富血小板血浆促子宫内膜增殖对妊娠结局的影响

Platelet-Rich Plasma Promoted the Growth of Endometrium and Pregnancy Rate in Women with Thin Endometrium

目的：探讨富血小板血浆（PRP）促子宫内膜增殖、改善薄型子宫内膜患者临床妊娠结局的应用价值。方法：选择薄型子宫内膜患者94例,其中53例予PRP治疗（PRP组）,于冷冻胚胎移植周期中给予PRP宫腔内灌注治疗,另41例未予PRP治疗（对照组）。ELISA法检测PRP组中PRP与全血中血小板计数（PLT）、血小板源生长因子（PDGF）-AB、PDGF-BB及转化生长因子β（TGF-β）的表达量,并比较PRP组与对照组黄体酮日子宫内膜厚度、胚胎种植率、生化妊娠率、临床妊娠率,同时采用Logistic多变量逻辑回归分析变量因素与妊娠结局的相关性。结果：153例行PRP宫腔内灌注的患者术后均未出现不良反应,制备的PRP中PLT、PDGF-AB、PDGF-BB及TGF-β表达量均较全血中明显升高（P〈0.01）。2PRP组黄体酮日子宫内膜可达7.56±0.38 mm,较对照组6.41±0.36 mm明显升高,差异有统计学意义（P〈0.05）。PRP组生化妊娠率、临床妊娠率、胚胎种植率均比对照组明显升高（P〈0.05）。3Logistic回归分析结果示,子宫内膜厚度与妊娠率有关（OR 1.48,95%CI 1.04~2.21,P〈0.05）;PRP与妊娠率有关（OR 3.16,95%CI 1.48~6.74,P〈0.05）。结论：制备的PRP达到治疗标准,结果满意。PRP具有促进子宫内膜增殖、改善薄型子宫内膜患者临床妊娠结局的临床效果,可作为菲薄子宫内膜的临床治疗中一种安全、有效的方法。

Objective： To investigate the effect of platelet-rich plasma（ PRP） administration in improving endometrium thickness and pregnancy rate in women with thin,poor responsive endometrium.Methods： A total of 94 patients undergoing assisted reproduction with thin endometrium were recruited in frozen-thawed embryo transfer cycle.53 and 41 patients were included in PRP treatment group and non-PRP group（ control group） respectively.The number of platelets,levels of platelet-derived growth factor-AB,-BB（ PDGF-AB,-BB） and transforming growth factor-beta（ TGF-β） were measured in PRP and peripheral blood by ELISA.Endometrial thickness,embryo implantation rate,biochemical pregnancy rate,and clinical pregnancy rate were compared on progesterone day between PRP group and control group. The relationship between the factors and pregnancy outcomes were analyzed by Logistic multivariate logistic regression analysis. Results： 153 cases who received PRP intrauterine infusion treatment had on side effects after the treatment.The PLT,PDGF-AB,PDGF-BB and TGF-β level in PRP blood were significantly higher than peripheral blood（ P 〈0. 01）. 2In PRP group,the thickness of endometrium（ 7. 56 ± 0. 38mm） on progesterone day was obviously higher than control group（ 6. 41±0. 36 mm）（ P〈0. 05）,embryo implantation rate,biochemical pregnancy rate,and clinical pregnancy rate in PRP group were obviously higher than control group（ P〈0. 05）.3Logistic regression analysis showed that endometrial thickness was related to the pregnancy rate（ OR 1. 48,95%CI 1. 04-2. 21,P 〈0. 05）,PRP was related to the pregnancy rate（ OR 3. 16,95%CI 1. 48-6. 74,P〈0. 05）.Conclusions： The prepared PRP achieves to the standard of clinical treatment,with satisfactory results.PRP plays an active role in promoting the proliferation of endometrium,and in improving pregnancy outcomes and embryo implantation rate,which can be a safe and effective method to treat the patients with thin,poor responsive endometrium.