在子宫内膜激增症和早期子宫内膜癌的孕激素治疗中,甲福明作为辅助剂:对随机对照试验的系统审查和元分析
Patricia Ann A Factor1, Koleen C Pasamba2
1Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines Manila.
Acta medica Philippina
|July 15, 2024
概括
当与孕激素治疗一起使用时,甲福明可能会改善活产率和在无异形性子宫内膜增生症的完整反应. 然而,证据有限,其对其他子宫内膜状况的有效性仍然不确定.
科学领域:
- 妇科 妇科 妇科 妇科
- 生殖内分泌学 生殖内分泌学
- 在瘤学瘤学.
背景情况:
- 甲福明在子宫内膜细胞上表现出抗增殖作用,这表明与孕激素治疗的潜在协同作用.
- 之前对甲胺和孕激素用于子宫内膜激增症和癌症的系统性审查由于回顾性队列存在局限性.
- 这项研究解决了对随机对照试验 (RCT) 进行严格元分析的需要,以评估辅助甲福林的疗效.
研究的目的:
- 系统地审查和对评估甲福明作为孕激素治疗辅助剂的疗效的RCT进行元分析.
- 确定辅助甲福明对子宫内膜增生和早期子宫内膜癌的临床回归率的影响.
- 评估二次结果,包括复发,临床怀孕和活产率.
主要方法:
- 按照柯克兰方法和PRISMA 2020指南进行系统审查和元分析.
- 纳入标准:具有子宫内膜增生 (有/没有异形) 或子宫内膜癌的生殖年龄妇女的RCT,接受孕激素和甲胺治疗.
- 主要结局:12至16周的完全响应率. 二次结果:复发,怀孕和活产率. 分析使用了几率比率 (OR) 和95%信心区间 (CI).
主要成果:
- 在分析中包括了6个RCT.
- 辅助性甲福明可能会增加无异形性子宫内膜质激增症的完全响应率 (OR 5.12) 和活产率 (OR 2.51),但证据的确定性很低.
- 甲胺对具有不平衡的子宫内膜增生,子宫内膜癌,复发率或临床怀孕率的临床反应没有显著影响.
结论:
- 目前关于甲福明与孕激素结合治疗子宫内膜增生和癌症的益处的证据尚不确定.
- 证据的确定性较低,需要在临床应用中谨慎.
- 需要使用更大的样本大小和更长的随访时间的高质量的RCT来制定最终的实践建议.
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