| Objective:This study was conducted to evaluate the clinical efficacy and difference of gonadotropin-releasing hormone agonist（Gn RH-a）combined witn levonorgestrel-releasing intrauterine system（LNG-IUS,trade name:mirena）and mirena alone in the treatment of adenomyosis by using a meta-analysis,so as to provide reference for clinical work.Methods:All relevant literatures published on Pub Med,Cochrane,Embase,Web of Science,Sinomed,CNKI,Wanfang,and VIP databases before December 30,2020 were retrieved by computer,and the required data were screened and extracted.After the quality evaluation of the qualified literatures,the data were Meta-analyzed on Rev Man5.3 software.Results:Seven randomized controlled trials（RCTs）were included,including a total of 570 patients,including 285 in the trial group（Gn RH-a combined with mirena）and 285 in the control group（Mirena）.Meta-analysis results showed that:（1）Dysmenorrhea VAS score:It is not clear whether there is a difference in dysmenorrhea VAS score between the two groups after 3 months of treatment;After 6 months of treatment showed that both groups could reduce the VAS score of dysmenorrhea,and the difference between the two groups was statistically significant（P<0.05）,the experimental group was better than the control group.（2）Menstrual volume PBAC score:It is not clear whether there was a difference in menstrual volume PBAC score between the two groups after 3 months of treatment;After 6months of treatment showed that both groups could reduce menstrual volume PBAC score,and the difference between the two groups was statistically significant（P<0.05）,the experimental group was better than the control group.（3）Uterine volume:After 3 months and 6 months of treatment showed that both groups could reduce the uterine volume,and the difference between the two groups was statistically significant（P<0.05）,the experimental group was better than the control group.（4）CA125:After 6 months of treatment showed a decrease in CA125 in both groups,and the difference between the two groups was statistically significant（P<0.05）,the experimental group was better than the control group.（5）Endometrial thickness:After 6 months of treatment,showed that both groups could reduce endometrial thickness,and the difference between the two groups was statistically significant（P<0.05）,the experimental group was better than the control group,which was just in accordance with the results of menstrual volume PBAC score after 6 months of treatment.（6）Effective rate:After 6 months of treatment showed that both groups could relieve the clinical symptoms,and the difference between the two groups was statistically significant（P<0.05）,the experimental group was higher than the control group.（7）Mirena shedding rate:After 6 months of treatment,the difference between the two groups was statistically significant（P<0.05）,the experimental group was lower than the control group.（8）Adverse reactions:The incidence of total adverse reactions after treatment was statistically significant between the two groups（P<0.05）,the experimental group was lower than the control group;Three studies[37,38,41]reported the occurrence of irregular vaginal bleeding 6 months after treatment,and the difference between the two groups was statistically significant（P<0.05）,the experimental group was lower than the control group;Two studies[36,37]reported the occurrence of nausea,and the difference between the two groups was not statistically significant（P=0.38）.There was no difference in the occurrence of nausea between the experimental group and the control group.（9）No serious complications were mentioned in the 7 RCTs.Conclusion:After 3 months of treatment,the combination of Gn RH-a and Mirena was more effective in reducing uterine volume than Mirena alone.After 6 months of treatment,Gn RH-a combined with Mirena was more effective than Mirena alone in improving the clinical efficacy and reducing the incidence of adverse reactions. |
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