宫腔灌注人粒细胞巨噬细胞刺激因子对薄型子宫内膜患者冻融胚胎移植疗效的研究

Efficacy of intrauterine perfusion of human granulocyte/macrophage colony-stimulating factor on outcome of frozen-thawed embryo transfer in patients with thin endometrium

目的研究宫腔内灌注重组人粒细胞巨噬细胞刺激因子(rhGM-CSF)凝胶对薄型子宫内膜患者冻融胚胎移植(FET)妊娠结局的影响。方法选取2018年1月至2019年12月在我院生殖中心行FET的156例薄型子宫内膜患者,根据宫腔内是否使用rhGM-CSF凝胶灌注分组,仅使用降调节激素替代方案治疗的为对照组(n=70),在降调节激素替代方案的基础上给予rhGM-CSF凝胶宫腔内灌注的为实验组(n=86)。比较两组患者黄体酮转化日子宫内膜厚度及助孕结局。实验组患者根据灌注治疗前子宫内膜厚度和灌注周期数的不同又分为3个亚组,将子宫内膜厚度为0.65~0.70 cm且灌注1周期的患者纳入实验A组(n=38),子宫内膜厚度为0.60~0.65 cm且灌注2周期的患者纳入实验B组(n=32),子宫内膜厚度≤0.6 cm且灌注3周期的患者纳入实验C组(n=16),比较3个亚组患者黄体酮转化日子宫内膜厚度及妊娠结局。结果实验组患者rhGM-CSF灌注后黄体酮转化日子宫内膜厚度为(0.74±0.13)cm显著厚于灌注前(0.65±0.53)cm和对照组(0.67±0.56)(P<0.05)。实验组的胚胎种植率、临床妊娠率及活产率均显著高于对照组(P<0.05),两组流产率比较无显著差异(P>0.05)。实验A组患者rhGM-CSF灌注后黄体酮转化日子宫内膜厚度与实验B组比较无显著差异(P>0.05),实验C组患者rhGM-CSF灌注后黄体酮转化日子宫内膜厚度显著低于A组和B组(P<0.05)。实验A胚胎种植率和临床妊娠率与实验B组比较均无显著差异(P>0.05),但两组流产率及活产率比较均有显著差异(P<0.05);实验C组胚胎种植率、临床妊娠率及活产率均显著低于A组和B组(P<0.05),但流产率与实验A组比较无显著差异(P>0.05)。结论薄型子宫内膜患者行FET时采用宫腔灌注rhGM-CSF凝胶治疗,能够显著增加子宫内膜厚度,有效改善妊娠结局。

Objective:To investigate the effect of intrauterine perfusion of recombinant human granulocyte/macrophage colony stimulating factor(rhGM-CSF)on the clinical outcomes of frozen-thawed embryo transfer(FET)in patients with thin endometriumMethods:The patients undergoing FET in Chengdu Women’s and Children’s Central Hospital from Jan.2018 to Dec.2019 were recruited.According to whether the rhGM-CSF gel was perfused into the intrauterine cavity,the patients were divided to two groups:the patients were only treated with down-regulation&hormone replacement therapy(HRT)in the control group(n=70);intrauterine rhGM-CSF gel was perfused into the intrauterine cavity on the basis of down-regulation&HRT in the experimental group(n=86).The differences of endometrium thickness and pregnancy outcome were compared between the two groups.The patients in the experimental group were divided into three subgroups according to the endometrial thickness before perfusion and perfusion cycle times.The patients with endometrial thickness of 0.65-0.70 cm and one perfusion cycle were included in the experimental group A(n=38).The patients with endometrial thickness of 0.60-0.65 cm and two perfusion cycles were included in the experimental group B(n=32).The patients with endometrial thickness≤0.6 cm and three perfusion cycles were included in group C(n=16).The endometrial thicknesses on progesterone transformation day and pregnancy outcomes were compared among the three subgroups.Results:The endometrial thickness on progesterone transformation day after rhGM-CSF perfusion in the experimental group[(0.74±0.13)cm]was significantly thicker than that in the control group[(0.67±0.56)cm]and that before rhGM-CSF perfusion[(0.65±0.53)cm](P<0.05).The embryo implantation rate,clinical pregnancy rate and live birth rate of the experimental group were significantly higher than those of the control group(P<0.05),and there was no significant difference in the abortion rate between the two groups(P>0.05).There was no significant difference in endometrial thickness on progesterone transformation day after rhGM-CSF perfusion between group A and B(P>0.05).The endometrial thickness on progesterone transformation day after rhGM-CSF in group C was significantly lower than that in group A and B(P<0.05).There was no significant difference in embryo implantation rate and clinical pregnancy rate between group A and B(P>0.05),but there was significant difference in abortion rate and live birth rate between the two groups(P<0.05).The embryo implantation rate,clinical pregnancy rate and live birth rate of group C were significantly lower than those of group A and B(P<0.05),but there was no significant difference in abortion rate between group A and B(P>0.05).Conclusions:Intrauterine infusion of rhGM-CSF can increase the endometrium thickness in FET cycle and improve pregnancy outcome.