宫腔内灌注粒细胞集落刺激因子联合低分子肝素在薄型子宫内膜患者冻融胚胎移植周期中的研究

目的:探讨宫腔内灌注粒细胞集落刺激因子(G-CSF)联合低分子肝素(LMWH)对薄型子宫内膜患者冻融胚胎移植(FET)周期中的临床疗效。方法:选取2018年6月-2019年10月于山西医科大学第一医院进行FET助孕治疗的薄型子宫内膜患者175例,根据患者自身意愿分为3组,A组:63例患者仅接受激素替代治疗;B组:52例患者接受激素替代治疗+宫腔内G-CSF灌注;C组:60例患者接受激素替代治疗+宫腔内G-CSF灌注+皮下注射LMWH。对3组患者的子宫内膜厚度、子宫内膜血流阻力指数(RI)、搏动指数(PI)、周期取消率、胚胎种植率、临床妊娠率、早期流产率、异位妊娠率等指标进行比较。结果:在内膜转化日,与A组相比,B、C组子宫内膜厚度、Ⅱ+Ⅲ型血流比例均增加,RI、PI均降低(P<0.05)。治疗结局方面,与A组相比,B、C组胚胎种植率、临床妊娠率增加,周期取消率降低,差异有统计学意义(P<0.05);B、C组间比较差异无统计学意义(P>0.05);C组早期流产率较B组降低,差异有统计学意义(P<0.05)。结论:在FET周期中宫腔内灌注G-CSF可提高薄型子宫内膜患者的子宫内膜厚度,改善子宫内膜的血流情况,提高胚胎种植率及临床妊娠率,注射LMWH可降低早期流产率。

The Application of Perfusion of Granulocyte Colony-Stimulating Factor in the Uterine Cavity Combined with Low Molecular Weight Heparin Injection in FET Women with Thin Endometrium

Objective:To investigate the clinical effect of intrauterine perfusion of the granulocyte colonystimulating factor(G-CSF)combined with low molecular weight heparin(LMWH)on the clinical outcomes of freeze-thaw embryo transfer(FET)in those patients with thin endometrium.Methods:A total of 175 patients with thin endometrium who received FET in the First Hospital of Shanxi Medical University from June 2018 to October2019 were selected and divided into 3 groups.Group A:63 patients only received hormone replacement therapy as the control group.Group B:52 patients received hormone replacement therapy and intrauterine G-CSF perfusion.Group C:60 patients received hormone replacement therapy and intrauterine G-CSF perfusion and subcutaneous injection of LMWH.Endometrial thickness,endometrial blood flow resistance index(RI),pulse index(PI),cycle cancellation rate,embryo implantation rate,clinical pregnancy rate,early abortion rate,ectopic pregnancy rate and other indicators of the three groups were compared.Results:On the endometrial conversion day,of endometrial thickness,typeⅡ+Ⅲblood flow type rate in the group B and C were significantly increased when compared with group A,while RI and PI in the group B and C were significantly lower(all P<0.05).The embryo implantation rate,clinical pregnancy rate and cycle cancellation rate in the group B and C were significantly reduced when compared with group A(P<0.05),and there were no significant differences between the group B and C(P>0.05).The early abortion rate in the group C was significantly lower than that in the group B(P<0.05).Conclusions:Intrauterine perfusion of G-CSF during the FET cycle can significantly improve the endometrial thickness of patients with thin endometrium,the blood flow of endometrium,the embryo implantation rate and clinical pregnancy rate.The combined LMWH injection can reduce the early abortion rate.