自体淋巴细胞宫腔灌注对反复种植失败患者妊娠结局的影响

Effect of Intrauterine Infusion of Lymphocytes on the Outcome of Pregnancy in Patients With Recurrent Implantation Failure

目的探讨自体外周血淋巴细胞宫腔内灌注治疗对胚胎反复着床失败(RIF)患者的冷冻胚胎移植(FET)周期妊娠结局的影响。方法选取2014年1月—2015年1月在南京医科大学附属常州市妇幼保健院生殖中心行FET的RIF患者74例,将再次FET周期移植前3 d要求接受淋巴细胞宫腔灌注治疗的患者作为治疗组(38例),未接受淋巴细胞宫腔灌注治疗的患者作为对照组(36例)。治疗组患者在行FET前3 d,抽取静脉血20 ml,应用淋巴细胞分离液制备自体淋巴细胞后行宫腔灌注治疗。观察两组内膜准备方案、FET周期移植胚胎数以及妊娠结局。结果两组年龄、不孕年限、基础卵泡刺激素(FSH)、体质指数(BMI)、移植优质胚胎数、不孕类型比较,差异均无统计学意义(P>0.05)。治疗组人工周期33例(86.8%),自然周期5例(13.2%),平均内膜厚度(9.5±1.2)mm,平均移植胚胎数(2.11±0.45)枚,平均移植优质胚胎数(1.51±0.50)枚;对照组人工周期30例(83.3%),自然周期6例(16.7%),平均内膜厚度(9.0±1.7)mm,平均移植胚胎数(2.17±0.44)枚,平均移植优质胚胎数(1.64±0.76)枚。两组内膜准备方案(χ2=0.18,P=0.67)、平均内膜厚度(t=1.35,P=0.18)、平均移植胚胎数(t=-0.58,P=0.55)、平均移植优质胚胎数(t=-0.83,P=0.41)比较,差异均无统计学意义。治疗组胚胎种植率为22.5%(18/80),临床妊娠率为34.2%(13/38);对照组胚胎种植率为7.0%(5/71),临床妊娠率为8.3%(3/36)。治疗组胚胎种植率和临床妊娠率均高于对照组,差异有统计学意义(χ2=7.388,P=0.007;χ2=7.791,P=0.010)。结论通过自体淋巴细胞宫腔内灌注免疫治疗,可以有效改善RIF患者FET周期的妊娠结局。

Objective To investigate the effect of intrauterine infusion of lymphocytes on the outcome of pregnancy of frozen embryo transfer（ FET） in patients with recurrent implantation failure（ RIF）. Methods We enrolled 74 RIF patients who received FET in the reproductive center in Changzhou Women and Children Health Hospital Affiliated to Nanjing Medical University from January 2014 to January 2015. Patients who required to have intrauterine infusion of lymphocytes three days before the next FET cycle were assigned into treatment group（ n = 38）,and patients who didn＇ t have intrauterine infusion of lymphocytes were assigned into control group（ n = 36）. After autologous lymphocytes were prepared using lymphocyte separation medium,and intrauterine infusion treatment was conducted. Intima preparation plan,number of transferred embryo during FET cycle and pregnancy outcomes of the two groups were observed. Results The two groups were not significantly different in age,years of infertility,FSH,BMI,number of high-quality transferred embryos and type of infertility（ P 0. 05 for all）. In treatment group, there were 33（ 86. 8%） cases of artificial cycle and 5（ 13. 2%） cases of natural cycle; the average thickness of intima was（ 9. 5 ± 1. 2） mm, the average number of transferred embryo was（ 2. 11 ± 0. 45）, and the average number of high quality transferred embryo was（ 1. 51 ± 0. 50）. In control group,there were 30（ 83. 3%） cases of artificial cycle and 6（ 16. 7%） cases of natural cycle; the average thickness of intima was（ 9. 0 ± 1. 7） mm,the average number of transferred embryo was（ 2. 17 ± 0. 44）,and the average number of high quality transferred embryo was（ 1. 64 ± 0. 76）. The two groups were not significantly different in intima preparation plan（ χ2= 0. 18,P = 0. 67）,the average thickness of intima（ t= 1. 35,P = 0. 18）,the average number of transferred embryo（ t =-0. 58, P = 0. 55）, and the average number of high quality transferred embryo（ t =-0. 83,P = 0. 41）. For treatment group,the embryo implantation rate of the treatment group was 22. 5%（ 18 /80）,and the clinical pregnancy rate was 34. 2%（ 13 /38）; for control group,the embryo implantation rate for control group was 7. 0%（ 5 /71）,and the clinical pregnancy rate was 8. 3%（ 3 /36）. Treatment group was higher than control group in the embryo implantation rate and clinical pregnancy rate（ χ2= 7. 388,P = 0. 007; χ2= 7. 791,P = 0. 010）.Conclusion Autologous lymphocyte infusion in intrauterine in FET cycle may be an effective approach to improve the embryo implantation rate and clinical pregnancy rate in patients with RIF.