Meta分析精子DNA完整性对辅助生殖结局的预测价值  

Meta-analysis of predictive value of sperm DNA integrity on assisted reproductive outcome

作　　者：谭艳 范立青[2] 

机构地区：[1]湖南省株洲市妇幼保健院生殖科,株洲412000 [2]中南大学生殖与干细胞工程研究所,长沙410078

出　　处：《生殖医学杂志》2017年第1期39-47,共9页Journal of Reproductive Medicine

摘　　要：目的系统评价精子DNA完整性对于宫腔内人工授精(IUI)、体外受精-胚胎移植(IVF-ET)以及卵胞浆内单精子注射(ICSI)等不同助孕方式妊娠结局的预测价值。方法采用电子检索和手工检索相结合的方式进行文献初检,检索Medline(via.OvidSP)、PubMed、Embase、CNKI、VIP等数据库,检索时限为建库至2016年3月,并手工检索相关会议资料。由2名评价者依据纳入与排除标准独立筛选研究文献、提取数据资料和评价方法学质量,然后采用RevMan 5.3软件进行Meta分析。结果最终纳入27篇队列研究,合计7 302个周期。Meta分析结果显示:DNA碎片指数(DFI)的增加会降低IUI临床妊娠率(RR=0.22,95%CI:0.12-0.41)、IVF受精率(RR=0.90,95%CI:0.86-0.95)、IVF优质胚胎率(RR=0.86,95%CI:0.82-0.91)、IVF临床妊娠率(RR=0.86,95%CI:0.76-0.98),并增加IVF流产率(RR=1.65,95%CI:1.05-2.57)和ICSI流产率(RR=1.57,95%CI:1.03-2.39)(P均<0.05);且DFI的检测方法中只有TUNEL法能预测IVF的临床妊娠率(RR=0.74,95%CI:0.55-0.99,P<0.05),DFI对ICSI受精率、优质胚胎率、临床妊娠率的影响无统计学意义(P>0.05)。结论 DFI水平高低对辅助生殖治疗的结局有一定的预测价值,DFI较高时选择ICSI的治疗方式可能更优于常规的IVF。但因纳入研究数量和质量的限制,上述结论还需开展更大规模流行病学研究和临床研究进一步验证。Objective. To evaluate systematically the predictive value of sperm DNA integrity on the outcome of intrauterine insemination （IUI）, IVF-ET and ICSI. Methods： The literatures were searched electronically and manually from the databases in both English and Chinese including Medline, Pub Med, Embase, CNKI, VIP and conference information till March 2016. The data were selected and extracted according to inclusion and exclusion criteria, and the quality of research methodology was evaluated by two independent reviewers. Then RevMan 5.3 software was used for Meta analysis. Results. Thirty study including 10 124 cycles were included. Meta analysis showed that elevation of DNA fragmentation index （DFI） reduced clinical pregnancy rate of IUI [RR = O. 22, 95% CI （0. 12, 0.41）], IVF-ET fertilization rate [-RR=0.90, 95%CI （0.86, 0.95）], high-quality embryo rate of IVF- ET [RR=0.86, 95%CI （0.82, 0.91）], clinical pregnancy rate of IVF-ET [RR=0. 86, 95%CI （0.76,0.98）] （all P〈0.05）. Elevation of DFI increased the abortion rates of IVF-ET ERR= 1.65,95 %CI（1.05, 2.57）] andICSI [RR=1.57,95%CI（1.03, 2.39）]（all P〈0.05）. Only the TUNEL method was able to predict the clinical pregnancy rate of IVF [RR=O. 74, 95%CI （0.55, 0.99）, P〈0.05]. There was no significant effect of DFI on fertilization rate, high-quality embryo rate, clinical pregnancy rate in ICSI （P〉 O. 05）. Conclusions： Existing evidence suggests that sperm DNA integrity can predict the outcome of the assisted reproduction. When DFI is higher, the outcome of ICSI treatment is better than that of IVF treatment. However, due to the limitations of the number and quality of studies included, the conclusions need to carry out larger epidemiological studies and clinical studies to further validate.

关 键 词：精子 DNA完整性 辅助生殖技术 META分析 

分 类 号：R[医药卫生]