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目的:系统评价宫腔灌注粒细胞集落刺激因子(G-CSF)对薄型子宫内膜不孕患者的治疗效果。方法:计算机检索PubMed、EMbase、the Cochrane Library、Web of Science、中国生物医学文献数据库、万方数据库和中国知网数据库,筛选G-CSF治疗薄型子宫内膜不孕患者的随机对照试验(RCT),检索时限截至2016年1月。由2位评价员独立进行文献筛选、资料提取并评价纳入研究的偏倚风险后,采用RevMan 5.2软件进行Meta分析。结果:共纳入8个RCT,包含779例行体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)或冷冻胚胎移植(frozen-thawed embryo transfer,FET)周期的不孕患者,共计840个周期。Meta分析结果显示:G-CSF宫腔灌注治疗组与非G-CSF宫腔灌注治疗组的胚胎种植率(OR=2.24,95%CI=1.43~3.51,P=0.000 4)、临床妊娠率(OR=2.13,95%CI=1.48~3.06,P<0.000 1)的差异有统计学意义,而排卵日子宫内膜厚度和早期流产率之间差异无统计学意义(P>0.05)。结论:宫腔灌注G-CSF的治疗对于行IVF-ET或FET的不孕患者,可提高胚胎种植率及临床妊娠率,且不会提高早期流产的风险,但不能明显提高子宫内膜厚度。
Objective: To systematically evaluate the therapeutic effect of intrauterine G-CSF on patients with thin endometrial infertility. METHODS: Randomized controlled trials (RCTs) of G-CSF in patients with thin endometrial infertility were screened by PubMed, the Cochrane Library, Web of Science, China Biomedical Literature Database, Wanfang Database and CNKI database. , The search deadline as of January 2016. After two independent reviewers screened the literature, extracted the data and evaluated the risk of inclusion in the study, Meta-analysis was performed using RevMan 5.2 software. RESULTS: Eight RCTs were included, including 779 infertile patients with in vitro fertilization and embryo transfer (IVF-ET) or frozen-thawed embryo transfer (FET) cycles, for a total of 840 A cycle. Meta-analysis showed that the rate of embryo implantation (OR = 2.24, 95% CI = 1.43-3.51, P = 0.0004), the clinical pregnancy rate OR = 2.13, 95% CI = 1.48 ~ 3.06, P <0.000 1). There was no significant difference between endometrial thickness and early miscarriage rate on ovulation day (P> 0.05). CONCLUSIONS: Intrauterine perfusion of G-CSF for IVF-ET or FET in infertility patients increases embryo implantation and clinical pregnancy rates without increasing the risk of early miscarriage but does not significantly increase endometrial thickness.