中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (18): 3310-3313.doi: 10.3969/j.issn.1673-8225.2010.18.019

• 器官移植循证医学 evidence-based medicine of organ transplantation • 上一篇    下一篇

宫腔内人工授精中应用上游法和密度梯度离心法的系统评价

李  涛1,2，郭庆华3，田金徽4，张  伟3，郭柏鸿5，李国平2，罗能钦5，李朝彬1，姜  雷3,4，贾文琴4，李仁举2，张  朋2,4，陈一戎5   

  1. 1陕西省宝鸡市妇幼保健院男科，陕西省宝鸡市    721000；2兰州大学第一临床医学院，甘肃省兰州市    730000；3兰州大学第一医院，甘肃省兰州市  730000；4兰州大学循证医学中心，甘肃省兰州市    730000；5甘肃省人民医院，甘肃省兰州市    730000
  • 出版日期:2010-04-30 发布日期:2010-04-30
  • 通讯作者: 陈一戎，硕士，主任医师，博士生导师，甘肃省人民医院泌尿外科，甘肃省兰州市 730000 cyirong@yahoo.com
  • 作者简介:李 涛★，男，1970年生，陕西省宝鸡市人，汉族，兰州大学临床医学院在读硕士，主治医师，主要从事泌尿外科与男科方面的研究。 litao22222828@sina.com

Swim-up and density gradient centrifugation preparation techniques for intrauterine insemination: A systematic review

Li Tao 1，2， Guo Qing-hua3,Tian Jin-hui4, Zhang Wei3, Guo Bai-hong5, Li Guo-ping2, Luo Neng-qin5, Li Zhao-bin1, Jiang Lei 3, 4, Jia Wen-qin4, Li Ren-ju2, Zhang Peng 2 , 4, Chen Yi-rong5   

  1. 1 Department of Andrology, Woman and Child Health Hospital, Baoji   721000, Shaanxi Province, China;    2 First Clinical Medical College of Lanzhou University, Lanzhou  730000, Gansu Province, China; 3 First Hospital of Lanzhou University, Lanzhou  730000, Gansu Province, China;4 Evidence-
    based Medicine Center of Lanzhou University, Lanzhou  730000, Gansu Province, China; 5 People’s Hospital of Gansu Province, Lanzhou   730000, Gansu Province, China
  • Online:2010-04-30 Published:2010-04-30
  • Contact: Chen Yi-rong, Master, Chief physician, Doctoral supervisor, People’s Hospital of Gansu Province, Lanzhou 730000, Gansu Province, China cyirong@yahoo.com
  • About author:Li Tao★, Studying for master’s degree, Attending physician, Department of Andrology, Woman and Child Health Hospital, Baoji 721000, Shaanxi Province, China; 2First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, China litao22222828@sina.com

PDF

506

被引次数

5

摘要：

背景：精子体外优选方法很多，最常见的是上游法和密度梯度离心法。采用何种方法来减少体外处理过程对精子的不良刺激，优选出具有良好受精潜能的精子，目前尚无定论。
目的：系统评价上游法和密度梯度离心法在宫腔内人工授精中的应用，比较两种精子优选法的优劣。
方法：计算机检索PubMed、Cochrane Library、EMBASE等数据库，手工检索专业相关期刊，检索时间为1966-01/2009-02。纳入关于两种精液优选法在宫腔内人工授精中应用的随机对照试验或半随机对照试验，评价纳入研究的方法学质量，并提取有效数据用RevMan 5.0.软件进行Meta分析。
结果与结论：纳入6个研究，包括4个随机对照试验和2个半随机对照试验，共486例患者，1 099个周期(优选精子的次数)。Meta分析结果显示，上游法与梯度离心法相比，周期妊娠率[OR=1.11，95%CI(0.8，1.55)]、流产率[OR=0.31, 95%CI(0.09，1.04)]、精子密度[WMD=-0.89，95%CI(-14.17，12.38)]、精子活力[WMD=-2.31，95%CI(-7.27，2.65)]，4项测量指标差异均无显著性意义。尽管与其他精子优选法相比，上游法与梯度离心法的周期妊娠率较高，但是该系统评价结果还不能提示这两种方法在宫腔内人工授精应用中何者临床效果更好。建议今后进行更多高质量的随机双盲对照试验为临床提供最佳证据，并且增加处理前后精子的质量对比，包括精子活力、精子密度以及精子功能等指标测量，以全面考察两种方法的优劣。

关键词: 宫腔内人工授精, 上游法, 密度梯度离心法, 精子优选法, 系统评价

Abstract:

BACKGROUND: There are many in vitro selection method of sperm, and swim-up and density gradient centrifugation are commonly used. It remains unclear which method minimizes bad stimulation to the sperm and select sperm with high fertilization potential.
OBJECTIVE: To evaluate the effectiveness of swim-up and gradient centrifugation preparation techniques on intrauterine insemination (IUI).
METHODS: A computer-based online search of Cochrane Library, PubMed, EMBASE databases was performed, and some related journals were manually searched for related articles published between January 1966 and February 2009. The quality of included randomized controlled trials (RCT) and q-randomized trials (Q-RCT) was evaluated and Meta-analysis was conducted by the Cochrane Collaboration’s software RevMan5.0. Experts.
RESULTS AND CONCLUSION: A total of 6 studies were included, involving 4 RCTs and 2 Q-RCTs. A total of 486 patients     (1 099 IUI cycles) were enrolled. The Meta-analysis indicated that there was no difference between swim-up and gradient centrifugation preparation techniques for the IUI in terms of cycle pregnancy rates [OR = 1.11, 95%CI (0.8, 1.55)], miscarriage rates [OR = 0.31, 95%CI (0.09,1.04)], sperm count [the weight mean difference (WMD) = -0.89, 95%CI(-14.17, 12.38)], sperm motility [WMD = -2.31, 95%CI(-7.27, 2.65)]. There is insufficient evidence to confirm which is the best method in the two specific preparation techniques. The quality of study methods should be improved. And more measure parameters should be included when comparing it before or after treatment, such as sperm motility, sperm count, sperm function.

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