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低分子肝素联合黄体酮治疗胚胎移植患者反复种植失败的有效性和安全性的Meta分析
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| 篇名： | 低分子肝素联合黄体酮治疗胚胎移植患者反复种植失败的有效性和安全性的Meta分析 |
| TITLE： | Meta-analysis of the Effectiveness and Safety of Low-molecular-weight Heparin Combined with Progesterone in the Treatment of Repeated Implant Failure in Embryo Transfer Patients |
| 摘要： | 目的：系统评价低分子肝素联合黄体酮治疗胚胎移植患者反复种植失败（RIF）的有效性和安全性，为其临床应用提供参考。方法：计算机检索Cochrane图书馆、PubMed、Embase、中国知网和万方数据库，收集低分子肝素联合黄体酮（试验组）对比黄体酮（对照组）用于RIF患者的随机对照试验（RCT）或观察性研究，检索时限为各数据库建库起至2020年7月。对符合纳入标准的研究进行资料提取，并采用Cochrane5.1.0偏倚风险评估工具和Newcastle-OttawaScale评价量表分别对RCT和观察性研究进行质量评价。采用RevMan5.3软件进行Meta分析。结果：共纳入15项研究，包括10项RCT和5项观察性研究，合计2353例患者。Meta分析结果显示，试验组患者的着床率[RR＝1.41，95％CI（1.24，1.60），P＜0.01]、妊娠率[RR＝1.38，95％CI（1.23，1.56），P＜0.01]、活产率[RR＝1.41，95％CI（1.19，1.67），P＜0.01]均显著高于对照组，差异均有统计学意义；流产率[RR＝0.54，95％CI（0.33，0.86），P＝0.01]显著低于对照组，差异有统计学意义。亚组分析结果显示，年龄≥35岁患者着床率[RR＝2.38，95％CI（1.31，4.31），P＝0.004]、妊娠率[RR＝2.58，95％CI（1.62，4.11），P＜0.001]均高于对照组，差异均有统计学意义。两组患者不良反应主要是少量出血和注射部位瘀斑，未见严重不良反应。结论：低分子肝素联用黄体酮可提高RIF患者的胚胎着床率、妊娠率和活产率，降低其流产率，且安全性较好。 |
| ABSTRACT： | OBJECTIVE：To systematically evaluate the effectiveness and safety of low-m olecular-weight heparin combined with progesterone in the treatment of repeated implant failure （RIF）in embryo transfer patients ，and to provide reference for clinical use of it. METHODS ：Retrieved from Cochrane library ，PubMed，Embase，CNKI and Wanfang database ，randomized controlled trail （RCT）or observational study about low-molecular-weight heparin combined with progesterone （trial group ）versus progesterone（control group ）for RIF patients were collected during the inception to Jul. 2020. After data extraction of studies met included criteria ，the Cochrane 5.1.0 bias risk assessment tool and the Newcastle-Ottawa Scale evaluation scale were used to evaluate the quality of RCTs and observational studies. Rev Man 5.3 software was used for Meta-analysis. RESULTS ：A total of 15 studies were included ，including 10 RCTs and 5 observational studies ，with a total of 2 353 patients. Results of Meta-analysis showed that the implantation rate [RR ＝1.41，95％CI（1.24，1.60），P＜0.01]，pregnancy rate [RR ＝1.38，95％CI（1.23，1.56）， P＜0.01]，live birth rate [RR ＝1.41，95％CI（1.19，1.67），P＜0.01] of trial group were significantly higher than those of control group，with statistical significance ；while the abortion rate [RR ＝0.54，95％ CI（0.33，0.86），P＝0.01] of trial group was significantly lower than that of control group ，with statistical significance. The results of subgroup analysis showed that the implantation rate [RR ＝2.38，95％CI（1.31，4.31），P＝0.004] and pregnancy rate [RR ＝2.58，95％CI（1.62，4.11），P＜0.001] of patients over 35 years old in trial group were higher than control group ，with statistical significance. The main ADR of 2 groups were a small amount of bleeding and ecchymosis at the injection site. No severe ADR was observed. CONCLUSIONS： Low-molecular-weight heparin combined with progesterone can improve the embry o implantation rate ， pregnancy rate and live birth rate of RIF patients ，reduce the abortion rate ，with good safety. |
| 期刊： | 2020年第31卷第23期 |
| 作者： | 刘克锋，张莹莹，杨丽，李哲，张瑞，赵杰 |
| AUTHORS： | LIU Kefeng ，ZHANG Yingying ，YANG Li，LI Zhe，ZHANG Rui，ZHAO Jie |
| 关键字： | 低分子肝素；胚胎移植；反复种植失败；有效性；安全性；Meta分析 |
| KEYWORDS： | Low-molecular-weight heparin ；Embryo transfer ；Repeated implantation failure ；Effectiveness；Safety；Meta- |
| 阅读数： | 250 次 |
| 本月下载数： | 6 次 |
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