【作者】 曲玉芳；

【导师】 侯丽辉；

【作者基本信息】 黑龙江中医药大学 ， 中医妇科学， 2007， 硕士

【摘要】 目的：系统分析二甲双胍联合克罗米芬(Clomiphene,CC)治疗多囊卵巢综合征(Polycystic ovary syndrome,PCOS)的有效性、安全性,以期做出客观、可信的评价,指导临床用药,提出临床研究中存在的问题,拟采取的对策。方法：采用循证医学(Evidence-based medicine,EBM)的方法,全面检索国内二甲双胍联合克罗米芬治疗多囊卵巢综合征的随机对照试验(Randomized controlled trial,RCT)文献资料并进行系统评价(Systematic review,SR),按文献可靠性的分级、试验分配的隐藏方案和JADAD量表评价文献的质量。采用Cochrane协作网提供的Revman4.2软件进行统计分析。结果：二甲双胍联合克罗米芬治疗多囊卵巢综合征临床排卵率(P<0.00001)、妊娠率(P<0.00001与单独克罗米芬组比较有显著意义；与单独二甲双胍组比较排卵率(P=0.0009<0.05=,高于单独应用二甲双胍组,妊娠率(P=0.02<0.05=显著高于单独应用二甲双胍组,二甲双胍联合克罗米芬治疗多囊卵巢综合征总体疗效肯定,为指导以后的临床用药提供了理论支持。倒漏斗图显示不对称,可能与发表偏倚及临床试验设计有关。结论：二甲双胍联合克罗米芬治疗多囊卵巢综合征是一种有效的方法。但临床随机对照试验的方法学质量较低,存在潜在的发表偏倚,其临床疗效及安全性有待今后随机对照、多中心的临床试验加以证实和重新评估。更多还原

【Abstract】 Purpose:To make the systematic review of "combinded treatment of clomiphene and metformin" in treating Polycystic ovary syndrome so that clinical treating decision can be made based on objective believable evaluation of the treatment to Polycystic ovary syndrome by the method, put forward the existent problem in the clinical research, draw up the methods to solve them.Method:All the randomized controlled trails about the research work of combinded treatment of metformin and clomiphene in treating Polycystic ovary syndrome in China were searched based on the methods of evidence-based medicine. All the articles were evaluated based on reliability classification, concealment of research allocation and JADAD scale review.Articles were analysised with Revman4.2 sofeware.Result:The ovulation rates and pregnancy rates of the group of combined treatment of metformin and clomiphene have conspicuous significance when compared with the clomiphene group (P<0.00001, P<0.00001)The ovulation rates and pregnancy rates of the group of combined treatment of metformin and clomiphene are conspicuous precede to the metformin group (P=00009<0.05, P=0.02<0.05).The therapeutic effect of the treatment method of combined metformin and clomiphene indicated for PCOS is ascertain, which provides the theory evidence for guiding the usage of medicine clinically. Asymmetry showed in "Funel Plot" may be related to the publication bias and the design of clinical experiment.Conclusion:Polycystic ovary syndrome in metformin and clomiphene is an efficical method.Because of the general poor methodological quality and potential publication bias,the efficacy and safety of metformin and clomiphene in the treatment of polycystic ovary syndrome should be evaluated by more rigorously designed, randmized, multiply-center trails.更多还原