附睾或睾丸精子对梗阻性无精子症ICSI治疗结局影响的系统评价  

ICSI with testicular or epididymal sperm for patients with obstructive azoospermia:A systematic review

作　　者：詹绪新[1] 万长春[2] 李海波[3] 苟江[1] 蔡鸿财 赵静[1] 闫春芳[1] 刁振宇[5] 商学军[6] 

机构地区：[1]西安市第四医院生殖医学科,陕西西安710004 [2]金湖县人民医院检验中心,江苏金湖211600 [3]南通市妇幼保健院检验科,江苏南通226006 [4]华中科技大学同济医学院计划生育研究所/生殖医学中心,湖北武汉430030 [5]南京大学医学院附属鼓楼医院生殖中心,江苏南京210008 [6]南方医科大学金陵医院/南京军区南京总医院男科,江苏南京210002

出　　处：《中华男科学杂志》2016年第12期1122-1130,共9页National Journal of Andrology

摘　　要：目的:系统评价梗阻性无精子症患者选择附睾精子或睾丸精子行ICSI治疗对其临床结局的影响。方法:通过计算机检索Pub Med、Medline、EMBASE、Cochrane图书馆和CNKI、VIP、CBM、万方数据库建库至2015年12月有关梗阻性无精子症患者采用附睾精子或睾丸精子行ICSI治疗的文献,由2位研究者按照纳入与排除标准进行文献筛选、资料提取和质量评价,并采用Rev Man5.3软件进行meta分析。结果:共纳入14项试验研究,包括梗阻性无精子症患者1 278例,共计1 552个周期。Meta分析结果显示:梗阻性无精子症患者行ICSI治疗,附睾精子比睾丸精子具有更好的受精率[RR=1.08,95%CI(1.05,1.11),P<0.01];附睾精子和睾丸精子的卵裂率[RR=1.04,95%CI(0.99,1.10),P=0.13]、优质胚胎率[RR=1.01,95%CI(0.93,1.09),P=0.85]、种植率[RR=1.14,95%CI(0.75,1.73),P=0.55]、临床妊娠率[RR=1.14,95%CI(0.98,1.31),P=0.08]以及流产率[RR=0.86,95%CI(0.53,1.39),P=0.54]差异均无统计学意义。结论:梗阻性无精子症患者行ICSI治疗,附睾精子显示出更高的受精率,而在卵裂率、优质胚胎率、种植率、临床妊娠率以及流产率方面,两者临床结局差异不大。Objective ： To assess the effects of testicular sperm and epididymal sperm on the outcomes of ICSI for patients with obstructive azoospermia. Methods： We searched PubMed, MEDLINE, EMBASE, Coehrane, CNKI, VIP, CBM, and Wanfang Database up to December 2015 for published literature relevant to ICSI with testicular or epididymal sperm for obstructive azoospermia pa- tients. According to the inclusion and exclusion criteria, two reviewers independently conducted literature screening, data extraction and quality assessment of the included trials, followed by meta-analysis with the RevMan 5.3 software. Results ： A total of 14 studies were identified, involving 1 278 patients and 1 553 ICSI cycles. ICSI with epididymal sperm exhibited a significantly higher fertilization rate than that with testieular sperm （RR = 1.08, 95% CI 1.05 -1.11, P 〈 0.01 ）. No statistically significant differences were observed between the epididymal and testicular sperm groups in the rates of cleavage （ RR = 1.04, 95% CI 0.99 - 1.10, P = 0.13）, good-quality embryo （RR = 1.01, 95% CI0.93-1.09,P = 0.85）, implantation （RR=1.14, 95% CI0.75-1.73, P = 0.55）, clinical pregnancy （RR = 1.14, 95% CI 0.98 - 1.31, P = 0.08）, and miscarriage （RR = 0.86, 95% CI 0.53 - 1.39, P = 0.54）. Conclusion ： ICSI with epididymal sperm yields a markedly higher fertilization rate than that with testicular sperm, but has no statistically significant differences from the latter in the rates of cleavage, good-quality embryo, implantation, clinical pregnan- cy, and miscarriage in the treatment of obstructive azoospermia.

关 键 词：梗阻性无精子症 附睾精子 睾丸精子 卵细胞胞质内单精子显微注射 meta分析 

分 类 号：R698.2[医药卫生—泌尿科学]