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目的评价乙型肝炎病毒(HBV)感染的不孕夫妇行体外受精(IVF)或卵胞浆内单精子注射(ICSI)后临床结局,为临床应用提供证据。方法采用计算机和手工检索主题词的方法,检索PubM ed、Embase、WileyO nline Library、Cochrane Library、Google Scholar、中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、重庆维普中文科技期刊全文数据库、万方科技期刊全文数据库,检索时限从建库至2014年5月,查找关于HBV感染的夫妻行IVF/ICSI后妊娠结局的相关研究,对纳入研究的文献进行质量评价,采用Revman5.2和Stata10.0软件进行Meta分析。结果纳入15个观察性研究,共9 343例。Meta分析结果显示,夫妻双方单纯一方感染HBV的人群与正常对照组相比,受精率、植入率和临床妊娠率差异无统计学意义。单纯女方感染HBV的人群,流产发生风险较高(RR=1.57,95%CI为1.05~2.36,P=0.03)。夫妻双方均感染HBV的人群与正常对照组相比,胚胎植入率有统计学意义(RR=0.44,95%CI为0.25~0.78,P=0.005),但临床妊娠率差异无统计学意义。结论单纯女方感染HBV的人群,流产发生风险较高。当夫妻双方均为HBV感染时,IVF/ICSI胚胎植入率可能受影响。
Objective To evaluate the clinical outcome of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) in infertile couples with hepatitis B virus (HBV) infection and provide evidence for clinical application. Methods Using computer and hand-searched keywords, we searched PubMed, Embase, Wiley Online Library, Cochrane Library, Google Scholar, CNKI, CBM, Full-text Database, Wanfang Sci-tech Journals Full-text Database, Retrieval Timeline From the establishment of the database to May 2014, we searched for relevant studies on pregnancy outcome after IVF / ICSI of couples with HBV infection and evaluated the quality of the included literature with Revman5. 2 and Stata10.0 software Meta-analysis. Results Fifteen observational studies were included, 9,343. Meta analysis showed that there was no significant difference in fertilization rate, implantation rate and clinical pregnancy rate between the two groups who were infected with HBV on one side only compared with the normal control group. Women with HBV infection alone have a higher risk of miscarriage (RR = 1.57, 95% CI, 1.05-2.66, P = 0.03). Embryo implantation rates were statistically significant (RR = 0.44, 95% CI 0.25-0.78, P = 0.005) in both groups infected with HBV, but there was no significant difference in clinical pregnancy rates between the two groups. Conclusions The risk of miscarriage is higher in women with HBV infection alone. IVF / ICSI embryo implantation rates may be affected when both spouses are HBV infected.