Juliana Almeida Oliveira, Gabriel Lage Neves, Matheus Eduardo Soares Pinhati, Flávia Ribeiro de Oliveira, Agnaldo Lopes da Silva Filho
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引用次数: 0
摘要
目的：我们旨在进行一项系统综述和荟萃分析，比较育龄妇女皮下植入和左炔诺孕酮宫内系统（LNG-IUS）的结果。方法：于2024年4月检索Pubmed、Embase和Cochrane试验，检索词为“etonogestrel”、“左炔诺孕酮”和“随机对照试验”。我们鉴定了2862个结果，将LNG-IUS与皮下植入物进行比较。随机对照试验（rct）的选择不受语言和发表年份的限制。结果：我们纳入了6项随机对照试验，共1503例患者。使用R Studio进行统计分析。皮下植入物与更高的不满意风险相关(OR 2.42；95% CI 1.47-3.98)，痤疮(OR 2.21；95% CI 1.21-4.04)，体重增加(OR 4.63；95% CI 1.96-10.63)，以及因副作用而移除器械(OR 2.02；95% CI 1.20-3.41)与LNG-IUS组比较。亚组分析显示，不规则出血可能受到妇科疾病的影响，使用皮下植入物的健康女性新发现卵巢囊肿的风险较低。Norplant-2与不规则出血风险增加和闭经或不频繁出血风险降低相关。在所有评估结果的研究中，留一分析和异质性分布良好。结论：与使用LNG-IUS的育龄妇女相比，使用皮下植入物的妇女出现痤疮、体重增加、因副作用而取出装置和不满的比例更高。试验注册：PROSPERO ID: CRD42024516472。
Subdermal implants vs. levonorgestrel intrauterine devices outcomes in reproductive-aged women: a systematic review and meta-analysis
Purpose
We aimed to conduct a systematic review and meta-analysis comparing the outcomes of subdermal implants and levonorgestrel intrauterine system (LNG-IUS) in reproductive-aged women.
Methods
In April 2024, we searched Pubmed, Embase and Cochrane trials using the search terms: “etonogestrel”, “levonorgestrel” and “randomized controlled trials”. We identified 2862 results comparing the LNG-IUS to subdermal implants. Randomized controlled trials (RCTs) were selected with no restrictions on language or year of publication.
Results
We include six RCTs comprising 1503 patients. R Studio was used for statistical analysis. Subdermal implants were associated with a higher risk of dissatisfaction (OR 2.42; 95% CI 1.47–3.98), acne (OR 2.21; 95% CI 1.21–4.04), weight gain (OR 4.63; 95% CI 1.96–10.63), and device removal due to side effects (OR 2.02; 95% CI 1.20–3.41) compared to the LNG-IUS group. Subgroup analysis indicated that irregular bleeding may be influenced by gynecological conditions, and the risk of new ovarian cyst detection was lower in healthy women using subdermal implants. Norplant-2 was associated with an increased risk of irregular bleeding and a decreased risk of amenorrhea or infrequent bleeding. The leave-one-out analysis and heterogeneity were well distributed among studies for all evaluated outcomes.
Conclusions
Reproductive-aged women in use of subdermal implants experienced a higher rate of acne, weight gain, device removal due to side effects and dissatisfaction compared to those in use of LNG-IUS.
期刊介绍：
Founded in 1870 as "Archiv für Gynaekologie", Archives of Gynecology and Obstetrics has a long and outstanding tradition. Since 1922 the journal has been the Organ of the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. "The Archives of Gynecology and Obstetrics" is circulated in over 40 countries world wide and is indexed in "PubMed/Medline" and "Science Citation Index Expanded/Journal Citation Report".
The journal publishes invited and submitted reviews; peer-reviewed original articles about clinical topics and basic research as well as news and views and guidelines and position statements from all sub-specialties in gynecology and obstetrics.
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