针灸对体外受精-胚胎移植患者妊娠结局影响的随机对照试验系统评价

发布时间：2018-02-12 15:42

本文关键词： 针灸体外受精胚胎移植临床妊娠率试管婴儿出生率系统评价　出处：《中华中医药杂志》2017年12期 　论文类型：期刊论文

【摘要】：目的:客观评价针灸提高体外受精与胚胎移植(IVF-ET)妊娠率的有效性和证据的指导力度。方法:计算机检索Pub Med、Embase、Cochrane Library、中国生物医学文献数据库、中国知网、万方和维普数据库,手工补充检索中国中医科学院图书馆关于针灸辅助生殖的重要会议集和过刊资料,由2名研究者单独筛选文献、提取资料。用软件Rev Man 5.3作Meta分析,用软件GRADEprofiler 3.6按照GRADE系统对Meta分析的结局指标进行证据分级。结果:共纳入的32篇RCTs,共4 815例IVF-ET女性患者。Meta分析结果:(1)针灸与西药促排方案比较对IVF-ET患者临床妊娠率(CPR)和出生率(LBR)影响,合并后的异质性分为(I2=0%,P=0.60;I2=0%,P=0.74),总合并效应量RR分别为(1.38,95%CI[1.23,1.55];1.29,95%CI[1.03,1.62]),差异具有统计学意义(Z=5.48,P0.00001;Z=2.21,P=0.03);(2)针灸与安慰针刺和空白对照比较对IVF-ET患者CPR的影响,合并后的异质性为I2=74%(P0.00001),总合并效应量RR=1.43(95%CI[1.15,1.77]),差异具有统计学意义(Z=3.21,P=0.001);(3)针灸与安慰针刺比较对IVF-ET患者LBR的影响,合并后的异质性为I2=70%(P=0.002),总合并效应量RR=1.18(95%CI[0.89,1.58]),不具有统计学差异(Z=0.14,P=0.25)。结论:基于目前的证据,针灸提高IVF-ET患者的CPR效果显著,针灸对LBR的影响未体现明显的优势,两个结局指标的GRADE证据分级均为低质量。
[Abstract]:Objective: to objectively evaluate the effectiveness of acupuncture and moxibustion in improving the pregnancy rate of IVF-ETs in vitro fertilization and embryo transfer. Methods: Pub Medbase Cochrane Library, Chinese Biomedical Literature Database, China knowledge Network, Wanfang and Weip databases were searched by computer. Manual supplementary retrieval of the important meeting and published materials of the Library of Chinese Academy of traditional Chinese Medicine on Acupuncture assisted Reproduction was carried out. Two researchers independently sifted the literature and extracted the data. Meta analysis was performed with the software Rev Man 5.3. The outcome index of Meta analysis was classified by software GRADEprofiler 3. 6 according to GRADE system. Results: a total of 32 RCTs were included. A total of 4 815 IVF-ET female patients. Meta analysis results: 1) comparison of acupuncture and moxibustion and western medicine to promote pregnancy in patients with IVF-ET. Rate of CPR) and birth rate of LBR), The heterogeneity after the merger was divided into two groups: P0. 60, P0. 60 and P0. 74. The total combined effect RR was 1. 38% 95 CI [1. 23 1. 55] CI [1. 03 卤1. 62]. The difference was statistically significant. The difference was statistically significant. The effect of acupuncture and moxibustion on CPR in patients with IVF-ET was compared with that of placebo acupuncture and blank control. The heterogeneity after the merger was I _ 2N _ (74) and P _ (0.00001), and the total combined effect quantity (RR=1.43(95%CI) was 1.151.77. The difference was statistically significant (P < 0.05). The effect of acupuncture and comfort acupuncture on LBR in patients with IVF-ET was significant (P < 0.05). The heterogeneity after the merger was I _ 2N _ (70) and P ~ (0.002), the total combined effect amount (RR=1.18(95%CI) was 0.89 ~ 1.58, and there was no statistical difference between them. Conclusion: based on the current evidence, acupuncture and moxibustion can significantly improve the CPR of IVF-ET patients, but the effect of acupuncture on LBR is not obvious. The GRADE evidence classification of the two outcome indicators was of low quality.
【作者单位】：中国中医科学院针灸研究所;中国中国科学院针灸医院;
【基金】：国家自然科学基金项目(No.81674087)~~
【分类号】：R714.8

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