囊胚活检中透明带开孔时机对临床结局影响的系统评价  

Systematic evaluation of the effect of timing of zona pellucida opening in blastocyst biopsy on clinical outcomes

作　　者：桑元坤 张丽媛 王琰[1] 谢广妹[1] 史莉 柴三明[1] Sang Yuankun;Zhang Liyuan;Wang Yan;Xie Guangmei;Shi Li;Chai Sanming(Reproductive Medical Center,Gansu Provincial Maternity and Childcare Hospital/Gansu Provincial Central Hospital,Lanzhou 730070,China)

机构地区：[1]甘肃省妇幼保健院、甘肃省中心医院生殖医学中心,兰州730070

出　　处：《中华生殖与避孕杂志》2024年第5期488-492,共5页Chinese Journal of Reproduction and Contraception

基　　金：甘肃省自然科学基金(21JR1RA047);兰州市科技计划项目(2023-4-67)。

摘　　要：目的系统比较滋养外胚层活检技术中同步透明带开孔与提前开孔的临床效果,为建立标准囊胚活检程序提供循证医学证据。方法计算机检索PubMed、Cochrane Library、Embase、Web of Science、中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊数据库和万方数据库,检索时限均为建库至2023年8月。检索两种透明带开孔时机应用效果比较的研究文献,主要评价指标为临床妊娠率和活产率,次要评价指标包括活检成功率、整倍体囊胚率和流产率。采用R4.2.2软件meta程序包进行meta分析。结果共纳入6篇原始研究,包括12223枚活检胚胎,2374个移植周期。meta分析结果显示,同步开孔组的临床妊娠率(RR=1.22,95%CI:1.14~1.30,P<0.01)和活产率(RR=1.22,95%CI:1.12~1.32,P<0.01)均高于提前开孔组。两组间的活检成功率(RR=1.38,95%CI:0.30~6.25,P=0.68)、整倍体囊胚率(RR=0.98,95%CI:0.83~1.15,P=0.81)和流产率(RR=1.06,95%CI:0.77~1.47,P=0.73)差异均无统计学意义。结论同步透明带开孔囊胚活检方案在临床妊娠率和活产率方面优于提前开孔,受纳入研究样本量及质量的限制,透明带开孔时机对临床效果的影响还需更多高质量的研究。Objective To systematically compare the clinical effects of simultaneous zona pellucida opening and prehatching in ectodermal biopsy techniques and to provide evidence-based medical evidence for the establishment of standard blastocyst biopsy procedure.Methods We systematically searched PubMed,Cochrane Library,Embase,Web of Science,CBM,CNKI,VIP and Wanfang Data published until August 2023.We searched the literatures for studies that compared the effects of two zona pellucida opening.Primary evaluation measures included clinical pregnancy rate and live birth rate,and secondary evaluation indicators included biopsy success rate,euploid blastocyst rate,and miscarriage rate.Meta-analysis was performed using the R4.2.2 software meta package.Results Six studies,including 12223 biopsy embryos and 2374 transfer cycles were subjected to analysis.The results of meta-analysis showed that the clinical pregnancy rate(RR=1.22,95%CI:1.14-1.30,P<0.01)and the live birth rate(RR=1.22,95%CI:1.12-1.32,P<0.01)in the simultaneous zona pellucida opening group were significantly higher than those in the prehatching group,and there were no significant differences between the two groups in biopsy success rate(RR=1.38,95%CI:0.30-6.25,P=0.68),euploid blastocyst rate(RR=0.98,95%CI:0.83-1.15,P=0.81)and miscarriage rate(RR=1.06,95%CI:0.77-1.47,P=0.73).Conclusion Stimultaneous zona pellucida opening blastocyst biopsy protocol is better than prehatching in terms of clinical pregnancy rate and live birth rate.Due to the limitation of sample size and quality of included studies,more high-quality studies are needed on the effect of zona pellucida opening timing on clinical outcomes.

关 键 词：META分析 透明带开孔时机 囊胚活检 

分 类 号：R714[医药卫生—妇产科学]