盆底神经肌肉电刺激治疗薄型子宫内膜患者的临床研究

Pelvic floor neuromuscular electrical stimulation in treatment of patients with thin endometrium

目的探讨盆底神经肌肉电刺激(PFNES)治疗,对于薄型子宫内膜(TE)患者子宫内膜厚度(ET)与血流灌注及妊娠情况的影响。方法选择2016年5月至2018年5月,在四川大学华西第二医院生殖医学科与生殖内分泌科接受门诊治疗、有生育需求的96例TE患者为研究对象。根据其是否接受PFNES治疗,将其分为研究组(n=51,采取雌激素+PFNES治疗)和对照组(n=45,仅采取雌激素治疗)。2组患者治疗前、后ET与子宫动脉搏动指数(PI)、阻力指数(RI)、子宫动脉收缩期与舒张期持续时间比值(S/D)的组间与组内比较,采用成组t检验与配对t检验。2组患者自然妊娠率、流产率比较,采用χ^(2)检验。与所有患者签署临床研究知情同意书。本研究获得四川大学华西第二医院伦理委员会的批准(审批文号:2015026)。2组患者年龄、不孕年限,基础雌二醇、卵泡刺激素(FSH)、促黄体激素(LH)水平,治疗前ET与子宫动脉PI、RI、S/D等临床资料比较,差异均无统计学意义(P>0.05)。结果①治疗后,研究组TE患者ET值为(9.2±1.1)mm,显著厚于其治疗前的(5.4±0.8)mm与对照组的(7.9±0.7)mm,并且差异均有统计学意义(t=6.327、4.352,均为P<0.001)。②治疗后,研究组TE患者子宫动脉PI、RI及S/D分别为(0.52±0.16)、(0.23±0.06)与(2.05±0.29),均显著低于其治疗前的(0.89±0.23)、(0.79±0.22)与(4.86±1.02),以及对照组的(0.78±0.12)、(0.67±0.14)与(3.92±1.02),并且差异均有统计学意义(t=4.178、6.743、7.246、6.583、5.235、5.932均为P<0.001)。③治疗1年后,研究组患者自然妊娠率为43.1%(22/51),显著高于对照组的13.3%(6/45),并且差异有统计学意义(χ^(2)=10.279,P=0.001);而2组患者流产率比较,差异无统计学意义(P>0.05)。结论采取PFNES治疗可增加TE患者的ET,提高子宫内膜血流灌注及其容受性,进而提高自然妊娠率。

Objective To investigate the effects of pelvic floor neuromuscular electrical stimulation(PFNES)on endometrial thickness(ET),blood perfusion and pregnancy in patients with TE.Methods A total of 96 outpatients with TE in the Department of Reproductive Medicine and Department of Reproductive Endocrinology,West China Second University Hospital,Sichuan University and had fertility needs from May 2016 to May 2018 were selected as research subjects.According to whether patients received PFNES therapy or not,they were divided into study group(n=51,received estrogen and PFNES therapy)and control group(n=45,only received estrogen therapy).ET,uterine artery pulsation index(PI),resistance index(RI),ratio of systolic to diastolic duration(S/D)before and after treatment in two groups were compared between groups and within groups by independent-samples t test and pairwise t test.Comparisons of spontaneous pregnancy rate and abortion rate between two groups were performed by chi-square test.All patients signed clinical research informed consents.This study was approved by the Ethics Committee of West China Second University Hospital,Sichuan University(Approved No.2015026).There were no statistical differences between two groups in age,years of infertility,basic estradiol,follicle stimulating hormone(FSH),luteinizing hormone(LH)levels,and ET,uterine artery PI,RI,S/D before treatment and other general clinical data(P>0.05).Results①After treatment,ET of TE patients in study group was(9.2±1.1)mm,which was significantly higher than that before treatment(5.4±0.8)mm,and also significantly higher than that of control group(7.9±0.7)mm,and differences were statistically significant(t=6.327,4.352,P all<0.001).②After treatment,uterine artery PI,RI and S/D of TE patients in study group were(0.52±0.16),(0.23±0.06),and(2.05±0.29),respectively,which were significantly lower than those before treatment(0.89±0.23),(0.79±0.22),and(4.86±1.02),and also significantly lower than those of control group of(0.78±0.12),(0.67±0.14)and(3.92±1.02),and all differences were statistically significant(t=4.178,6.743,7.246,6.583,5.235,5.932;P all<0.001).③One year after treatment in two groups,spontaneous pregnancy rate of study group was 43.1%(22/51),which was significantly higher than that of control group 13.3%(6/45),and the difference was statistically significant(χ^(2)=10.279,P=0.001);while there was no statistically significant difference in abortion rate between two groups(P>0.05).Conclusions The treatment of PFNES can increase ET of TE patients,improve endometrial blood perfusion and receptivity,thus improving spontaneous pregnancy rate of patients.