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目的为给单胚胎移植的临床应用提供更可靠的证据,对国内外公开发表的选择性单个与两个卵裂期胚胎移植的临床研究进行Meta分析。方法计算机检索PubMed、Ovid、EMbase、MEDLINE、CENTRAL等中外生物医学数据库,收集有关选择性单个与两个卵裂期胚胎移植的随机对照试验(RCT)。按Cochrane系统评价方法,由两位研究者独立选择文献、提取资料并评价纳入研究的方法学质量后,采用RevMan 5.1软件进行Meta分析。结果共纳入9个RCT,共计2 784例患者,其中试验组1 452例,对照组1 332例。Meta分析结果显示:与两个卵裂期胚胎移植比较,选择性单个卵裂期胚胎移植降低了每个移植周期的活产率[RR=0.66,95%CI(0.59,0.73),P<0.000 01],显著降低了多胎妊娠率[RR=0.05,95%CI(0.02,0.11),P<0.000 01],亦降低了早产儿发生率[RR=0.39,95%CI(0.26,0.60),P<0.000 1]和低体重儿发生率[RR=0.25,95%CI(0.15,0.44),P<0.000 01],但对异位妊娠率[RR=0.55,95%CI(0.11,2.77),P=0.47]、流产率[RR=1.33,95%CI(0.92,1.91),P=0.13]和围产儿死亡率[RR=0.31,95%CI(0.03,2.76),P=0.29]无影响。结论与两个胚胎移植相比,选择性单胚胎移植降低了每移植周期临床妊娠率、多胎妊娠率、早产儿发生率及低体重儿发生率,在其他指标方面两组无显著差异。
Objective To provide more reliable evidence for the clinical application of single embryo transfer and to conduct a meta-analysis of the published clinical studies of selective single and double cleavage embryo transfer at home and abroad. Methods Chinese and foreign biomedical databases, such as PubMed, Ovid, EMbase, MEDLINE and CENTRAL, were searched by computer to collect randomized controlled trials (RCTs) on selective single and double cleavage embryo transfer. According to the Cochrane systematic review method, two researchers independently selected the literature, extracted the data, and evaluated the quality of the methodology included in the study. Meta-analysis was performed using RevMan 5.1 software. Results A total of 9 RCTs were enrolled in this study. A total of 2 784 patients were enrolled, of which 1 452 were in the experimental group and 1 332 in the control group. Meta-analysis showed that selective single cleavage embryo transfer reduced live births per transplant cycle compared with two cleavage stage embryo transfers [RR = 0.66,95% CI (0.59, 0.73), P <0.000 01], significantly reducing the rate of multiple pregnancies [RR = 0.95, 95% CI (0.02, 0.11), P <0.0001] (RR = 0.25, 95% CI (0.15, 0.44), P <0.000 01], but the rate of ectopic pregnancy [RR = 0.55,95% CI (0.11, 2.77) , P = 0.47], abortion rate [RR = 1.33, 95% CI (0.92, 1.91), P = 0.13] and perinatal mortality [RR = 0.31,95% CI (0.03,2.76), P = 0.29] influences. Conclusions Selective single embryo transfer reduces clinical pregnancy rates, multiple pregnancy rates, premature births, and the incidence of low birth weight infants per transplant compared with the two embryo transfers. There are no significant differences in the other parameters between the two groups.