中医药干预体外受精-胚胎移植妊娠结局的系统评价

A Systematic Review of Chinese Medicine Intervention in Vitro Fertilization-embryo Transfer Pregnancy Outcome

目的:对中医药干预体外受精-胚胎移植(In vitro fertilization-embryo transfer,IVF-ET)妊娠结局的有效性和安全性进行系统评价。方法:计算机检索中、英文6个数据库(包括CNKI、万方、维普、CBM、PubMed、Cochrane Library),检索范围自建库至2019年6月,选取IVF-ET长方案联合中医药治疗的随机对照试验(RCT),按照统一纳排标准进行文献筛选、资料提取及质量评价,并使用RevMan5.3进行meta分析。结果:共纳入28篇文献,共2775例不孕症患者。结果显示:治疗组在提高临床妊娠率(RR=1.52,95%CI:1.38~1.68)、受精率(RR=1.12,95%CI:1.06~1.19)、优胚率(RR=1.30,95%CI:1.17~1.44)、胚胎种植率(RR=1.47,95%CI:1.26~1.71),以及降低Gn使用量(SMD=-0.39,95%CI:-0.65~-0.12)、早期流产率(RR=0.43,95%CI:0.21~0.87)、OHSS发生率(RR=0.41,95%CI:0.28~0.59)、生化妊娠率(RR=1.35,95%CI:1.04~1.76)疗效优于对照组;与对照组相比,治疗组在降低周期取消率(RR=0.80,95%CI:0.45~1.42)、增加子宫内膜厚度(MD=0.07,95%CI:-0.31~0.45)方面无明显优势,目前临床治疗未发现明显不良反应。结论:中医药对IVF-ET长方案具有良好的干预效果,但由于纳入文献数量有限、质量较低,结论具有一定的局限性,未来需要多中心、大样本、科学严谨的临床研究及高质量文献进一步证实。

Objective:To systematically evaluate the effectiveness and safety of traditional Chinese medicine intervention in vitro fertilization-embryo transfer(IVF-ET)pregnancy outcome.Methods:A computer search of 6 Chinese and English databases(including CNKI,Wanfang,Weipu,CBM,PubMed,Cochrane Library),the search scope was self-built until June 2019,and randomized IVF-ET long regimen combined with Chinese medicine treatment Controlled Trial(RCT),according to the unified acceptance criteria for literature screening,data extraction and quality evaluation,and using RevMan5.3 for meta-analysis.Results:A total of 28 articles were included,including 2775 patients with infertility.The results showed that the treatment group was improving the clinical pregnancy rate(RR=1.52,95%CI:1.38-1.68),fertilization rate(RR=1.12,95%CI:1.06-1.19),excellent embryo rate(RR=1.30,95%CI:1.17-1.44),embryo implantation rate(RR=1.47,95%CI:1.26-1.71),and reduced Gn usage(SMD=-0.39,95%CI:-0.65--0.12),early abortion rate(RR=0.43,95%CI:0.21-0.87),incidence of OHSS(RR=0.41,95%CI:0.28-0.59),biochemical pregnancy rate(RR=1.35,95%CI:1.04-1.76)The curative effect is better than the control Group:Compared with the control group,the treatment group did not obviously reduce the cycle cancellation rate(RR=0.80,95%CI:0.45-1.42)and increase the endometrial thickness(MD=0.07,95%CI:-0.31-0.45).No obvious adverse reactions have been found in current clinical treatment.Conclusion:Traditional Chinese medicine has a good intervention effect on the long-term IVF-ET program.However,due to the limited amount of included literature and low quality,the conclusion has certain limitations.In the future,multi-center,large sample,scientifically rigorous clinical research and high quality are needed.The literature further confirms.