宫腔灌注富血小板血浆对反复种植失败患者妊娠结局影响的Meta分析

Meta-analysis of the effect of intrauterine perfusion of platelet-rich plasma on pregnancy outcome of patients with repeated implantation failure

目的评估宫腔灌注富血小板血浆(PRP)对反复种植失败(RIF)妇女妊娠结局的影响。方法使用PubMed、Embase、Scopus、Web of Science、CochraneLibrary、中国知识基础设施工程、维普数据库、万方数据库,检索PRP宫腔灌注治疗RIF患者的临床研究。提取数据后使用固定效应模型或随机效应模型进行Meta分析。结果共纳入7项研究。接受PRP宫腔灌注女性的生化妊娠率[OR=2.18,95%CI:[1.34,3.52],P<0.05]、临床妊娠率(OR=2.47,95%CI:[1.66,3.68],P<0.05)、活产率(OR=5.00,95%CI:[1.09,22.99],P<0.05)和胚胎种植率(OR=1.99,95%CI:[1.36,2.93],P<0.05)高于对照组,流产率低于对照组(OR=0.28,95%CI:[0.10,0.77],P<0.05)。亚组分析显示宫腔灌注0.5 mL PRP组的临床妊娠率高于宫腔灌注1.0 mL PRP组(P<0.05),流产率低于宫腔灌注1.0 mL PRP组(P<0.05)。结论宫腔灌注PRP可提高RIF患者的胚胎种植率、活产率、生化妊娠率和临床妊娠率,且显著降低流产的风险,宫腔灌注0.5 mL PRP具有更好的临床效果。

Objective To evaluate the effect of intrauterine perfusion of platelet-rich plasma(PRP)on pregnancy outcomes in women with repeated implantation failure(RIF).Methods PubMed,Embase,Scopus,Web of Science,Cochrane Library,VIP databases,and China Nationl Knowledge Infrastructure were used to search for clinical studies of patients with RIF treated with PRP intrauterine perfusion.Data was extracted and Metaanalyses were performed using fixed-effects models or random-effects models.Results Seven studies were included.Compared with the control group,the PRP group had significantly higher rates of chemical pregnan cy[odds ratio(OR):2.18,95%confidence interval(CI):[1.34,3.52],P<0.05],clinical pregnancy(OR=2.47,95%CI:[1.66,3.68],P<0.05),live birth(OR=5.00,95%CI:[1.09,22.99],P<0.05),embryo implantation(OR=1.99,95%CI:[1.36,2.93],P<0.05)and significantly lower miscarriage rate(OR=0.28,95%CI:[0.10,0.77],P<0.05).A subgroup analysis showed that the clinical pregnancy rate was significantly higher in the group with 0.5 mL PRP than that in that with 1.0 mL PRP(P<0.05),and the miscarriage rate was significantly lower than in that with 1.0 mL PRP(P<0.05).Conclusion Intrauterine perfusion of PRP improves the embryo implantation rate,live birth rate,chemical pregnancy rate,clinical pregnancy rate and significantly reduces the risk of miscarriage in patients with RIF.Intrauterine infusion of 0.5 mL PRP has a relative ly better pregnancy outcomes.