonatal related outcomes
