發(fā)布時(shí)間：2018-02-12 15:42

  本文關(guān)鍵詞： 針灸 體外受精 胚胎移植 臨床妊娠率 試管嬰兒出生率 系統(tǒng)評(píng)價(jià)　出處：《中華中醫(yī)藥雜志》2017年12期 　論文類(lèi)型：期刊論文

【摘要】：目的:客觀評(píng)價(jià)針灸提高體外受精與胚胎移植(IVF-ET)妊娠率的有效性和證據(jù)的指導(dǎo)力度。方法:計(jì)算機(jī)檢索Pub Med、Embase、Cochrane Library、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)、中國(guó)知網(wǎng)、萬(wàn)方和維普數(shù)據(jù)庫(kù),手工補(bǔ)充檢索中國(guó)中醫(yī)科學(xué)院圖書(shū)館關(guān)于針灸輔助生殖的重要會(huì)議集和過(guò)刊資料,由2名研究者單獨(dú)篩選文獻(xiàn)、提取資料。用軟件Rev Man 5.3作Meta分析,用軟件GRADEprofiler 3.6按照GRADE系統(tǒng)對(duì)Meta分析的結(jié)局指標(biāo)進(jìn)行證據(jù)分級(jí)。結(jié)果:共納入的32篇RCTs,共4 815例IVF-ET女性患者。Meta分析結(jié)果:(1)針灸與西藥促排方案比較對(duì)IVF-ET患者臨床妊娠率(CPR)和出生率(LBR)影響,合并后的異質(zhì)性分為(I2=0%,P=0.60;I2=0%,P=0.74),總合并效應(yīng)量RR分別為(1.38,95%CI[1.23,1.55];1.29,95%CI[1.03,1.62]),差異具有統(tǒng)計(jì)學(xué)意義(Z=5.48,P0.00001;Z=2.21,P=0.03);(2)針灸與安慰針刺和空白對(duì)照比較對(duì)IVF-ET患者CPR的影響,合并后的異質(zhì)性為I2=74%(P0.00001),總合并效應(yīng)量RR=1.43(95%CI[1.15,1.77]),差異具有統(tǒng)計(jì)學(xué)意義(Z=3.21,P=0.001);(3)針灸與安慰針刺比較對(duì)IVF-ET患者LBR的影響,合并后的異質(zhì)性為I2=70%(P=0.002),總合并效應(yīng)量RR=1.18(95%CI[0.89,1.58]),不具有統(tǒng)計(jì)學(xué)差異(Z=0.14,P=0.25)。結(jié)論:基于目前的證據(jù),針灸提高IVF-ET患者的CPR效果顯著,針灸對(duì)LBR的影響未體現(xiàn)明顯的優(yōu)勢(shì),兩個(gè)結(jié)局指標(biāo)的GRADE證據(jù)分級(jí)均為低質(zhì)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 鹵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.
【作者單位】： 中國(guó)中醫(yī)科學(xué)院針灸研究所;中國(guó)中國(guó)科學(xué)院針灸醫(yī)院;
【基金】：國(guó)家自然科學(xué)基金項(xiàng)目(No.81674087)~~
【分類(lèi)號(hào)】：R714.8

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