主动免疫治疗不明原因反复自然流产疗效的循证医学评价

Evideme-based medicime assessment abaut the curative effects of active immunotherapy on recurrent spontaneous abortion

目的探讨主动免疫治疗不明原因反复自然流产的疗效,治疗方案的规范性,治疗机理,对子代的影响等。方法用Cochrane协作网系统评价方法,搜集1981年以来该领域突出的随机对照试验/临床对照试验及前瞻性队列研究论文,两个研究者独立进行文献质量评价及证据综合,Meta分析用Revman4.2.8软件。结果纳入10篇前瞻性队列研究论文及1篇回顾性队列研究论文,获991例研究主动免疫治疗反复自然流产的疗效,治疗组与对照组相比,治疗成功率(OR值6.72,95%可信区间2.65～17.02)及治疗后的妊娠成功率(OR值2.45,95%可信区间1.65～3.63)明显较高;治疗前后CD4/CD8比较,治疗后CD4/CD8比值下降(,加权均数差-0.49,95%可信区间为-0.56～-0.39);治疗方案的规范性评价及纳入的2篇主动免疫治疗复发性流产后子代随访结果的研究,作定性描述。结论主动免疫治疗不明原因反复自然流产的疗效确切,但治疗方案的规范性,治疗机理,对子代的影响等尚需进一步的研究。

[ Objective] To evaluate the curative effects of active immunotherapy on RSA （recurrent spontaneous abortion） ,the standardization of eurative program, the mechanism and the irdluenees on filial generation. [Method] To searched Medline, Embase, Coehrane Library, Chinese Biomed-database, correlative websites and nine Chinese medieal journals. The studies that were included in the reference list were additionally searehed. Only RCTs （randomized control trials）, CCT（clinical control trials） and prospective cohort studies were ineluded. Two researchers evaluated the quality of the literature and eombined the evidenee independently. Revman 4.2.8 was used for metaanalysis. [Result] Ten prospective eohort studies and one rela-ospeetive cohort study with 991 eases were included. The RSA group with active immunotherapy showed apparent curative ettects（OR6.72.95%CI2.65-17.02）, and had a higher successful pregnancy rate than the comparing group（OR2.45,95%CI1.65-3.63）. And after treating, the scale of CD4/CD8 of the RSA group has deereased（WMD-0.49,95%-0.56- -0.39）. [Conclusion] The active immunotherapy has remarkable eurative effeets on RSA, however, its standardization, mechanism and influences on filial generation still need more in-depth researeh.