阿司匹林对宫腔镜下宫腔粘连分离术后妊娠影响的Meta分析

Effect of aspirin on pregnancy after hysteroscopic intrauterine adhesiolysis:a metaanalysis

目的系统评价阿司匹林对宫腔镜下宫腔粘连分离术后妊娠的影响。方法计算机检索PubMed、Cochrane Library、EMbase、中国知网、CBM及万方数据库,检索时间为2020年10月1日前,检索词为“阿司匹林”或“乙酰水杨酸”“宫内粘连”或“Asherman综合征”或“IUA”。收集宫腔镜下宫腔粘连分离术后采用阿司匹林辅助治疗的随机对照试验。采用RevMan 5.3软件分析妊娠率、活产率及自然流产率。结果共纳入8项随机对照研究,共557例因宫腔粘连需要宫腔镜检查的患者。Meta分析结果显示:阿司匹林可提高宫腔镜下宫腔粘连分离术后的妊娠率[RR=1.83,95%CI(1.40~2.39),P<0.05]。②阿司匹林对宫腔镜下宫腔粘连分离术后活产率及自然流产率的影响差异无统计学意义[活产率:RR=1.64,95%CI(1.01~2.68),P=0.05;自然流产率:RR=0.48,95%CI(0.23~1.01),P=0.05]。结论阿司匹林可提高宫腔镜下宫腔粘连分离术后的妊娠率,活产率及自然流产率的影响有待进一步研究。

Objective To systematically evaluate the effects of aspirin on pregnancy after hysteroscopic intrauterine adhesiolysis.Methods PubMed,Cochrane Library,EMbase,Cnki,CBM and Wanfang databases were retrieved by computer before October 1,2020,using the terms:"Aspirin"or"Acetylsalicylic acid"and"Intrauterine adhesions"or"Asherman syndrome"or"IUA".Randomized controlled trials of aspirin-assisted treatment after hysteroscopic adhesiolysis were collected.RevMan 5.3 software was used to analyze the pregnancy rate,live birth rate and spontaneous abortion rate.Results A total of 8 clinical randomized controlled studies were included,including 557 fertile patients with intrauterine adhesions requiring hysteroscopy.Meta analysis results show that:aspirin can improve pregnancy rate after hysteroscopic adhesiolysis;[RR=1.83,95%CI(1.40-2.39),P<0.05].There was no statistically significant difference in the effect of aspirin on live birth rate and postoperative spontaneous abortion rate[live birth rate:RR=1.64,95%CI(1.01-2.68),P=0.05;abortion rate:RR=0.48,95%CI(0.23-1.01),P=0.05].Conclusion Aspirin can improve pregnancy rate after hysteroscopic adhesiolysis.The effects of live birth rate and spontaneous abortion rate need to be further studied.