机械刺激内膜应用于胚胎移植失败患者对妊娠结局影响的Meta分析

Meta analysis of effect of endometrial mechanical stimulation on reproductive outcome in patients with previously failed IVF cycle

目的探索子宫内膜的机械刺激是否可以改善胚胎移植失败患者的妊娠结局。方法采用计算机检索方法,收集中国科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)、中国生物医学期刊数据库(CMCC)、中国医学学术会议论文数据库(CMAC)、中国知网(CNKI)、万方数据库以及Cochrane Library、PubMed、ProQuest Medical Library、Medline等外文生物医学期刊文献数据库以及手工检索国内相关妇产科杂志中关于机械损伤刺激子宫内膜对胚胎移植失败患者妊娠结局影响的随机对照试验及前瞻性研究文献,提取相关数据资料,并对所纳入文献进行系统评价,使用Revman 5.2软件进行Meta分析。结果共纳入6个研究,纳入946例患者,其中内膜机械损伤刺激组(试验组)451例,未刺激组(对照组)495例。Meta分析结果显示,试验组较对照组临床妊娠率有显著性提高,且两组差异有统计学意义[RR=1.74,95%CI(1.16-2.60),P=0.007];试验组与对照组比较活产率有提高,且差异亦有统计学意义[RR=1.44,95%CI(1.19-1.75),P=0.0002];试验组与对照组相比,两组流产率无显著性差异[RR=0.82,95%CI(0.47-1.42),P=0.47]。结论子宫内膜的机械损伤刺激可以提高胚胎移植失败患者的临床妊娠率、活产率,但不增加流产率。

Objective： To assess the effect of endometrial mechanical stimulation on reproductive outcome in patients who had previous failed in IVF. Methods： The literatures about the effect of endometrial mechanical stimulation on reproductive outcome in patients who had previous failed in IVF in the randomized controlled trials and prospective studies were searched from VIP, CBM, CMCC, CMAC, C PubMed,ProQuest Medical Library, Medline database. Then by Meta analysis with Revman 5.2. NKI, Wanfang database, Cochrane Library, the literatures were systematically evaluated Results. There were six literatures including 946 patients,of which 451 patients in endometrial injury group （experiment group）and 495 patients in no injury group （control group）. Meta analysis showed that clinical pregnancy rate（RR=1. 74,95%CI（1.16,2. 60） ,P=0. 007）and live birth rate（RR= 1.44,95GCI（1.19,1.75） ,P =0. 0002）were significantly higher in endometrial injury group than those in control group. There was no significant difference in abortion rate between the groups （RR = 0.82,95 % CI（0. 47,1.42）, P= 0. 47）.Conclusions： The mechanical stimulation can improve clinical pregnancy rate,live birth rate,and does not increase abortion rate in patients who had previous failed in IVF.