体质量指数对不孕症患者助孕治疗效果的系统性评价

Evaluation of Clinical Outcomes by BMI in Infertile Patients with Assisted Reproduction Treatment:A Meta Analysis

目的：系统评价女性不孕患者的不同体质量指数（BMI）与体外受精-胚胎移植/胞浆内单精子注射（IVF-ET/ICSI）结局的关系,指导临床采取更合理的治疗。方法：计算机检索2000年1月—2014年6月中国生物医学文献数据库（CBM）、万方数据库、中国学术期刊网专题全文数据库（CNKI）、维普数据库、Pub Med、外文生物医学期刊文献数据库（FMJS）中不同BMI（BMI≤25 kg/m^2,BMI〉25 kg/m^2）对不孕症患者IVF-ET/ICSI助孕治疗效果的随机对照试验（RCT）、临床对照试验（CCT）。质量评估后采用Rev Man 5.0软件进行Meta分析。结果：最终纳入6个研究,共2 297个周期。Meta分析结果显示：对不孕症患者,BMI偏高组的临床妊娠率（OR=0.72,95%CI：0.58-0.90,P=0.004）、出生率（OR=0.65,95%CI：0.47-0.91,P=0.01）均低于对照组,且差异有统计学意义;流产率高于对照组（OR=1.70,95%CI：1.23-2.35,P=0.001）,差异有统计学意义;异位妊娠率（OR=1.51,95%CI：0.71-3.22,P=0.28）和周期取消率（OR=1.06,95%CI：0.70-1.62,P=0.77）差异无统计学意义。结论：对进入ART治疗周期之前的BMI升高患者,应鼓励其减轻体质量来改善妊娠结局。

Objective： To evaluate the clinical outcomes by BMI in infertile patients with assisted reproductive treatment, so as to guide the reasonable clinical treatment. Methods： We searched CBM,Wanfang,CNKI,VIP,Pub Med and FMJS. Those randomized controlled trails（RCTs） or clinical controlled trails（CCT） were identified,which focused on the comparison of clinical outcomes in infertile patients with IVF-ET/ICSI treatment by BMI（between BMI〉25 kg/m^2 and BMI≤25 kg/m^2）. The duration of search was from January 2000 to June2014. The extracted data were analyzed by Rev Man 5.0. Results： Six literatures with 2 297 cycles were selected for Meta analysis. Meta analysis showed that the pregnancy rate [OR=0.72,95%CI（0.58,0.90）,P=0.004],birth rate [OR=0.65,95%CI（0.47,0.91）,P=0.01] in the high BMI group（BMI〉25 kg/m^2） were significantly lower than those in the low BMI group（BMI≤25 kg/m^2）;and the abortion rate [OR=1.70,95%CI（1.23,2.35）,P=0.001]was significantly higher than that in the low BMI group（BMI≤25 kg/m2）. There were not significant differences in the incidence of ectopic pregnancy [OR=1.51,95%CI（0.71,3.22）,P=0.28] and the cycle cancellation rate[OR=1.06,95%CI（0.70,1.62）,P=0.77] between two groups. Conclusions： It is necessary to ask those infertile women with high BMI to control body weight,and to lower BMI before their ART treatment,so as to improve their clinical outcomes of ART treatment.