粒细胞集落刺激因子宫腔灌注在改善薄型子宫内膜中的应用价值

Application value of intrauterine perfusion of granulocyte colony- stimulating factor in improving thin endometrium

目的:探讨粒细胞集落刺激因子(G-CSF)宫腔灌注对薄型子宫内膜容受性的影响。方法:选取既往因移植日内膜<7 mm取消新鲜体外受精(IVF)组移植周期,该周期拟行冻融胚胎移植患者204例。随机分为两组,激素替代组118例(对照组)和激素替代联合G-CSF宫腔灌注组86例(观察组),观察并分析治疗前后两组子宫内膜增厚情况,子宫内膜下血流情况及临床结局。结果:两组患者治疗后子宫内膜厚度均较前增加,观察组治疗前后比较差异有统计学意义(P<0.05);观察组子宫内膜治疗前后增加幅度高于对照组,差异有统计学意义(P<0.05)。观察组月经第15天(D15)Ⅱ+Ⅲ血流类型较对照组Ⅱ+Ⅲ血流类型显著增加,差异有统计学意义(P<0.01);观察组D15Ⅱ+Ⅲ血流类型较月经第8天(D8)Ⅱ+Ⅲ血流类型显著增加,差异有统计学意义(P<0.01)。观察组D15搏动指数(PI)、阻力指数(RI)较D8 PI、RI降低,差异有统计学意义(P<0.05)。观察组临床妊娠率高于对照组,差异有统计学意义(P<0.05)。结论:G-CSF宫腔灌注可增加薄型子宫内膜厚度,改善子宫内膜下血流状况,有效提高临床妊娠率。

Objective： To explore the effect of intrauterine perfusion of granulocyte colony - stimulating factor （ G - CSF） On re- ceptivity of thin endometrium. Methods： A total of 204 patients who canceled fresh in vitro fertilization （IVF） cycles because of the thick- ness of endometrium 〈 7 mm on the day of transfer and underwent frozen - thawed embryo transfer were selected and randomly divided into control group （118 cases, hormone replacement therapy） and observation group （86 cases, hormone replacement therapy combined with in- trauterine perfusion of G -CSF） ; the endometrial thicknesses, endometrial blood flow conditions and clinical outcomes in the two groups before and after treatment were observed and analyzed. Results： The endometrial thicknesses after treatment in the two groups were thicker than those before treatment, and there was statistically significant difference in observation group （ P 〈 0. 05 ） ; the increasing amplitude of endometrial thickness after treatment in observation group was statistically significantly higher than that in control group （ P 〈 0. 05 ） . The percentage of type Ⅱ and type Ⅲ endometrial blood flow on the fifteenth day of menstruation in observation group was statistically significantly higher than that in control group （ P 〈 0. 01 ） ; in observation group, the percentage of type ]1 and type 11I endometrial blood flow on the fifteenth day of menstruation was statistically significantly higher than that on the eighth day of menstruation （ P 〈 0. 01 ） . In observation group, pulsatility index （PI） and resistance index （RI） on the fifteenth day of menstruation were statistically significantly lower than those on the eighth day of menstruation （ P 〈 0. 05 ） . The clinical pregnancy rate in observation group was statistically significantly higher than that in control group （ P 〈 0. 05 ） . Conclusion： Intrauterine perfusion of G - CSF can increase thin endometrial thickness, improve endometrial blood flow condition and effectively improve clinical pregnancy rate.