Meta-analysis Of GyneFix IN IUD On The Clinical Effect And Adverse Reaction

Recently, the procreation health has become a hot topic in the international activities about population and development,woman problem and hygiene field,etc. The government has already defined the guideline which is mainly relying on prolonged action contraceptive. Nowadays,the widely used contraceptive device on clinic is medicine contraception,tool contraception and natural contraception. The contraception of the intrauterine device is a kind of tool contraception which is effective,safe,convenient, economical and reversible. With the development of IUD,after the first generation–metal ring IUD,the second generation-copper-IUD and the third generation of IUD has already developed into practice which is frameless copper IUD-GyneFix IUD. GyneFix IUD has abandoned the frame structure of the traditional intrauterine device. It is smart and unbending,so it can effectively reduce the incidence of side reaction,such as haemorrhage and pains caused by endometrium injury. At the bottom of uterus,releasing a large amount of copper ion could increase the impact of contraception and decrease the incidence of pregnancy with IUD in situs. The drug of antiphlogistic,styptic,incretion and so on have been released in the,which can cure inflammation ,haemorrhage etc of uterus.GyneFix has three series of products :One of them is GyneFix IN,used in intermenstrium and after induced abortion and also for emergency contraception,especially suitable for the contraception losers who have used traditional intrauterine device ever,for instance: repeating amotio,pregnancy with IUD in situs,taking out for indisposition;The second is GyneFix Rou Shi;The third is GyneFix Zhi Mei. More and more results of study show that GyneFix IN intrauterine device (GyneFix IN IUD ) has better clinical results and smaller side effect,but it still lacks the evidence of evidence-based medicine. The alleged evidence-based medicine is the clinical medicine followed evidence,which utilizes the best evidence at present to constitute the scheme of diagnosis and treatment on the individual patient consciously,definitely and prudently.By effectively indexing,adopting appropriate literatures and then appraising them,I utilized meta-analysis method-the core research approach of evidence-based medicine,estimating strictly,also analysis clinical effect and side effect of the GyneFix IN IUD qualitatively and quantificationally providing medical evidence for evidence-based medicine.Then through the rigorous estimation,to analyse the result of the test of the clinical effect and the side effect of the GyneFix IN intrauterine device synthetically,and offer the evidence of evidence-based medicine to clinical practice of GyneFix IN IUD. Through the computer,I have indexed relevant literatures published in MEDLINE,PUBMED,Cochrane Controlled Trials Register,China National Knowledge Infrastructure and so on,from 1998 to 2004,and used the keywords Meta-analysis,GyneFix IUD,clinical results and side effect;indexed relevant technical magazines and the proceedings of academic meeting by hand;tracing and indexing literatures by calling writers and consulting reference literatures of papers and reviews,149 papers have been obtained.Then according to including and excluding standards,there are 18 papers about randomized controlled trail of GyneFix IN IUD involved in this study. On the basis of Jadad scale,two papers are 3 points(high-quailty study) and 16 ones are 1-2 points(low-quailty study). Utilizing Meta-analysis software package RevManManage4.2 Which the Cochrane Collaboration provide to compute statistically. The targets type of this study is two sort variable,so OR is selected as pooled variable. Homogeneity test of 23 targets have been carried on by fixed effects model (Peto method). Homogeneity of targets have been carried on by fixed effects model (Peto method) combining variables,and heterogeneity of targets havebeen carried on by random effects model (Dersimonian-Laird method) combining variables. Through forest plot, the test of combining impact variables have been made; through fixed effects model (Peto method) and random effects model (Dersimonian-Laird method) and amount of effect varied (OR and RR ) ,the sensitiveness analysis have been made;through estimating funnel plot ,the publication bias analysis have been made .The result shows that only menstrual volume and menstrual period changes,secretion changes and haemorrhage of 3 months followed-up, and lumbago abdominal pain of 12 months followed up, five targets together, have heterogeneity,other targets have homogeneity,which prove slight diversities of literatures and relative credibility of conclusions. There are a certain of discrepancies on combined OR,RR and their 95% confidence interval of 3 months menstrual volume and menstrual period,although others have few differences,which proves the analysis result is relatively steady,and the conclusion is reliable basically.The funnel plot of most literatures are asymmetric in various degree,which explain that there is publication bias in various degree.When literatures have heterogeneity and the results of sensitivity analysis present unstable,definite conclusions cannot be made; whereas definite conclusions can be obtained.This data was statistically computed, and the result shows,comparing with other type IUDs,GyneFix IN IUD can reduce: the incidence of change in menstruation,the change of secretion,lumbar and abdominal pain and haemorrhage among the women whose follow-up period is 1 month;the incidence of lumbar and abdominal pain among the women whose follow-up period is 3 months;the incidence of change in menstruation,the change of secretion,lumbar and abdominal pain and haemorrhage among the women whose follow-up periods is 6 months;the incidence of pregnancy with IUD in situs,amotio,taking out for indisposition,the change in menstrual volume,the change in menstrual period,the change of secretion,lumbar and abdominal pain and haemorrhage among the womenwhose follow-up period is 12 months.Above all,GyneFix IN IUD superior to others(the incidence of most side effects and bad results occures little),particularly,obviously lower trend emerges when individuals bring IUD more than 12 months. Potential publication bias and low quality of trail reduced the authenticity of the data offered by meta-analysis in various degrees,which makes the existing evidence unable to fully prove that the GyneFix IN IUD is superior to others. So it is necessary to use research approach of clinical epidemiology to carry on the extensive clinical trail,especially to improve the quality of trail,and then offer the sufficient evidence for clinical practice of the GyneFix IUD.