移植前不同胚胎筛选方法有效性比较的系统评价

发布时间：2018-10-09 17:18

【摘要】：目的：系统评价传统形态学方法与其他胚胎筛选方法在移植前胚胎筛选用于新鲜胚胎或玻璃化冷冻后胚胎移植的有效性,为实现选择性单胚胎移植提供理论依据。方法：计算机检索PubMed、ISI Web of Knowledge、EMbase、OVID-Iww-oup(医学全文)、超星Medalink(百链图书馆—外文)、中国生物医学文献服务系统、万方数据库、CNKI中国知网(总库)和超星Medalink(百链图书馆—中文),并手工检索相关中文杂志9种,查找比较通过形态学方法筛选胚胎与通过其他胚胎筛选方法,包括近红外分光镜技术(NIR)法及全面染色体检查(CCS)法选胚胎用于新鲜胚胎或玻璃化冷冻后胚胎移植的有效性的随机对照试验(RCT)。按纳入排除标准筛选文献、提取资料和评价质量后,采用RevMan5.1软件进行Meta分析。结果：共纳入4篇RCT,合计951例患者。其纳入研究质量A级3篇,B级1篇。Meta分析结果显示：与NIR法及CCS法筛选胚胎组相比,单纯通过传统形态学方法筛选胚胎组在临床妊娠率[OR=0.94,(0.71,1.24)]、活产率[OR=0.90,(0.60,1.37)]方面,两组差异均无统计学意义；仅NIR组的胚胎碎片程度较高,两组差异有统计学意义[OR=0.40,(0.27,0.59)]。而CCS组能在保证临床妊娠率及活产率的同时有效的降低多胎妊娠率,因只有一项研究报道,故未进行Meta分析。结论：单纯通过形态学方法筛选胚胎较之其他方法在临床妊娠率、活产率方面,两种方案疗效相当,且对细胞的损伤较小,具有较好的安全性,故在没有证据表明最优方法之前,单纯通过形态学方法筛选胚胎对行新鲜胚胎或玻璃化冷冻胚胎移植的患者仍然是较理想的选择,而CCS法可能在未来更优于传统形态学方法用于筛选胚胎。鉴于纳入研究存在质量和数量的不足以及方法学的差异,故上述结论仅供临床参考,需要开展更多后效评价和不断更新。
[Abstract]:Objective: to evaluate the effectiveness of traditional morphological methods and other embryo screening methods in the selection of fresh embryos or vitrified frozen embryos in order to provide theoretical basis for selective single embryo transfer. Methods: PubMed,ISI Web of Knowledge,EMbase,OVID-Iww-oup (full text of Medicine), Superstar Medalink (100 chain Library-Foreign language), Chinese Biomedical document Service system, The Wanfang database includes CNKI China knowledge Network (CNKI) and Superstar Medalink (hundred chain Library-Chinese), and manually retrieves 9 related Chinese magazines to find and compare the methods of embryo screening by morphological method and other embryo screening methods. Randomized controlled trial (RCT)., including Near-Infrared Spectroscopy (NIR) and Total chromosome Test (CCS), for the effectiveness of embryo selection for fresh or vitrified embryo transfer The literature was screened according to the exclusion criteria, the data was extracted and the quality was evaluated. Meta analysis was carried out with RevMan5.1 software. Results: a total of 951 patients with RCT, were included. The results of meta-analysis showed that compared with NIR method and CCS method, the clinical pregnancy rate [OR=0.94, (0.71 卤1.24)] and live birth rate [OR=0.90, (0.601.37)] were obtained by traditional morphological method. There was no significant difference between the two groups, but the degree of embryo fragments in NIR group was higher, and the difference between the two groups was statistically significant [OR=0.40, (0.270.59)]. The CCS group can effectively reduce the multiple pregnancy rate while ensuring the clinical pregnancy rate and the live birth rate. Because there is only one study report, no Meta analysis was carried out. Conclusion: compared with other methods, the clinical pregnancy rate and the live rate of embryo screening by morphological method are the same, and the cell damage is less, so it has better safety. So until there is no evidence that the optimal method is available, it is still an ideal choice for patients undergoing fresh or vitrified embryo transfer to screen embryos by morphological method alone. The CCS method may be better than the traditional morphological method for embryo screening in the future. In view of the lack of quality and quantity and the differences in methodology, the above conclusions are only for clinical reference and need to be evaluated and updated continuously.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.6

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