辅助生殖技术中低氧浓度胚胎培养的meta分析  

A meta-analysis of low oxygen concentrations for embryo culture in assisted reproductive technology

作　　者：牛子儒[1] 岳晓静[1] 孔群钰[2] 王元芬[1] 侯彩英[3] 姚元庆[1] 

机构地区：[1]中国人民解放军总医院妇产科,北京100853 [2]复旦大学卫生统计学教研室 [3]中国人民解放军第二炮兵清河门诊部

出　　处：《中国计划生育学杂志》2013年第5期295-301,共7页Chinese Journal of Family Planning

基　　金：全军"十二五"重点项目(BWS11J508)

摘　　要：目的:用meta分析方法探讨低氧浓度胚胎培养对体外受精/卵胞浆内单精子注射临床结局的影响。方法:计算机检索PubMed、Ebase、Cochrane Database、中国知网(CNKI)、中国生物医学文献服务系统(CBM)、万方数据库,收集国内外有关低氧浓度胚胎培养的随机对照试验(RCTs)。对纳入的研究进行质量评价,采用RevMan5.1软件对种植率、妊娠率等进行meta分析。结果:排除不符合纳入标准、失访人数不明确、重复发表、文献质量过低的研究后,共纳入10项RCTs,累计调查对象5520例,其中低氧组2645例,常氧组2875例。meta分析显示:与常氧培养相比,低氧培养可提高着床率(OR=1.16,95%CI:1.05～1.29,P=0.01)、继续妊娠率(OR=1.32,95%CI:1.12～1.55,P<0.001)及临床妊娠率(OR=1.28,95%CI:1.07～1.53,P=0.008),且不增加多胎妊娠率(OR=1.19,95%CI:0.67～2.14,P=0.32)及流产率(OR=0.98,95%CI:0.63～1.53,P=0.93)。结论:低氧浓度胚胎培养可以一定程度地提高种植率及妊娠率,且不增加多胎及流产的风险,但更确切的效果仍需更多观察指标的大规模长期随机对照研究加以确认。Objective ： To determine whether embryo culture at low oxygen concentrations could improve clinical outcome in as-sisted reproductive technology. Methods ： Prospective, randomised, controlled studies of application of low oxygen concentra-tions in embryo culture were searched and screened in PubMed, Ebase, Cochrane Library, China National Knowledge Intemet （CNKI）, Chinese Biological Medicine Disk（CBM） and Database of Wanfang. After quality assessment and data extraction, a meta analysis was conducted in implantation rates and pregnancy rates by Revman5.1 software. Results： After exclusion and selection, ten studies with a total of 5520 cases （2645 with low oxygen and 2875 with ambient oxygen） were included in the a-nalysis. Evidence of a beneficial effect of culturing in low oxygen concentration was found for higher implantation rate （ OR： 1. 16, 95% CI：1. 05 - 1.29, P =0.01 ） , ongoing pregnancy rate （ OR：1. 32, 95% CI：1. 12 - 1.55, P 〈0. 001 ） and clinical pregnancy rate （ OR： 1.28, 95 % CI： 1.07 - 1.53, P = 0. 008 ）. There were no evidence that culturing embryos under low oxy-gen concentrations resulted in higher numbers of adverse events such as multiple pregnancies （OR：1. 19, 95% CI： 0. 67 - 2. 14, P = 0.32） or miscarriages （ OR ：0. 98, 95 % CI：0. 63 - 1.53, P = 0.93 ）. Conclusion ： The results of this meta-analy-sis suggest that culturing embryos under conditions with low oxygen concentrations could improve the success rate of assisted reproductive technology, resulting in high pregnancy rate without increasing the risk of adverse events. Further reseaeches and more systematic reviews are needed.

关 键 词：胚胎培养 氧浓度 体外受精 卵胞浆内单精子注射 META分析 

分 类 号：R714.8[医药卫生—妇产科学]