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免疫调节疗法对反复着床失败患者的有效性：系统评价和网络荟萃分析。

The effectiveness of immunomodulatory therapies for patients with repeated implantation failure: a systematic review and network meta-analysis.

机构信息

Kapok Zhucheng Medical Clinic, No. 302, No. 9, Huaqiang Road, Tianhe District, Guangzhou, 510623, China.

Shanghai Kapok Integrated Traditional Chinese and Western Medicine Clinic Co., Ltd., 3rd Floor, No. 21 Pudong South Road, Pudong New Area, Shanghai, 200126, China.

出版信息

Sci Rep. 2022 Nov 1;12(1):18434. doi: 10.1038/s41598-022-21014-9.

DOI:10.1038/s41598-022-21014-9
PMID:36319652
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9626579/
Abstract

This meta-analysis analyzed the clinical pregnancy outcomes of repeated implantation failure (RIF) patients treated with immunomodulatory therapies. Publications (published by August 16, 2021) were identified by searching the PubMed, Embase, and Web of Science databases. The quality of the studies was evaluated with the Cochrane bias risk assessment tool, and a network meta-analysis was performed with Stata 14.0. The outcomes were clinical pregnancy rate (CPR), live birth rate (LBR), and implantation rate (IR). The results of our network meta-analysis of 16 RCTs (including 2,008 participants) show that PBMCs, PRP, and SC-GCSF can significantly improve the CPR compared with LMWH (PBMCs: OR 2.15; 95% CI 1.21-3.83; PRP: OR 2.38; 95% CI 1.08-5.24; SC-GCSF: OR 2.46; 95% CI 1.05-5.72). The LBR of PRP was significantly higher than those of IU-GCSF (OR 3.81; 95% CI 1.22-11.86), LMWH (OR 4.38; 95% CI 1.50-12.90), and intralipid (OR 3.85; 95% CI 1.03-14.29), and the LBR of PBMCs was also significantly better than that of LMWH (OR 2.35; 95% CI 1.14-4.85). Furthermore, PRP treatment significantly improved the IR compared with LMWH treatment (OR 2.81; 95% CI 1.07-7.4). The limited evidence from existing RCTs suggests that PBMCs and PRP are the best therapeutic options for RIF patients. However, owing to the quantity limitation, more top-quality research is required to obtain additional high-level evidence.

摘要

这项荟萃分析分析了接受免疫调节治疗的反复着床失败（RIF）患者的临床妊娠结局。通过检索 PubMed、Embase 和 Web of Science 数据库，确定了出版物（截至 2021 年 8 月 16 日发布）。使用 Cochrane 偏倚风险评估工具评估研究质量，并使用 Stata 14.0 进行网络荟萃分析。结果为临床妊娠率（CPR）、活产率（LBR）和着床率（IR）。我们对 16 项 RCT 的网络荟萃分析结果（包括 2008 名参与者）表明，PBMC、PRP 和 SC-GCSF 与 LMWH 相比可以显著提高 CPR（PBMC：OR 2.15；95%CI 1.21-3.83；PRP：OR 2.38；95%CI 1.08-5.24；SC-GCSF：OR 2.46；95%CI 1.05-5.72）。PRP 的 LBR 显著高于 IU-GCSF（OR 3.81；95%CI 1.22-11.86）、LMWH（OR 4.38；95%CI 1.50-12.90）和中链甘油三酯（OR 3.85；95%CI 1.03-14.29），PBMC 的 LBR 也显著优于 LMWH（OR 2.35；95%CI 1.14-4.85）。此外，PRP 治疗与 LMWH 治疗相比，IR 显著改善（OR 2.81；95%CI 1.07-7.4）。现有 RCT 的有限证据表明，PBMC 和 PRP 是 RIF 患者的最佳治疗选择。然而，由于数量限制，需要更多高质量的研究来获得更多高级别的证据。

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