Meta Analysis Of The Efficacy And Safety Between Mifepristone And GnRH-a In The Subsequent Treatment Of The Endometriosis After Surgery

Background and objective: Endometriosis is a common estrogen-dependent disorder,its incidence is increasing tendency every year,it affects about 5~10% the health of the women in the reproductive age.Endometriosis is benign disease,but it has the ability of the plantation and metastasis,just like the malignant tumor,so endometriosis is easy to recurrence and invasiveness.For the pathogenesis of the endometriosis,there has many theories,but not one of them can be sure.The main clinical symptoms are pelvic pain and infertility,and seriously affect the most women’normal life. Postopreative recurrence increase the time of the operation,how to solve this problem is still a difficult to the all gynecologists.The treatments to the endometriosis have surgery and medical,but in clinical,given the drugs after the conservation surgery is the most usefulmethod. Atpresent, commonlyuseddrughave mifepristone,danazol,Gn RH-a,gestrinone,progesterone,oral contraceptives,and so on,but all the drug are described,their therapertic effect and the side effects and the effects to the hormone level need more research to prove.This article wants to research the efficacy and safety of the ecdometriosis after the conservative surgery through the Meta analysis to provide a guidance of the future clinical medical treatment.Methods: We search Pubmed, Mdiline,EMbase,CNKI, Wanfangdatabases, Wei Pu,CJFD, CBM, OVID,and search the whole articles from the database built to the December 2015.According to the inclusion and exclusion criteria,we chose seven articles having 805 patients.we diveide the patients into two groups:the experimental group and the control group.The experimental group is given mifepristone and Gn RH-a to endometriosis after the conservation surgery,and the control group is not given every drugs.We get the every data from the seven articles,and using Revman software do the Meta analysis.Result: According to the inclusion and exclusion criteria,12 articles were finally included,1 of which in English and 6 in Chinese. The Meta-analysis finds that:1In complete remission rate,partial remission rate,recurrence rate,pregnancy rate,the postoperative using mifepristone compared with surgery alone,respectively,the results are RR=0.31,95%CI(0.22,0.44),P<0.00001、RR=0.31,95%CI(0.22,0.44),P<0.00001、RR=0.37,95%CI(0.25,0.55),P<0.00001、RR=1.34,95%CI(0.77,2.33),P>0.29;.2In complete remission rate,partial remission rate,recurrence rate,the postoperative using Gn RH-a compared with surgery alone,respectively,the results are RR=0.24,95%CI(0.14,0.41),P<0.00001、RR=0.24,95%CI(0.14,0.41),P<0.00001、RR=0.26,95%CI(0.16,0.42),P<0.00001、RR=2.59,95%CI(1.54,4.44),P=0.00005。3In complete remission rate,partial remission rate,recurrence rate,the postoperative using mifepristone compared with Gn RH-a,respectively,the results are RR=0.99,95%CI(0.92,1.08),P=0.89;RR=1.25,95%CI(0.73,2.12),P=0.42;RR=1.50,95%CI(0.87,2.58),P=0.14;RR=0.53,95%CI(0.40,0.71),P<0.001。Based on the results,the efficacy of the postoperative with medicine treatment is significantly better than the surgery alone,but there is no difference between the mifepristone and Gn RH-a.As to the pregnancy rate,Gn RH-a is better than mifepristone and surgery alone.4 The results of the changes of the hormone level after the postoperative with mifepristone and Gn RH-a are follows:E2, MD=71.52, 95%CI(68.53, 74.51),P<0.00001;FSH,MD=3.51,95%CI(3.36,3.65,P<0.00001;LH,MD=4.56,95%CI(4.36,4.75),P<0.00001;PRL,MD=9.08,95%CI(-11.05,29.20),P=0.350。In the inhibitory of the E2、FSH、LH,Gn RH-a is stronger than mifepristone,but to the influence of PRL,there is no big difference.5In the medicine treatment after operation group,the patients had not been found doing surgery again.But in the simple surgical group,8% patients were done surgery again.That shows the medicine treatment after operation can obviously reduce the patients doing surgery again.6The Mete analysis of the mifepristone group and the Gn RH-a group in the impact of the bone mineral density is as follows:MD=0.07,95%CI(0.07,0.07),P<0.00001.In the inhibition of the bone mineral density,Gn RH-a is better than mifepristone.7In the side effects of the medical treatment,the side effects of mifepristone is lighter,it has no syndrome of low estrogen,no need to the reverse add treatment,the gastrointestinal symptoms are not serious.Many patients have the vaginal irregular bleeding,it can be controlled by adjusting the dosage. The side effects of Gn RH-a are serious.Many patients have the syndrome of low estrogen,which need the reverse add treatment.Mifepristone and Gn RH-a both have effect on the liver function,but do not need special treatment. Long time use of mifepristone,we should alert the endometrial lesions,especially for the patients with obesity,hypertension,diabetes etc. with high-risk endometrial lesions should be used with caution.Conclusion: Using the mifepristone and Gn RH-a after the conservative operation of endometriosis can obviously improve the clinical symptom,reduce the rate of recurrence,reduce the times of the operation again.There is no difference in the efficacy.Gn RH-a is better than mifepristone in the pregnancy rate, and the inhibitory of the E2、FSH、LH,and he inhibition of the bone mineral density,but to the influence of PRL,there is no big difference.But to the influence of the liver function and gastrointestinal symptoms,mifepristone is stronger than Gn RH-a.Long time use of mifepristone,we should alert the endometrial lesions。As to the Gn RH-a,mifepristone have less side effects and low price,which are better accepted by patients and worth widely used in clinical.For the fertility requirements or the patients with high-risk endometrial lesions,Gn RH-a is a better choice.