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目的:比较高孕激素状态下促排卵（progestin-primed ovarian stimulation，PPOS）方案与拮抗剂方案对卵巢低反应（poor ovarian response，POR）患者的临床应用效果。方法:通过检索Pubmed、The Cochrane Library、Embase、Web of Science、CNKI、Wanfang Data、CBM数据库，搜集PPOS方案与拮抗剂方案应用于POR患者的队列研究和随机对照试验（randomized controlled trials，RCT），检索时限从建库至2020年5月。严格筛选文献和提取资料后，队列研究使用改良纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale，NOS）系统评价方法、RCT研究使用Cochrane系统评价方法对文献进行质量评价，并使用RevMan5.3软件进行meta分析。结果:共纳入队列研究7篇，RCT文献3篇，包括1977例POR患者，其中PPOS方案组1053例，拮抗剂方案924例。Meta分析结果显示，PPOS方案的促性腺激素（gonadotropin，Gn）使用时间延长（n P=0.02），但Gn总用量与拮抗剂方案相比差异无统计学意义（n P>0.05）；PPOS方案的直径≥14 mm卵泡数和获卵数与拮抗剂方案相比差异无统计学意义（n P>0.05），Mn Ⅱ卵率和受精率显著高于拮抗剂方案（n P=0.04，n P0.05）；PPOS方案的早发黄体生成素（luteinizing hormone，LH）峰发生率明显降低（n P=0.04），扳机日雌二醇、孕酮、卵泡刺激素、LH水平与拮抗剂方案相比差异均无统计学意义（均n P>0.05）；PPOS方案的临床妊娠率高于拮抗剂方案，而流产率低于拮抗剂方案（n P=0.03，n P0.05）。n 结论:PPOS方案可明显降低POR患者促排卵中LH峰发生率，提高Mn II卵率，改善妊娠结局，降低不良妊娠发生率，可在POR患者中广泛安全使用。n “,”Objective:To compare the clinical efficacy of progestin-primed ovarian stimulation (PPOS) protocol and gonadotropin-releasing hormone (GnRH)-antagonist protocol in patients with poor ovarian response (POR).Methods:By retrieving Pubmed, the Cochrane Library, Embase, Web of Science, CNKI, Wanfang Data, and CBM databases, the cohort studies and randomized controlled trials (RCTs) of PPOS and antagonist protocols applied to POR patients were collect and the retrieval time period was from establishment of the database to May 2020. After rigorous literature screening and data extraction, the cohort study used Newcastle Ottawa Scale (NOS) system evaluation method, the RCT used Cochrane system evaluation method to evaluate the literature quality, and the RevMan5.3 software was used for meta-analysis.Results:A total of 7 cohort studies and 3 RCTs were included, totally 1977 POR patients, including 1053 in the PPOS protocol group and 924 in the antagonist protocol. Meta-analysis showed that the duration of gonadotropin (Gn) used in PPOS protocol group was extended (n P=0.02), but there was no significant difference in the total dosage of Gn used compared with the antagonist protocol (n P>0.05). There were no significant differences in the number of follicles with a diameter ≥14 mm and the number of retrieved oocytes between PPOS protocol group and antagonist protocol group (alln P>0.05), the Mn Ⅱ oocyte rate and the fertilization rate were significantly higher than those of antagonist protocol (n P=0.04, n P0.05). The incidence of early onset luteinizing hormone (LH) peak significantly reduced with PPOS protocol (n P=0.04), the levels of estrogen, progesterone, follicle-stimulating hormone (FSH) and LH on trigger day were not significantly different from those of antagonist protocol (all n P>0.05). The clinical pregnancy rate of PPOS protocol was higher than that of the antagonist protocol, but the abortion rate was lower than that of the antagonist protocol (n P=0.03, n P0.05).n Conclusion:PPOS protocol can significantly reduce the incidence of premature LH surge in ovulation induction in POR patients, increase the Mn Ⅱ oocytes rate, improve the pregnancy outcome, reduce the incidence of adverse pregnancy, and can be widely and safely used in POR patients.n