淋巴细胞主动免疫和传统保胎对封闭抗体阴性复发性流产患者疗效的Meta分析

Meta analysis of the efficacy of lymphocytic active immunization and traditional fetal protection in patients with blocked antibody negative recurrent abortion

目的系统评价淋巴细胞免疫治疗和黄体酮加hCG保胎治疗对封闭抗体阴性复发性流产(recurrent spontaneous abortion,RSA)患者的疗效。方法计算机检索VIP、CNKI、WanFang Data、Sinme、Web of Science、PubMed、Cochrane Library和Embase中英文数据库,检索日期截止于2022年3月,检索完成后提取所有中外文数据库中淋巴细胞主动免疫治疗、黄体酮加hCG保胎治疗封闭抗体阴性RSA患者疗效的随机对照研究。文献的筛选、资料提取及纳入研究的偏倚风险评估由2名作者独立完成,再通过RevMan 5.4.1应用软件完成Meta分析。结果最终14个随机对照试验被纳入,共计1692例研究对象。Meta分析结果显示:采用淋巴细胞主动免疫疗法较黄体酮加hCG保胎治疗,可提高RSA的妊娠成功率(RR=1.60,95%CI:1.42-1.80,P<0.001),淋巴细胞主动免疫治疗组封闭抗体转阳患者较封闭抗体阴性者妊娠率高(RR=1.58,95%CI:1.35-1.85,P<0.001),差异均有统计学意义。结论淋巴细胞主动免疫治疗较传统保胎治疗可提高RSA患者的妊娠率、封闭抗体转阳者妊娠率。

Objective To systematically evaluate lymphocyte active immunotherapy,progesterone and hCG fetal protection treatment to blocking antibody negative recurrent spontaneous abortion(RSA).Methods VIP,CNKI,WanFang Data,Sinme,Web of Science,PubMed,Cochrane Library and Embase of Chinese and English database were retrieved.The retrieval was terminated till March 2022.After the retrieval completion,a randomized controlled study on the efficacy of lymphocyte active immunotherapy,progesterone and hCG fetal protection treatment to blocking antibody negative RSA in all Chinese and foreign databases was extracted.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies,then Meta-analysis was performed by using Revman 5.4.1.Results Finally 14 randomized controlled trials were included,totaling 1692 cases of research objects.Meta analysis results show that the use of lymphocyte active immunotherapy than progesterone and hCG fetal protection treatment can improve the pregnancy success rate of RSA(RR=1.60,95%CI:1.42-1.80,P<0.001).The RSA patients with blocking antibody positive after lymphocyte active immunotherapy had a higher pregnancy rate compared with those with blocking antibody negative,all with statistically significant differences(RR=1.58,95%CI:1.35-1.85,P<0.001).Conclusion Compared with traditional fetal protection therapy,lymphocyte active immunotherapy can improve the pregnancy rate of patients with RSA and those with positive blocking antibody.