促性腺激素释放激素类似物对化疗患者卵巢功能保护有效性的系统分析-@@专业论文.docxVIP

The Meta—analysis On the Effect of GnRH analog (GnRHa) in Prevention of premature ovarian failure during Chemotherapy Abstract Purpose: The use of GnRH analog (GnRHa) to preserve ovarian function has been investigated in several small studies. We performed a systematic review of studies examining whether a GnRHa administered during chemotherapy is protective of ovarian function and fertility. Methods :Using database included PubMed，Spring，Ovid，CBM，FMJS,CNKI etc．Keyword included “GnRHa”，“chemotherapy”，“ovarian damage／ovarian function／ premature ovarian failure”etc ．We searched the literature included studies that reported an association between GnRHa and ovarian preservation in women receiving chemotherapy. Studies without a control group were excluded. Ovarian preservation was defined as the resumption of menstrual cycles and a premenopausal follicle-stimulating hormone (FSH) after chemotherapy. Fertility was determined by a woman’s ability to become pregnant.Software RevMan 5.1.7 WaS used to assess control trials． Results:seven papers were included．the total of cases were 624．All of the studies had homogeneity(I2=0%，Po．05)．so the study could be analyzed merged，which used the fixed—effect model．The result showed The use of GnRH agonists (GnRHa) during chemotherapy is protective of ovarian function.(P0．01).Further evaluations in adequately powered large RCTs are needed to confirm these findings． Key word “GnRHa” ， “chemotherapy” ， “ovarian damage ／ ovarian function ／ premature ovarian failure”。 引言 化疗药物对快速分裂的细胞如胃肠道上皮细胞、骨髓细胞的损害是可逆的， 但对卵巢的损害是不可逆的。这与卵巢有限的储备有关，始基卵泡作为卵细胞储 备的唯一形式，在孕20周时达高峰后开始闭锁，出生时存留下1百万一2百万个， 初潮时还有40万～50万个，绝经后仅有数个残存。可见，女性一生中，卵细胞的 储备在胎儿期已成定局。随着恶性肿瘤年轻化趋势，许多年轻女性在接受化疗中， 性腺功能损害可造成不可逆的卵巢功能衰竭。从而可能丧失生育能力和女性内分 泌功能，严重影响其身心健康及生活质量。在提高患者生存率的同时，保护卵巢 功能，预防化疗后卵巢早衰的发生，对于提高患者愈后的生活质量显得十分重要。 如何减少化疗所致的卵巢损伤，成为目前研究的热点。 化疗药物对生长卵泡的破坏，使性激素分泌减少，反馈性引起下丘脑GnRH、 垂体促性腺激素（FSH、LH）分泌增加，加速初级卵泡向生长卵泡的的发展，使 其再次受到化疗药物的破坏，形成恶性循环，甚至耗竭原始卵泡和生长卵泡,最 终引起卵巢早衰（Premature ovarian failure,P