■比较四种常用免疫调节疗法对子宫内膜薄型患者的子宫内膜容受性和妊娠结局的有效性。
■这项系统综述和网络荟萃分析使用截至2024年1月的文献检索,以确定比较人绒毛膜促性腺激素(hCG)子宫内膜容受性和妊娠结局的相关试验,富血小板血浆(PRP),输注粒细胞集落刺激因子(IG-CSF),子宫内膜薄型患者的外周血单核细胞(PBMC)。我们使用累积排序下的表面(SUCRA)对四种常见的免疫调节疗法对子宫内膜厚度进行排序,植入率(IR),临床妊娠率(CPR),和活产率(LBR)。使用RoB2和ROBINS-I评估证据的确定性。
■22项研究的汇总结果表明,hCG(均差[MD]:3.05,95%置信区间[CI]:1.46-4.64)和PRP(MD:0.98,95%CI:0.20-1.76)显着增加子宫内膜厚度。在IG-CSF中,hCG最好(MD=-2.56,95%CI=-4.30至-0.82),PBMC(MD=-2.75,95%CI=-5.49至-0.01),和PRP(MD=-2.07,95%CI=-3.84至-0.30)增加子宫内膜厚度。然而,IG-CSF和PRP显著改善IR(IG-CSF:风险比(RR;IG-CSF:RR=1.33,95%CI=1.06-1.67;PRP:RR=1.63,95%CI=1.19-2.23),和LBR(IG-CSF:RR=1.53,95%CI=1.16-2.02;PRP:RR=1.59,95%CI=1.08-2.36)。
■现有证据表明,hCG和皮下或子宫内CSF(SG-CSF)可能是当前子宫内膜薄型患者的最佳治疗选择。然而,未来有必要进行高质量和大规模的研究来验证我们的研究结果.
UNASSIGNED: To compare the effectiveness of endometrial receptivity and pregnancy outcomes of four common immunomodulatory therapies for patients with thin endometrium.
UNASSIGNED: This systematic review and network meta-analysis using a literature search up to January 2024, to identify relevant trials comparing endometrial receptivity and pregnancy outcomes of human chorionic gonadotropin (hCG), platelet-rich plasma (PRP), infusion of granulocyte colony-stimulating factor (IG-CSF), and peripheral blood mononuclear cell (PBMC) for patients with thin endometrium. We used surface under the cumulative ranking (SUCRA) to ranked four common immunomodulatory therapies on endometrium thickness, implantation rate (IR), clinical pregnancy rate (CPR), and live birth rate (LBR). RoB2 and ROBINS-I were used to assess the certainty of evidence.
UNASSIGNED: The pooled results of 22 studies showed that hCG (mean difference [MD]: 3.05, 95% confidence interval [CI]: 1.46-4.64) and PRP (MD: 0.98, 95% CI: 0.20-1.76) significantly increase endometrium thickness. The hCG was the best among the IG-CSF (MD = -2.56, 95% CI = -4.30 to -0.82), PBMC (MD = -2.75, 95% CI = -5.49 to -0.01), and PRP (MD = -2.07, 95% CI = -3.84 to -0.30) in increasing endometrium thickness. However, IG-CSF and PRP significantly improved IR (IG-CSF: risk ratio (RR; IG-CSF: RR = 1.33, 95% CI = 1.06-1.67; PRP: RR = 1.63, 95% CI = 1.19-2.23), and LBR (IG-CSF: RR = 1.53, 95% CI = 1.16-2.02; PRP: RR = 1.59, 95% CI = 1.08-2.36).
UNASSIGNED: Available evidence reveals that hCG and subcutaneous or intrauterine CSF (SG-CSF) may be the best treatment options for current thin endometrium patients. However, future high-quality and large-scale studies are necessary to validate our findings.