生长激素在薄型子宫内膜患者冻融胚胎移植周期内膜准备中应用的临床研究

Clinical Study Clinical research on the application of growth hormone in the preparation of thin endometrium

目的探讨薄型子宫内膜患者冻融胚胎移植(FET)周期使用激素替代联合生长激素(growth hormone,GH)准备内膜的有效性。方法采用前瞻性队列研究,选取2017年1月至2019年6月期间就诊于沈阳九州家圆医院生殖中心,既往因人绒毛膜促性腺激素(hCG)注射日内膜厚度<7 mm取消新鲜周期移植拟FET的患者。经患者知情同意,根据患者意愿分成3组:A组激素替代同时宫腔灌注GH(n=76);B组激素替代同时给予皮下注射GH(n=72);C组单纯激素替代治疗(n=66)。比较3组间患者基本情况及FET预后指标。结果3组间患者的年龄、不孕年限、体质量指数(BMI)、基础卵泡刺激素(FSH)、基础黄体生成素(LH)、基础雌二醇水平差异均无统计学意义(P>0.05)。3组间移植胚胎数、移植优质胚胎数及治疗前子宫内膜厚度差异均无统计学意义(P>0.05)。治疗后,子宫内膜厚度A组[(7.7±0.8)mm]显著高于B组[(7.3±0.8)mm,P=0.002]和C组[(6.7±0.9)mm,P<0.001],B组显著高于C组(P<0.001)。子宫内膜血流:阻力指数(RI)和搏动指数(PI)A组(0.52±0.10,1.27±0.21)低于B组(0.57±0.07,1.64±0.41)和C组(0.68±0.14,2.27±0.48),3组间差异有统计学意义(P<0.001)。收缩末期与舒张末期血流速度比值(S/D):C组(3.39±0.89)显著高于B组(2.50±0.46,P<0.001)和A组(2.37±0.32,P<0.001);A组和B组间差异无统计学意义(P>0.05)。C组周期取消率(33.33%)比A组(13.16%)、B组(18.06%)都高,3组间差异有统计学意义(P=0.010)。A组临床妊娠率(48.48%)高于其他两组(28.81%,27.27%),3组间差异有统计学意义(P=0.027),但流产率3组间差异没有统计学意义(P>0.05)。结论在FET周期,激素替代联合宫腔灌注GH治疗可增加子宫内膜厚度、改善薄型子宫内膜下血流状况,而且操作简单。

Objective To explore the effectiveness of growth hormone(GH)combined with hormone replacement therapy in thin endometrium patients prepararing for frozen-thawed embryo transfer(FET).Methods Prospective cohort study was performed.Totally 214 patients who had been treated in Reproductive Center of Jiuzhou Perfect Hospital of Shenyang from January 2017 to June 2019,cancelled fresh cycle transplantation due to endometrial thickness less than 7 mm on the day of human chorionic gonadotropin(hCG)administration in previous fresh cycle,were divided into three groups according to their wishes:group A,hormone replacement combined with intrauterine perfusion of growth hormone(n=76);group B,hormone replacement combined with subcutaneous injection of GH(n=72);group C,single hormone replacement therapy(n=66).The basic situation of patients and prognostic indicators of FET among the three groups were compared.Results There was no significant difference in age,infertility duration,body mass index(BMI),basic follicular stimulating hormone(FSH),basic luteinizing hormone(LH)and basic estrogen among the three groups(P>0.05).And there was no significant difference in the number of embryos transferred,the number of high-quality embryos transferred and the thickness of endometrium before treatment(P>0.05).After treatment,endometrial thickness of group A[(7.7±0.8)mm]was higher than that of group B[(7.3±0.8)mm,P=0.002]and group C[(6.7±0.9)mm,P<0.001],and that of group B was higher than that of group C(P<0.001),the difference was statistically significant.Endometrial blood flow:resistance index(RI)and pulsation index(PI)of group A(0.52±0.10,1.27±0.21)were lower than those of group B(0.57±0.07,1.64±0.41)and group C(0.68±0.14,2.27±0.48),and the difference among the three groups was statistically significant(P<0.001).Ratio of end systolic to end diastolic velocity(S/D)of group C(3.39±0.89)was higher than that of group B(2.50±0.46,P<0.001)and group A(2.37±0.32,P<0.001),but there was no significant difference between group A and group B(P>0.05).The cancellation rate of cycle in group C(33.33%)was higher than that in group A(13.16%)and group B(18.06%),and the pregnancy rate in group A(48.48%)was higher than that in groups B and C(28.81%,27.27%),the differences were statistically significant among the three groups(P=0.010,P=0.027).But there was no significant difference in abortion rate among the three groups(P>0.05).Conclusion In FET cycle,hormone replacement combined with GH intrauterine perfusion can increase endometrial thickness,improve thin endometrial blood flow,and the operation is simple.