摘要
目的系统评价体外受精(IVF)周期联合使用生长激素(GH)对助孕结局的影响。方法计算机检索CBM、WanFang Data、CNKI、VIP、PubMed、EMbase、Web of Science和The Cochrane Library数据库,搜集IVF周期联合使用GH对助孕结局影响的随机对照试验(RCT),检索时限均为建库至2019年10月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果最终纳入10个RCT,包括691例不孕女性。Meta分析结果显示不孕女性IVF助孕周期联合使用GH,可增加卵巢低反应患者的获卵数[MD=1.58,95%CI(1.29,1.87),P<0.00001]、MⅡ期卵母细胞数[MD=2.26,95%CI(1.77,2.74),P<0.00001],提高其种植率[RR=1.20,95%CI(1.02,1.40),P=0.03]、临床妊娠率[RR=1.46,95%CI(1.08,1.98),P=0.01]和活产率[RR=1.62,95%CI(1.05,2.51),P=0.03]。但两组在受精率[RR=1.00,95%CI(0.92,1.08),P=0.18]、流产率[RR=1.44,95%CI(0.65,3.17),P=0.37]和不良事件发生情况方面的差异无统计学意义。结论当前证据表明,GH可部份改善卵巢低反应、高龄或既往IVF失败患者IVF周期的助孕结局。受纳入研究数量和质量的限制,上述结论需要更多高质量研究予以验证。
Objectives To systematically review the efficacy of adjuvant growth hormone(GH)in IVF protocols.Methods CBM,WanFang Data,CNKI,VIP,PubMed,EMbase,Web of Science and The Cochrane Library databases were electronically searched to collect randomized controlled trials(RCTs)on the efficacy of adjuvant GH in IVF protocols from inception to October 2019.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies,then,the meta-analysis was performed by using RevMan 5.3 software.Results A total of 10 RCTs involving 691 infertile females were included.Results of meta-analysis demonstrated that adjuvant GH in IVF protocols could increase collected oocytes number(MD=1.58,95%CI 1.29 to 1.87,P<0.00001),MⅡstage oocytes number(MD=2.26,95%CI 1.77 to 2.74,P<0.00001),implantation rate(RR=1.20,95%CI 1.02 to 1.40,P=0.03),clinical pregnancy rate(RR=1.46,95%CI 1.08 to 1.98,P=0.01)and live birth rate(RR=1.62,95%CI 1.05 to 2.51,P=0.03).However,there was no difference in fertilization rate(RR=1.06,95%CI 0.97 to 1.16,P<0.18),miscarriage rate(RR=1.44,95%CI 0.65 to 3.17,P=0.37)and adverse reactions between two groups.Conclusions Current evidence shows that GH can improve the fertility outcomes of IVF cycles in patients with POR,elderly or previous IVF failures.But due to limited quality and quantity of the included studies,more high-quality studies are required to verify the above conclusion.
作者
侯海燕
秦琰
郁琦
甄璟然
胡春秀
王蕊
陈娟
李银丹
HOU Haiyan;QIN Yan;YU Qi;ZHEN Jingran;HU Chunxiu;WANG Rui;CHEN Juan;LI Yindan(Department of Reproductive Medicine,Characteristic Medical Center of PAP,Tianjin 300162,P.R.China;Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100036,P.R.China;Gynecological Endocrinology and Reproduction Center,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100036,P.R.China)
出处
《中国循证医学杂志》
CSCD
北大核心
2020年第4期418-425,共8页
Chinese Journal of Evidence-based Medicine
基金
国家自然科学基金项目(编号:81402691)
天津市自然科学基金项目(编号:15JCQNJC12300)。
关键词
生长激素
体外受精
IVF
活产率
卵巢低反应
系统评价
Meta分析
随机对照试验
Growth hormone
In-vitro fertilization
IVF
Live birth rate
Poor ovarian response
Systematic review
Meta-analysis
Randomized controlled trial
