【摘要】：目的：系統(tǒng)評價傳統(tǒng)形態(tài)學方法與其他胚胎篩選方法在移植前胚胎篩選用于新鮮胚胎或玻璃化冷凍后胚胎移植的有效性,為實現(xiàn)選擇性單胚胎移植提供理論依據(jù)。方法：計算機檢索PubMed、ISI Web of Knowledge、EMbase、OVID-Iww-oup(醫(yī)學全文)、超星Medalink(百鏈圖書館—外文)、中國生物醫(yī)學文獻服務系統(tǒng)、萬方數(shù)據(jù)庫、CNKI中國知網(wǎng)(總庫)和超星Medalink(百鏈圖書館—中文),并手工檢索相關中文雜志9種,查找比較通過形態(tài)學方法篩選胚胎與通過其他胚胎篩選方法,包括近紅外分光鏡技術(NIR)法及全面染色體檢查(CCS)法選胚胎用于新鮮胚胎或玻璃化冷凍后胚胎移植的有效性的隨機對照試驗(RCT)。按納入排除標準篩選文獻、提取資料和評價質(zhì)量后,采用RevMan5.1軟件進行Meta分析。結果：共納入4篇RCT,合計951例患者。其納入研究質(zhì)量A級3篇,B級1篇。Meta分析結果顯示：與NIR法及CCS法篩選胚胎組相比,單純通過傳統(tǒng)形態(tài)學方法篩選胚胎組在臨床妊娠率[OR=0.94,(0.71,1.24)]、活產(chǎn)率[OR=0.90,(0.60,1.37)]方面,兩組差異均無統(tǒng)計學意義；僅NIR組的胚胎碎片程度較高,兩組差異有統(tǒng)計學意義[OR=0.40,(0.27,0.59)]。而CCS組能在保證臨床妊娠率及活產(chǎn)率的同時有效的降低多胎妊娠率,因只有一項研究報道,故未進行Meta分析。結論：單純通過形態(tài)學方法篩選胚胎較之其他方法在臨床妊娠率、活產(chǎn)率方面,兩種方案療效相當,且對細胞的損傷較小,具有較好的安全性,故在沒有證據(jù)表明最優(yōu)方法之前,單純通過形態(tài)學方法篩選胚胎對行新鮮胚胎或玻璃化冷凍胚胎移植的患者仍然是較理想的選擇,而CCS法可能在未來更優(yōu)于傳統(tǒng)形態(tài)學方法用于篩選胚胎。鑒于納入研究存在質(zhì)量和數(shù)量的不足以及方法學的差異,故上述結論僅供臨床參考,需要開展更多后效評價和不斷更新。
[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 鹵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.
【學位授予單位】：新疆醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R711.6

【參考文獻】

相關期刊論文 前4條

1 楊書;李婷婷;劉新;;應用漏斗圖識別發(fā)表性偏倚的效率研究[J];成都醫(yī)學院學報;2007年01期

2 高雅琴;喬杰;常紀;;不孕癥輔助生殖技術(ART)的臨床研究[J];中國實用醫(yī)藥;2009年36期

3 王丹;翟俊霞;牟振云;宗紅俠;趙曉東;王學義;顧平;;Meta分析中的異質(zhì)性及其處理方法[J];中國循證醫(yī)學雜志;2009年10期

4 黃江濤;唐運革;王奇玲;文任乾;唐立新;梁光鈞;江滿菊;區(qū)海云;黃橋海;;廣東省已婚居民不孕癥及影響因素分析[J];中國公共衛(wèi)生;2013年02期

，

本文編號：2260137