主动免疫治疗对体外受精-胚胎移植的反复性自然流产患者的临床应用价值

Clinical value of active immunotherapy in the treatment of IVF-ET RSA

目的:探讨主动免疫治疗对体外受精-胚胎移植的反复性自然流产(recurrent spontaneous abortion,RSA)患者的临床应用价值。方法:分析2003年7月～2011年4月,在南京医科大学第一附属医院临床生殖科免疫治疗的42例RSA患者行IVF/ICSI治疗的62个周期。RSA患者采用淋巴细胞行主动免疫治疗,妊娠后分别采用人绒毛膜促性腺激素(human chorionic go-nadotrophin,HCG)或黄体酮保胎治疗。结果:移植胚胎数目为116个,平均移植胚胎数目为(1.87±0.61)个,HCG日内膜厚度为(9.08±2.03)mm。成功率为64.29%(27/42),免疫妊娠成功率96.43%(27/28),胚胎种植率28.45%(33/116),生化妊娠率50.00%(31/62),临床妊娠率45.16%(28/62),流产率3.57%(1/28),活产率24.19%(15/62),剖宫产率93.33%(14/15)。结论:对于行IVF/ICSI治疗的RSA患者,主动免疫治疗可以提高患者免疫反应性,有效降低流产率,有助于妊娠成功,是一种安全简单有效的治疗方法。

Objective：To investigate the clinical value of active immunotherapy in the treatment of IVF-ET RSA.Methods：We retrospectively analyzed 62 cycles of IVF / ICSI RSA among 42 infertile couples during July 2003 to April 2011.The RSA patients were treated by active immunotherapy combined with tocolysis using HCG or Progesterone after pregnancy.Results：The number of embryo transferred was 116,the average number of embryo transferred was 1.87 ± 0.61,and the endometrial thickness of HCG day was（9.08 ± 2.03） mm.The achievement rate was 64.29%（27 / 42）,the pregnancy achievement rate behind immunotherapy treatment was 96.43%（27 / 28）,the embryo implantation rate was 28.45%（33 / 116）,the biochemical pregnancy rate was 50.00%（31 / 62）,the clinical pregnancy rate was 45.16%（28 / 62）,the miscarriage rate was 3.57%（1 / 28）,the live birth rate was 24.19%（15 / 62）,the cesarean section rate was 93.33%（14 / 15）.Conclusion：In IVF / ICSI RSA,the active immunotherapy can improve the patient immunity reactivity,effectively reduce the miscarriage rate,and improve the successful pregnancy.So it is a safe and simple treatment.