静脉滴注免疫球蛋白提高复发性流产活产率的Meta分析

Improving the live birth rate of recurrent spontaneous abortion by intravenous drip of immunoglobulin:a Meta analysis

目的:评价静脉滴注免疫球蛋白(IVIG)在治疗复发性流产中提高活产率方面的有效性。方法:以"复发性流产;静脉滴注免疫球蛋白;活产率;随机对照试验"等为检索词,检索Cochrane图书馆(至2012年第1期)、MEDLIN(1980-2011)、EMBASE(1984-2011)、中国生物医学文献光盘数据库(1978-2011)、中文期刊全文数据库(1979-2011)、万方会议库、学术会议论文库、ISTP procedding中国和灰色文献网站等的文献,并手工检索相关文献,评价文献质量,采用RevMan 5.1.2进行数据分析,对于异质性小的研究合并效应量。结果 :纳入8个随机对照试验,共447个受试对象。IVIG与安慰剂相比,治疗复发性流产的总活产率(不考虑开始用药时间、流产类型)差异无统计学意义(P>0.05),在确定妊娠后开始用药、原发性及继发性复发性流产妊娠前开始用药等方面活产率比较无明显差异(P>0.05),而其在继发性复发性流产、继发性复发性流产(妊娠后开始用药)方面比较差异有统计学意义(P<0.05)。结论:Meta分析未发现IVIG治疗复发性流产的显著益处,IVIG治疗复发性流产证据尚不充分,疗效尚不确定,尤其对于原发性复发性流产,但在治疗继发性复发性流产方面,妊娠后开始用药或可提高活产率,需进一步探讨IVIG治疗复发性流产的作用机制,并需要更多高质量且针对IVIG治疗复发性流产适合人群、人种、用药时机、剂量的随机对照试验。

Objective： To evaluate the effectiveness of intravenous drip of immunoglobulin （WIG） in improving the live birth rate of recurrent spontaneous abortion （RSA） . Methods： Taking ＂ recurrent spontaneous abortion, intravenous drip of WIG, live birth rate, randomized case- control trial＂ as key words, a systematic search strategy was applied to Cochrane Central Register of Controlled Trials （to 2012）, Medline （ 1980 - 2011 ）, CBMdisc （ 1978 - 2011 ）, CJFD （ 1979 - 2011 ）, Wanfang database, ISTP, and gray literature websites, the related literatures were retrieved manually, the qualities of the literatures were evaluated, RevMan 5.1.2 software was used for data anal- ysis, the influencing quantities of studies with little heterogeneity were combined. Results： A total of 8 random case - control study （447 study objects） was included, there was no statistically significant difference in the total live birth rate （not considering the start time of treat- ment and the types of abortion） between IVIG and placebo （P 〉 0. 05 ） ; for the patients with primary RSA, there was no statistically signifi- cant difference in the total live birth rate between the patients treated after pregnancy and the patients treated after pregnancy （P 〉 0. 05）, for the patients with secondary RSA, there was statistically significant difference in the total live birth rate between the patients treated after preg- nancy and the patients treated after pregnancy （P 〈0. 05） . Conclusion： Meta analysis didnt find significant advantages of WIG in treat- ment of recurrent spontaneous abortion; the proof of WIG for treatment of recurrent spontaneous abortion is not sufficient, and the curative effect is indefinite, especially for primary recurrent spontaneous abortion, but in the aspect of treatment of recurrent spontaneous abortion, drug therapy after pregnancy may improve the live birth rate, the mechanism of IVIG in treatment of recurrent spontaneous abortion should be further researched, more random case - control trails with high quality are needed suitable for the population, ethnic group, opportunity of dru therapy, and dose taretin IVIG in treatment of recurrent snontaneous abortion.