背景:反复植入失败(RIF)是接受体外受精(IVF)治疗的低生育能力妇女和护理人员的一种压力情况。粒细胞集落刺激因子(G-CSF)似乎在辅助生殖技术中起重要作用。然而,目前尚不清楚G-CSF是否能有效改善RIF患者的治疗效果.
目的:描述和总结粒细胞集落刺激因子(G-CSF)治疗RIF的现有证据。
方法:从开始至2019年11月,通过计算机在国内外数据库中全面检索相关科学文献。并纳入相关随机对照试验(RCTs),评估G-CSF在无法解释的RIF中的疗效。荟萃分析由Stata12进行。0软件,我们估计了G-CSF对植入率(IR)的相对风险(RRs)和相关的95%置信区间(CIs),临床妊娠率(CPR),使用固定效应模型评估原因不明的RIF患者的流产率(AR)。此外,根据不同给药方式进行亚组分析。
结果:共有11篇文章被纳入最终的meta分析,样本量从13到107例患者。G-CSF与IR升高相关[RR=2.346,95CI(1.615-3.409),I2=0。0%]和CPR[RR=1.910,95CI(1.562-2.337),I2=0.0%]在无法解释的RIF患者中。当通过给药方法进一步分层时,亚组分析显示,宫内注射和皮下注射均能改善IR[皮下注射:RR=2.400,95CI(1.268-4.542),I2=0.0%;宫内注射:RR=2.317,95CI(1.462-3.673),I2=0.0%]和CPR[皮下注射:RR=2。022,95CI(1.443-2.832),I2=0。0%;宫内注射:RR=1.848,95CI(1.438-2.376),I2=0。0%]。G-CSF与不明原因RIF患者的AR无关[RR=2.092,95CI(0.815-5.369),I2=0.0%]。
结论:目前的证据支持G-CSF对不明原因RIF患者的种植率和临床妊娠率的积极作用,尤其是皮下注射时。没有确凿的证据表明G-CSF与流产率之间存在关联。此外,纳入的文章很少报道G-CSF的副作用,所以它的安全性还有待调查。因此,未来的研究应该进行评估。
BACKGROUND: Repeated implantation failure (RIF) is a stressful situation for subfertile women undergoing in vitro fertilisation (IVF) treatment and caregivers. Granulocyte-colony stimulating factor (G-CSF) seems to play an important role in assisted reproductive techniques. However, it is currently unknown whether G-CSF is effective in improving results for patients with RIF.
OBJECTIVE: To describe and summarize current evidence of the effect of the granulocyte colony stimulating factor (G-CSF) in treating RIF.
METHODS: Relevant scientific literature was thoroughly searched by computer in domestic and foreign database from the inceptions to November 2019. And relevant randomized controlled trials (RCTs) assessing the efficacy of G-CSF in unexplained RIF were included. The meta-analysis was conducted by Stata 12. 0 software, and we estimated relative risks (RRs) and associated 95 % confidence intervals (CIs) of G-CSF on implantation rate (IR), the clinical pregnancy rate (CPR), the abortion rate (AR) in patients with unexplained RIF using fixed-effect model. Besides, Subgroup analysis was performed according to the different administration methods.
RESULTS: A total of eleven articles were included for the final meta-analysis with sample sizes ranging from 13 to 107 patients. The G-CSF was associated with an increased IR [RR = 2.346, 95 %CI (1.615-3.409), I2 = 0. 0%] and CPR [RR = 1.910, 95 %CI (1.562-2.337), I2 = 0.0 %] in patients with unexplained RIF. When further stratified by the method of administration, the subgroup analysis revealed that both intrauterine injection and subcutaneous injection are capable of improving IR[subcutaneous injection:RR = 2.400, 95 %CI (1. 268-4. 542), I2 = 0.0 %; intrauterine injection:RR = 2.317, 95 %CI (1.462-3.673), I2 = 0.0 %] and CPR[subcutaneous injection: RR = 2. 022, 95 %CI (1.443-2.832), I2 = 0. 0%; intrauterine injeciton: RR = 1.848, 95 %CI (1.438-2.376), I2 = 0. 0%]. G-CSF was not associated with AR in patients with unexplained RIF [RR = 2.092, 95 %CI (0.815-5.369), I2 = 0.0 %].
CONCLUSIONS: The current evidence support G-CSF\'s positive effect on the implantation rate and clinical pregnancy rate of patients with unexplained RIF, especially when administrated by subcutaneous injection. There is no conclusive evidence for the association between G-CSF and the abortion rate. Moreover, few of the included articles reported side effects of G-CSF, so its safety remains to be investigated.Thus, future research should evaluate.