无宫腔受压子宫肌瘤对辅助生殖结局影响的Meta分析

Impact of Non-cavity-distorting Fibroids on Assisted Reproductive Outcomes:A Meta-analysis

目的系统评价无宫腔受压子宫肌瘤对辅助生殖结局的影响。方法系统检索PubMed、Embase、Cochrane Library、Web of Science和Ovid数据库的观察性研究,检索时间从建库至2019年11月31日,比较无宫腔受压子宫肌瘤患者(肌瘤组)和无肌瘤患者(无肌瘤组)的辅助生殖结局,采用RevMan 5.3软件进行Meta分析。结果共纳入29项研究,包括10591例患者,其中肌瘤组3419例,无肌瘤组7172例。Meta分析结果显示,与无肌瘤组相比,肌瘤组活产率、临床妊娠率、胚胎植入率降低(RR=0.73,95%CI 0.67~0.80;RR=0.81,95%CI 0.75~0.89;RR=0.78,95%CI 0.68~0.88,均P<0.01);与无肌瘤组相比,肌瘤组流产率、自然流产率增加(RR=1.46,95%CI 1.24~1.71;RR=1.67,95%CI 1.12~2.48,均P≤0.01)。两组异位妊娠率和早产率比较差异无统计学意义(RR=1.20,95%CI 0.43~3.35;RR=1.01,95%CI 0.63~1.61,均P>0.05)。结论无宫腔受压子宫肌瘤与辅助生殖结局的活产率、临床妊娠率、胚胎植入率降低及流产率、自然流产率升高有关。

Objective To systematically evaluate the effects of non-cavity-distorting fibroids on assisted reproductive outcomes.Methods A systematic search of observational studies of PubMed,Embase,Cochrane Library,Web of Science and Ovid databases(from establishment to Nov.31,2019)was performed to compare reproductive outcomes between women with non-cavity-distorting fibroids(fibroids group)and women without fibroids(non-fibroids group),and Meta-analysis was conducted using RevMan 5.3 software.Results A total of 29 studies including 10591 patients were included,comprising 3419 cases in the fibroids group and 7172 cases in the non-fibroids group.Meta-analysis showed that the live birth rate,clinical pregnancy rate and embryo implantation rate in the fibroids group were lower than those in the non-fibroids group(RR=0.73,95%CI 0.67-0.80;RR=0.81,95%CI 0.75-0.89;RR=0.78,95%CI 0.68-0.88,all P<0.01).The abortion rate and spontaneous abortion rate increased in the fibroids group compared with the non-fibroids group(RR=1.46,95%CI 1.24-1.71;RR=1.67,95%CI 1.12-2.48,all P≤0.01).There was no significant difference in the rate of ectopic pregnancy and premature birth between the two groups(RR=1.20,95%CI 0.43-3.35;RR=1.01,95%CI 0.63-1.61,all P>0.05).Conclusion Non-cavity-distorting fibroids are associated with reduced live birth rate,clinical pregnancy rate,embryo implantation rate,and increased abortion rate and spontaneous abortion rate in assisted reproduction outcomes.