免疫抑制剂在反复胚胎种植失败患者中的应用价值研究

Study on the application value of immunosuppressant in patients with repeated embryo implantation failure

目的:观察免疫抑制剂环孢素A在反复胚胎着床失败患者中的临床疗效,探索免疫抑制剂在辅助生殖中的应用价值。方法:回顾性分析2016年1月至2018年1月在某院行体外受精-胚胎移植助孕治疗的97例反复胚胎着床失败患者的临床资料,根据再次行胚胎移植时是否应用环孢素A将患者分为研究组54例,对照组43例。比较2组患者胚胎着床率、临床妊娠率,观察外周血淋巴细胞免疫表型变化,以及不良事件发生情况。结果:采用χ2检验比较组间差异,研究组胚胎着床率(28.89%)、临床妊娠率(46.3%)均高于对照组(11.11%,23.26%),差异有显著性(P<0.05);治疗后CD3+T细胞、CD4+T细胞占淋巴细胞的比率下降,但差异无显著性;治疗后活化的CD3+T细胞比率(CD3+HLA-DR+)、B淋巴细胞(CD3-CD19+)较治疗前无显著性(P>0.05),CD8+T细胞占淋巴细胞的比率上升、CD4+/CD8+比值下降,NK细胞(CD3-CD16+CD56+)占淋巴细胞的比率明显下降,差异有显著性(P<0.05)。2组患者治疗过程中均未出现严重不良事件。结论:免疫抑制剂环孢素A能增加反复着床失败患者的胚胎着床率,提高临床妊娠率,促使外周血免疫细胞分布向有利于胚胎着床方向偏移,免疫抑制剂在辅助生殖中的应用值得进一步开展研究。

OBJECTIVE To observe the clinical efficacy of cyclosporine A in patients with recurrent embryo implantation failure and explore the value of immunosuppressive agents in assisted reproduction.METHODS The clinical data of 97 patients with repeated embryo implantation failure who underwent in vitro fertilization-embryo transfer assisted pregnancy treatment in our hospital from January 2016 to January 2018 were retrospectively analyzed.The patients were divided into study group(n=54)and control group(n=43)according to whether cyclosporine A was used during repeated embryo transfer.The embryo implantation rate,clinical pregnancy rate,immunophenotype of peripheral blood lymphocytes and adverse events were compared between the two groups.RESULTS The embryo implantation rate(28.89%)and clinical pregnancy rate(46.3%)in the study group were higher than those in the control group(11.11%,23.26%),with statistically significant differences.After treatment,the proportion of CD3+T cells and CD4+T cells in lymphocytes decreased,but the difference was not statistically significant.The ratio of activated CD3+T cells(CD3+hla-dr+)and B lymphocytes(CD3-CD19+)showed no significant difference after treatment(P>0.05);the ratio of CD8+T cells to lymphocytes increased,the ratio of CD4+/CD8+decreased,and the ratio of NK cells(CD3-CD16+CD56+)to lymphocytes decreased significantly(P<0.05).No serious adverse events occurred during the treatment of patients in both groups.CONCLUSION Cyclosporine A can increase the embryo implantation rate of patients with repeated implantation failure and improve the clinical pregnancy rate.The distribution of peripheral blood immune cells was shifted in favor of embryo implantation.The application of immunosuppressant in assisted reproduction is worthy of further research.