反复种植失败与辅助孵化的系统评价  

Repeated implantation Ffailure and assisted hatching:a systematic review

作　　者：祁静[1] 王致辉[1] 宁冰雪[1] 范莹露 张萌[1] 腊晓琳[1] 巩晓芸[1] QI Jing;WANG Zhihui;NING Bingxue;FAN Yinglu;ZHANG Meng;LA Xiaoling;GONG Xiaoyun(Department of Reproductive Fertility,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院生殖医学中心,乌鲁木齐830054

出　　处：《新疆医科大学学报》2020年第5期587-592,596,共7页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区自然科学基金(2017D01C284)。

摘　　要：目的系统评价辅助孵化(AH)对反复种植失败(RIF)患者再次助孕治疗的临床妊娠结局的影响。方法计算机检索Medline、Cochrane图书馆、中国期刊全文数据库、中国生物医学文献数据库等中外期刊数据库,检索时限至2019年7月。纳入在RIF患者应用AH的随机对照试验,由两名评价员独立提取资料,并对其方法学质量进行评价。对符合纳入标准的研究用Rev Man 5.3软件进行Meta分析。结果共检索到符合纳入标准随机对照的文献10篇,共有研究对象2256例,其中AH组1106例,对照组1150例。Meta分析结果显示:与对照组对比,AH组的临床妊娠率[OR=0.13,95%CI(0.06,0.20),P=0.0002]、每胚胎的种植率[OR=2.13,95%CI(1.33,3.41),P=0.002]、活产率[OR=2.16,95%CI(1.40,3.35),P=0.0005]较高;但对于多胎妊娠率的比较,对照组的多胎妊娠率相对较低[OR=1.56,95%CI(1.06,2.31),P=0.02];流产率比较两组无统计学差异[OR=1.26,95%CI(0.84,1.91),P=0.27]。结论AH可以改善RIF患者再次助孕治疗的某些临床结局,如提高妊娠率、每胚胎种植率和活产率。AH不会增加流产率,但有增加多胎妊娠率的风险。此外,由于本研究的局限性,该结论尚需高质量、大样本的随机对照试验进一步证实。Objective To assess the effect of assisted reproductive technology with assisted hatching(AH)in treatment of patients with repeated implantation failure(RIF).Methods All randomized controlled trials(RCTs)about AH in the treatment of patients with RIF were retrieved from databases including Cochrane Library,MEDLINE,CNKI,VIP and Wanfang databases updating to Jul,2019.Information was collected by two evaluaters independently.The quality of included RCTs was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions,and the Cochrane Collaboration's software Rev Man 5.3 was used for meta-analysis.Results There were 10 RCTs(2,256 participants)included.Compare with the control group,the clinical pregnancy rate(OR=0.13,95%CI 0.06 to 0.20,P=0.0002),the implantation rate(OR=2.13,95%CI 1.33 to 3.41,P=0.002)and the live birth rate(OR=2.16,95%CI 1.40 to 3.35,P=0.0005)were increased in the AH group.Compare with the control group,the multiple pregnancy rate in the AH group was higher(OR=1.56,95%CI 1.06 to 2.31,P=0.02).The differences of the miscarriage rate between the two groups had no statically significance(OR=1.26,95%CI 0.84 to 1.91,P=0.27).Conclusion Current evidence showed that AH was related to improve the clinical pregnancy,the implantation and live birth rates in women with previous repeated implantation failure.AH was unlikely to increase the miscarriage rate,but it may increased the multiple pregnancy rate.However,considering the limitation of the methodological quality and sample size of the included studies,more high-quality,large-scale RCTs are still needed to confirm this conclusion.

关 键 词：辅助孵化 反复种植失败 系统评价 

分 类 号：R711.6[医药卫生—妇产科学]