SCSA法检测精子DNA碎片指数与辅助生育结局关系的meta分析

A meta-analysis of association between sperm DNA fragmentation index determined by the sperm chromatin structure assay and clinical outcomes after assisted reproduction

目的:探究精子染色质结构分析法(SCSA)检测精子DNA碎片指数(DFI)与体外受精(IVF)、卵胞浆内单精子注射(ICSI)妊娠结局的关系。方法:计算机检索Pubmed、Cochrane library、EMBASE、Springer Link、CNKI、万方和维普等数据库,收集使用SCSA法检测DFI(DFI阈值27%或30%)与IVF、ICSI妊娠结局关系的文献,由两位检索人员根据纳入、排除标准独立筛选文献,提取数据后采用Stata 12.0软件进行meta分析。妊娠结局包括生化妊娠(BP)、临床妊娠(CP)、流产(PL)。相对危险度(RR)和95%可信区间(95%CI)用于评估DFI与妊娠结局的关系。结果:meta分析中纳入9篇有效文献(共2008个周期)。meta分析结果显示,DFI升高显著增加ICSI组生化妊娠率(RR=1.24,95%CI 1.00~1.52)、流产率(RR=2.21,95%CI 1.29~3.78),而与临床妊娠率无显著相关;DFI升高与IVF组的生化妊娠率、临床妊娠率、流产率均无显著相关。结论:SCSA法检测DFI对ICSI的妊娠结局有预测价值,而对IVF的妊娠结局无预测作用,仍需要纳入更多的大样本优质研究以进一步验证。

Objective：To explore the association between sperm DNA fragmentation index（DFI）determined by the sperm chromatin structure assay（SCSA）and pregnancy outcome after in vitro fertilization（IVF）or intracytoplasmic sperm injection（ICSI）.Method：Databases,such as Cochrane Library,EMbase,Springer Link,CNKI,Wanfang,and VIP were searched.The related literatures about the association between sperm DNA DFI（threshold of DFI was 27%or 30%）determined by SCSA and pregnancy outcome after IVF or ICSI were collected.The eligible literatures were selected by two researchers independently according to include and exclude standards,and related information was extracted from the eligible literatures by this two researchers independently,and a meta-analysis was conducted using STATA 12.0software.Pregnancy outcomes included biochemical pregnancy（BP）,clinical pregnancy（CP）and pregnancy loss（PL）.The relationship between DFI and pregnancy outcome was evaluated used Relative Risk（RR）and95% confidence intervals（95% CI）.Results：9cohort studies（2008couples）were included for meta-analysis,and the result showed that higher DFI could significant increase the rate of BP and PL of women after ICSI（pooled RR（95%CI）1.24（1.00-1.52）,2.21（1.29-3.78）,respectively）.However,higher DFI had no relationship to rate of CP of women after ICSI.And higher DFI had no any relationship to rate of BP,CP and PL of women after IVF.Conclusion：DFI detected by SCSA has value for predicting pregnancy outcome after ICSI,but had no value for pregnancy outcome after IVF.Further better designed clinical study with larger sample should be added to the meta-analysis for get more reliable conclusions.