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目的:系统性评价二甲双胍对常规体外受精/卵胞质内单精子显微注射(IVF/ICSI)中多囊卵巢综合征(PCOS)患者妊娠结局的有效性,旨在为助孕前的干预措施提供理论依据。方法:计算机检索中国学术期刊全文数据库(CNKI)、万方数据库、维普数据库、Pub Med、Medline、Embase有关二甲双胍对IVF/ICSI中PCOS患者妊娠结局的临床随机对照试验(RCT)。按Cochrane系统评价方法,首先对纳入的文献进行质量评价和资料提取后,采用Rev Man5.2软件进行Meta分析。结果:纳入11个RCT研究,共1 310例患者,其中二甲双胍组713例,对照组597例。Meta分析结果显示:与对照组相比较,二甲双胍组的临床妊娠率(OR=1.60,95%CI:1.26~2.04,P=0.000 2)较高,卵巢过度刺激综合征(OHSS)发生率较低(OR=0.45,95%CI:0.31~0.64,P=0.000 1)。而活产率(OR=1.38,95%CI:0.98~1.94,P=0.06)和流产率(OR=0.72,95%CI:0.51~1.02,P=0.07)组间无统计学差异。结论:二甲双胍可提高IVF/ICSI中PCOS患者的妊娠率、降低OHSS发生率,但不能提高活产率及降低流产率。
OBJECTIVE: To systematically evaluate the efficacy of metformin in pregnancy outcome in women with polycystic ovary syndrome (PCOS) in routine in vitro fertilization / intracytoplasmic sperm injection (IVF / ICSI) and to provide theory for pre-pregnancy interventions in accordance with. Methods: The clinical randomized controlled trials (RCTs) of metformin on pregnancy outcomes in patients with PCOS in IVF / ICSI were searched by CNKI, Wanfang Database, VIP database, Pub Med, Medline and Embase. According to the method of Cochrane systematic review, firstly, the quality evaluation and data extraction of the included documents were carried out, and Meta-analysis was performed by using Rev Man5.2 software. RESULTS: Eleven RCTs were enrolled in a total of 1 310 patients, including 713 in the metformin group and 597 in the control group. Meta-analysis showed that the clinical pregnancy rate (OR = 1.60, 95% CI: 1.26-2.04, P = 0.000 2) and the incidence of OHSS in the metformin group were lower than those in the control group (OR = 0.45, 95% CI: 0.31-0.64, P = 0.0001). There was no significant difference between the live birth rate (OR = 1.38, 95% CI: 0.98-1.94, P = 0.06) and abortion rate (OR = 0.72, 95% CI: 0.51-1.02, P = 0.07). Conclusion: Metformin can increase the pregnancy rate of PCOS patients in IVF / ICSI and reduce the incidence of OHSS, but can not increase the live birth rate and reduce the abortion rate.