血浆D-二聚体水平对复苏周期结局的意义

Association of plasma D-dimmer levels with outcome of frozen-thawed embryo transfer cycles

目的探讨血浆D-二聚体水平对复苏周期妊娠率、种植率以及流产率的意义。方法在接受体外受精(IVF)和单精子卵泡浆内显微注射(ICSI)治疗患者中,选择2015年1月至2016年7月复苏周期的患者,排除染色体异常及子宫畸形、多囊卵巢综合征(PCOS)及甲状腺疾病,按就诊日期随机分为对照组(A组)913例,D-二聚体检测组(B组)614例。A组未检测D-二聚体,B组所有患者于准备复苏周期月经第2天早晨抽血检测每例患者D-二聚体水平。B组D-二聚体水平高于参考值范围的患者给予低分子肝素钙注射液4 100U皮下注射7~21d至D-二聚体恢复至正常值,再予阿司匹林25mg口服至妊娠,3次/d。对于既往有难免流产史、D-二聚体值持续性或反复性升高的患者,予低分子肝素钙注射液4 100U/d皮下注射至妊娠12周以上。分析两组妊娠率、种植率、流产率的差异。结果 B组D-二聚体升高者为178例,占29.0%。A组与B组的妊娠率、着床率比较,差异均无统计学意义(均P>0.05);但B组流产率低于A组,差异有统计学意义(P<0.01)。结论在复苏周期前通过检测发现高D-二聚体患者,皮下注射速碧林及口服阿司匹林改善血液高凝状态,虽不能提高患者的妊娠率、着床率,但可有效降低流产率。

Objective To investigate the association of D-dimmer with the outcome of frozen-thawed embryo transfer cycles.Methods Data were obtained from frozen-thawed embryo transfer cycles patients between January 2015 to July 2016,the patients with chromosomal abnormalities and uterine malformation,polycystic ovary syndrome(PCOS)and thyroid diseases were excluded.Patients were divided into the control group(A,n=913)and D-Dimmer treatment group(B,n=614),according to the admission date.D-Dimmer levels were measured in group(B)on the d2 of the period cycle.If the D-Dimmer levels were higher than the reference range,low molecular heparin calcium 4100U was injected subcutaneously for 7-21d until D-Dimmer level returned to normal,then oral aspirin 25mg was given tid until pregnancy.The patients who had a history of inevitable abortion,the D-Dimmer levels were persistently or repeatedly increased,low molecular heparin calcium 4100U qd was subcutaneously injected for more than 12 weeks of pregnancy.The pregnancy rate,implantation rate,and pregnancy loss rate were analyzed with Chi-square and T test.Results The D-Dimmer levels were increased in 178 cases of group B(29.0%).There were no significant differences in pregnancy rate and implantation rate between groups A and B(P>0.05),but the rate of pregnancy loss in the group B was lower than that in group A(P<0.01).Conclusion Low-molecular-weight heparin injection and oral aspirin given to high D-Dimmer patients before frozen-thawed embryo transfer cycles can effectively reduce the pregnancy loss rate.