温肾活血方对反复移植失败患者种植窗子宫内膜形态及血流的影响

Effect of Wenshen Huoxue decoction on endometrial morphology and blood flow at implantation window in patients with repeated implantation failure

目的探讨温肾活血方对反复移植失败(RIF)患者种植窗子宫内膜形态及血流的影响。方法选取2016年1月至2017年2月于我院生殖医学中心就诊的100例RIF患者为研究对象,使用随机数字表进行分组,给予不同处理:对照组(50例)予以常规冻融胚胎移植(FET)方案进行内膜准备;中药组(50例)在对照组基础上加用温肾活血方口服,自月经第3天开始服用至移植前1日。比较两组的临床妊娠率、种植率,子宫内膜厚度、血流情况,螺旋动脉搏动指数(PI)及阻力指数(RI),并HE染色观察子宫内膜形态,扫描电镜观察胞饮突发育等。结果中药组临床妊娠率(40.0%)、种植率(23.2%)有高于对照组(分别为24.0%、14.9%)的趋势,但均无显著性差异(P>0.05);中药组移植日子宫内膜厚度、血流情况、PI及RI均明显优于对照组(P<0.05);中药组移植日子宫内膜腺体及腺腔面积显著高于对照组(P<0.05);RIF患者移植日子宫内膜胞饮突数量减少,中药组较对照组胞饮突发育成熟,形态饱满,表面绒毛减少。结论温肾活血方能够有效改善RIF患者种植窗子宫内膜形态,改善内膜血流状态,增加子宫内膜容受性,有利于胚胎着床。

Objective： To explore the effects of Wenshen Huoxue decoction on endometrial morphology and blood flow at implantation window in patients with repeated implantation failure（RIF）.Methods： One hundred patients with RIF who were treated in our hospital from January 2016 to February 2017 were selected as subjects.The patients were randomly divided into WSHX group and control group,and 50 patients for each group.The control group was given the conventional regimen of frozen-thawed embryo transfer（FET）for endometrial preparation.Based on the control group,the patients in WSHX group was given Wenshen Huoxue decoction from the third day of the menstrual cycle to one day before transplantation.The clinical pregnancy rate,implantation rate,endometrial thickness,blood flow,spiral artery pulsatility index（PI）and resistance index（RI）were compared between the two groups.HE staining was used to observe the morphology of endometrium,and scanning electron microscopy was used to observe pinopode.Results： The clinical pregnancy rate（40.0% vs.24.0%）and the implantation rate（23.2% vs.14.9%）in WSHX group were higher than control group,but with no significant difference（P0.05）.The endometrial thickness,blood flow,PI and RI in WSHX group were significantly better than those in control group（P0.05）.The area of the endometrial gland and glandular cavity in WSHX group was significantly bigger than that of control group（P0.05）.The number of pinopode in the endometrium was decreased in the patients with RIF.The development of pinopodes in WSHX group was more mature than control group.Conclusions： Wenshen Huoxue decoction can improve the endometrial morphology at implantation window and blood flow,and increase endometrial tolerance for promoting embryo implantation.