粒细胞集落刺激因子对复发性流产影响的Meta分析

Meta analysis of the effect of granulocyte colonystimulating factor on recurrent abortion

目的系统评价粒细胞集落刺激因子(G-CSF)治疗复发性流产的临床疗效。方法通过检索中国知识基础设施工程、万方数据库、维普数据库、中国生物医学文献数据库、Pubmed、Medline、MDConsult、Embase、OVID、Science、谷歌学术、JBJS、Informahealthcare、WOS-SCI、APA等数据库,获得G-CSF治疗复发性流产患者的随机对照试验相关研究,检索时间为建库至2022年12月。两位评价员对相关文献独立筛选、提取资料并评价偏倚风险,采用RevMan 5.3进行Meta分析、敏感性分析和发表偏倚评价。结果共纳入随机对照试验5篇,复发性流产患者480例,其中观察组265例,对照组215例;Meta分析结果表明采用皮下注射的流产率差异无统计学意义,RR=0.84,95%CI:[0.60,1.19],P=0.340。实验组采用宫腔灌注给药的流产率低于对照组,差异具有统计学意义,RR=0.33,95%CI:[0.18,0.63],P=0.001。确认妊娠后用药的活产率差异无统计学意义,RR=0.91,95%CI:[0.71,1.17],P=0.480。排卵期用药的2篇文献活产率差异无统计学意义,RR=1.48,95%CI:[0.76,2.88],P=0.240。纳入5篇文献均统计了流产率,其中妊娠后用药2篇,排卵期用药3篇,妊娠后用药的流产率差异无统计学意义,RR=0.84,95%CI:[0.60,1.19],P=0.340。排卵期用药的流产率较低,差异有统计学意义,RR=0.33,95%CI:[0.18,0.63],P=0.001。结论G-CSF宫腔灌注用药和排卵期用药可降低流产风险,提高活产率。

Objective To systematically evaluate the clinical effect of granulocyte colony-stimulating factor(G-CSF)in the treatment of recurrent abortion.Method Databases such as China Knowledge Network,Wanfang datebase,Vip datebase,China Biomedical,Pubmed,Medline,MDConsult,Embase,OVID,Science,Google Scholar,JBJS,Informahealthcare,WOS-SCI and APA were searched by computer to screen G-CSF for recurrent miscarriage patients in randomized controlled trials,with a search period from database construction to December 2022.Two evaluators were arranged to independently screen,extract information and evaluate the risk of bias in the relevant literature;Meta-analysis,sensitivity analysis and publication bias analysis were performed using RevMan 5.3.Results A total of 5 randomized controlled trials were included,including 480 patients with recurrent abortion,with 265 in the observation group and 215 in the control group.The results of the Meta-analysis showed that there was no statistical difference in the abortion rate of subcutaneous injection,RR=0.84,95%CI:[0.60,1.19],P=0.340.The abortion rate of the experimental group using intrauterine perfusion was lower than that of the control group,the difference being statistically significant,RR=0.33,95%CI:[0.18,0.63],P=0.001.There was no significant difference in the live birth rate after confirmed pregnancy,RR=0.91,95%CI:[0.71,1.17],P=0.480,and no significant difference in the live birth rate between the two literatures using drugs during ovulation,RR=1.48,95%CI:[0.76,2.88],P=0.240.The abortion rate was analyzed in all the five literatures included,of which 2 literatures were treated after pregnancy and 3 literatures were treated during ovulation.There was no significant difference in the abortion rate after pregnancy,RR=0.84,95%CI:[0.60,1.19],P=0.340.The rate of abortion in the ovulation period was lower,the difference being statistically significant,RR=0.33,95%CI:[0.18,0.63],P=0.001.Conclusion Intrauterine perfusion and ovulation administration of G-CSF can reduce the risk of abortion and increase the rate of live birth.