辅助生殖技术和子代先天性心脏缺陷率相关性队列研究的Meta分析  

Congenital heart defect in children conceived by IVF or ICSI:a systematic review and meta-analysis of cohort studies

作　　者：欧莹 华芮[1] 林妙玲 全松[1] OU Ying;HUA Rui;LIN Miao-ling;QUAN Song(Center of Human Assistant Reproduction Technology,Nanfang Hospital,Guangzhou 510515)

机构地区：[1]南方医科大学南方医院妇产科生殖医学中心,广州510515

出　　处：《生殖医学杂志》2018年第12期1175-1183,共9页Journal of Reproductive Medicine

基　　金：国家重点研发计划(2016YFC1000205);中华医学会临床医学科研专项资金-生殖医学青年医师研究与发展项目(16020170633)

摘　　要：目的评价辅助生殖技术(ART)对子代先天性心脏缺陷(CHD)发生的影响。方法计算机检索Cochrane Library、PubMed、EMbase、中国生物医学文献数据库、中国知网、维普和万方,检索时间从建库至2017年12月,并辅助其他检索方式。纳入开展卵胞浆内单精子注射(ICSI)和体外受精(IVF)助孕妊娠后子代CHD状况比较的队列研究,进行方法学的质量评估,使用RevMan 5.3进行Meta分析,并根据异质性进行敏感性分析和发表偏倚风险评估。结果共纳入13个高质量队列研究,出生儿共63 147例。Meta分析结果显示:(1)ICSI组和IVF组子代CHD发生率比较无显著性差异,OR=1.09[95%CI(0.93,1.27)](P>0.05)。(2)对新鲜移植周期进行亚组分析,ICSI组子代CHD发生率显著高于IVF组,OR=2.07[95%CI(1.28,3.37)](P<0.05)。(3)对房间隔缺损(ASD)、室间隔缺损(VSD)、法洛四联症(TOF)及动脉导管未闭(PDA)4种常见的CHD进行亚组分析,ICSI组与IVF组子代患病率比较无显著性差异(P>0.05)。结论 IVF和ICSI两种不同授精方式对子代CHD发生率的影响并不明显,对4种常见CHD发生的影响亦不明显;而新鲜周期中ICSI助孕子代CHD的发生率明显高于IVF助孕。但尚需更进一步的研究加以分析探讨。Objective ： To assess the effect of IVF and ICSI on congenital heart defects （CHD） in progeny by a meta-analysis of cohort studies.Methods ： All the cohort studies published related to congenital heart defects （CHD） in progeny conceived by IVF or ICSI were searched from Cochrane Library,PubMed,Embase,CBM,CNKI,VIP and Wanfang from building database to December 2017.The CHD status of offspring conceived by IVF or ICSI was compared.Methodological quality was assessed.RevMan 5.3 was used for meta-analysis and sensitivity analysis and publication bias risk assessment based on heterogeneity.Results ： A total of 13 high quality cohort studies were included,involving 63 147 children conceived by IVF or ICSI.The results of meta-analysis showed that there was no significant difference in the incidence of CHD between ICSI group and IVF group, OR =1.09 [95% CI （0.93,1.27）] （ P 〉0.05）.Subgroup analysis of the fresh transplantation cycle,the incidence of CHD in the ICSI group was significantly higher than that in the IVF group, OR =2.07 [95% CI （1.28,3.37）] （ P 〈0.05）.The results of subgroup analysis of four common CHDs showed that there was no significant difference in the incidence of atrial septal defect （ASD）,ventricular septal defect （VSD）,tetralogy of fallot （TOF）,and patent ductus arteriosus （PDA） in progeny between ICSI and IVF group （ P 〉0.05） .Conclusions ： The effects of IVF and ICSI treatment on the incidence of CHD in offspring are not obvious,and the effects on the incidence of 4 common CHDs are also not obvious.In the fresh cycle,the incidence of CHD in the progeny of ICSI is significantly higher than that in IVF.However,further research is needed to analyze and explore.

关 键 词：卵胞浆内单精子注射 体外受精 先天性心脏缺陷 队列研究 META分析 

分 类 号：R714.8[医药卫生—妇产科学]