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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2014, Vol. 10 ›› Issue (02) : 170 -176. doi: 10.3877/cma.j.issn.1673-5250.2014.02.010

所属专题： 专题评论； 文献；

论著

阿托西班与利托君治疗早产临床疗效的系统评价
周小燕1, 徐望明1,*,*(), 董兰1, 王慧明1, 罗增丽1, 解美婷1   
  1. 1. 430060，武汉大学人民医院生殖中心
  • 收稿日期:2013-11-20 修回日期:2013-12-30 出版日期:2014-04-01
  • 通信作者: 徐望明

Atosiban Versus Ritodrine in the Treatment of Preterm Labour: A Systematic Review

Xiaoyan Zhou1, Wangming Xu1(), Lan Dong1, Huiming Wang1, Zengli Luo1, Meiting Xie1   

  1. 1. Reproduction Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
  • Received:2013-11-20 Revised:2013-12-30 Published:2014-04-01
  • Corresponding author: Wangming Xu
  • About author:
    (Corresponding author: Xu Wangming, Email: )
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周小燕, 徐望明, 董兰, 王慧明, 罗增丽, 解美婷. 阿托西班与利托君治疗早产临床疗效的系统评价[J/OL]. 中华妇幼临床医学杂志(电子版), 2014, 10(02): 170-176.

Xiaoyan Zhou, Wangming Xu, Lan Dong, Huiming Wang, Zengli Luo, Meiting Xie. Atosiban Versus Ritodrine in the Treatment of Preterm Labour: A Systematic Review[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2014, 10(02): 170-176.

目的

探讨阿托西班（atosiban）与利托君（ritodrine）治疗早产的临床疗效及安全性。

方法

根据系统评价原则，计算机全面检索相关文献数据库，收集国内外有关阿托西班和利托君治疗早产的随机对照试验（RCT），对符合本研究纳入标准的临床研究采用RevMan 5.1软件进行Meta分析。

结果

通过文献检索，共计4篇RCT文献符合本研究纳入标准，共计纳入420例患者。①3篇英文文献的方法学质量高，研究对象一致，均为早产患者，进行Meta分析的结果显示，阿托西班组与利托君组在治疗早产的有效率、延长分娩时间、增加新生儿出生体质量、降低新生儿窒息率及围生儿死亡率等方面比较，差异无统计学意义（P>0.05）；但孕妇心动过速发生率与因母体不良反应中断治疗率，阿托西班组较利托君组显著降低，且差异均有统计学意义[RR＝0.02, 95%CI（0.01~ 0.08），P<0.01；RR＝0.03, 95%CI （0.01~ 0.15），P<0.01]。②1篇中文文献的方法学质量较差，且研究对象为先兆早产患者，独立进行描述性分析结果显示，阿托西班与利托君治疗先兆早产在显效时间、延长妊娠时间、保胎成功率、足月分娩率、增加新生儿出生体质量与降低不良反应发生率方面比较，差异均无统计学意义（P>0.05）。

结论

阿托西班治疗早产的临床疗效与利托君相当，国内外研究中比较二者不良反应发生率的结果有所不同，尚不能断定阿托西班治疗早产的安全性明显优于利托君。尚需更多国内外高质量、大样本的RCT结合成本-效益分析，以更全面、客观、正确地评价阿托西班在治疗早产中的确切临床价值．

关键词: 评价研究, 早产, 阿托西班, 利托君, 系统评价
Objective

To explore the clinical efficacy and safety between atosiban and ritodrine in treatment of preterm labour.

Methods

The relevant data base were searched according to the principles of systematic review to collect all the randomized controlled trials(RCT) involving treatment of preterm labour using atosiban and ritodrine. According to treatment strategies, the subjects were divided into atosiban group and ritodrine group. Meta-analysis of including studies was performed by Rev Man 5.1 software.

Results

A total of 4 pieces RCT were included with 420 subjects．①Three of them were English literature, RCT with high quality included patients of preterm labour．The Meta-analysis showed there were no statistic differences in tocolytic efficacy, gestational age at delivery, birth weight of neonatal, rates of neonatal asphyxia or perinatal death between two groups (P>0.05) ．The incidence of maternal tachycardia and early drug termination due to adverse events in atosiban group were substantially lower than those in ritodrine group [RR=0.02, 95% CI(0.01-0.08) , P<0.01; RR=0.03, 95% CI(0.01-0.15) , P<0.01], respectively．②One Chinese study with relatively lower quality included patients of threatened preterm labour．A descriptive analysis conducted independently showed that there were no significant differences between two groups in time-to-effect, prolonged pregnancy duration, tocolysis rate, full-term delivery rate, birth weight or adverse events rate (P>0.05) .

Conclusions

Atosiban treatment of preterm labour was better than that of ritodrine. There had difference between domestic and abroad studies in term of incidence of adverse events. It is quite necessary to perform more high-quality and large-scale RCT in combination with cost-effectiveness evaluation to assess the exact clinic value of atosiban in treatment of preterm labour more reliably.

Key words: Evaluation studies, Premature birth, Atosiban, Ritodrine, Systematic review
表1 纳入研究的方法学质量评价比较
Table 1 Comparison of methodology quality evaluation on included studies
纳入研究 随机分组 分配隐藏 盲法 失访和退出 基线比较 ITT 质量等级
Moutquin等[5]，2000 清楚 充分 双盲 清楚 可比 有 A
Shim等[6]，2006 清楚 充分 单盲 清楚 可比 有 A
Lin等[7]，2009 清楚 否 非盲 清楚 可比 有 B
骆绮云等[8],2012 不清楚 否 非盲 清楚 可比 无 B
图1 治疗有效率的比较
Figure 1 Comparison of rates of tocolytic efficacy between atosiban group and ritodrine group
图2 平均分娩孕周的比较
Figure 2 Comparison of average gestational age at delivery between atosiban group and ritodrine group
图3 新生儿平均出生体质量的比较
Figure 3 Comparison of average neonatal birth weight between atosiban group and ritodrine group
图4 新生儿转NICU率的比较
Figure 4 Comparison of rates of neonatal NICU admission between atosiban group and ritodrine group
图5 孕妇心动过速发生率比较
Figure 5 Comparison of rates of maternal tachycardia between atosiban group and ritodrine group
图6 因不良反应中断治疗率比较
Figure 6 Comparison of rates of drug termination due to adverse events between atosiban group and ritodrine group
表2 利托君与阿托西班治疗先兆早产效果及安全性比较（±s）
Table 2 Comparison of efficacy and safety in treatment threatened premature labor between atosiban group and ritodrine group （±s）
组别 n 显效时间(min) 延长妊娠时间(d) 保胎成功率[n(%)] 足月分娩率[n(%)] 新生儿出生体质量(g) 不良反应发生率[n(%)]
利托君 40 42.6±8.2 25.9±9.5 37(92.5) 30(75.0) 2751±363.6 6(15.0)
阿托西班 30 40.8±7.1 27.1±6.3 28(93.3) 22(73.3) 2813±266.0 3(10.0)
χ2/t 　 0.964 0.601 0.000 0.025 1.250 0.066
P 　 >0.1 >0.25 1.000 0.875 >0.1 0.797
[1]
Mercer BM，Merlino AA．Magnesium sulfate for preterm labour and preterm birth[J]．Obstetric Gynecol，2009，114(3):650-658．
[2]
中华医学会妇产科学会产科学组．早产的临床诊断与治疗推荐指南(草案)[M]．中华妇产科杂志，2007, 42(7):498-500．
[3]
Ananth CV，Joseph KS，Oyelese Y，et al．Trends in preterm birth and perinatal mortality among singletons：United States，1989 through 2000[J]．Obstet Gynecol，2005，105(5Ptl):1084-1091．
[4]
边旭明，付晨薇．早产的定义分类和诊断[J]．现代妇产科进展，2011，20(3):164-165．
[5]
Moutquin JM，Sherman D，Cohen H，et al．Double blind，randomized，controlled trial of atosiban and ritodrine in the treatment of preterm labor：Amulticenter effectiveness and safety study[J]．Am J Obstet Gynecol，2000，182(5):1191-1199．
[6]
Shim JY，Park YW，Yoon BH，et al．Multicentre，parallel group，randomised，single-blind study of the safety and efficacy of atosiban versus ritodrine in the treatment of acute preterm labour in Korean women[J]．BJOG，2006，113(11):1228-1234．
[7]
Lin CH，Lin SY，Shyu MK，et al．Randomized trial of oxytocin antagonist atosiban versus beta-adrenergic agonists in the treatment of spontaneous preterm labor in Taiwanese Women[J]． J Formos Med Assoc，2009，108(6):493-501．
[8]
骆绮云，蒙顺好等．3种宫缩抑制剂治疗先兆早产的临床疗效分析[J]．现代医药卫生，2012，28(7):969-970．
[9]
Wex J，Connolly M，Rath W．Atosiban versus betamimetics in the treatment of preterm labour in Germany：An economic evaluation．BMC Pregnancy Childbirth，2009，9(1):23．
[10]
Wex J，Abou-Setta AM，Clerici G，et al．Atosiban versus betamimetics in the treatment of preterm labour in Italy：Clinical and economic importance of side-effects[J]．Eur J Obstet Gynecol Reproduc Bio，2011，157(2):128-135．
[11]
Rao AK，Cheng YW，Caughey AB．Perinatal complications among different Asian-American subgroups．Am J ObstetGynecol，2006，194:e39-41．
[12]
Rao AK，Daniels K，El-Sayed YY，et al．Perinatal outcomes among Asian American and Pacific Islander women [J]．Am J Obstet Gynecol，2006，195(7):834-838．
[13]
Patel RR，Steer P，Doyle P，et al．Does gestation vary by ethnic group? A London-based study of over 122，000 preg-nancies with spontaneous onset of labour[J]．Int J Epidemiol，2004，33(1):107-113．
[14]
Robertson PA，Sniderman SH，Laros RK Jr，et al．Neonatal morbidity according to gestational age and birth weight from five tertiary care centers in the United States，1983 through 1986[J]． Am J Obstet Gynecol，1992，166(15):1629-1645．
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