反复胚胎移植失败与首次胚胎移植成功不孕症患者阴道微生态特点差异

Difference of vaginal microecological characteristics of the infertile patients with repeated embryo transfer failure and with successful embryo transfer for the first time

目的:分析反复胚胎移植失败与首次胚胎移植成功不孕症患者的阴道菌群微生态特点差异。方法:收集2016年2月-2019年10月在本院反复胚胎移植失败的不孕症患者77例为失败组,首次胚胎移植成功的不孕症患者80例为成功组,比较两组阴道分泌物菌群微生态形态学和功能学特点差异。结果:失败组阴道分泌物菌群多样性(I级和IV级)、菌群密集度(I级和IV级)、滴虫检测阳性比例均高于成功组(P<0.05),而真菌检测两组无差异(P>0.05);失败组以乳杆菌为优势菌比例及Nugent评分低于成功组,阴道分泌物PH>4.6、白细胞酯酶阳性、乙酰氨基葡萄糖苷酶阳性、唾液酸苷酶阳性、β-葡萄糖醛酸酶阳性及过氧化氢水平不足占比均高于成功组,诊断为微生态失调(55.8%)高于成功组(13.8%)(均P<0.05)。失败组以中间型BV、BV、AV、TV检出率高于成功组(P<0.05),VVC、BV+VVC、中间型BV+VVC检出率两组无差异(P>0.05)。结论:反复胚胎移植失败不孕症患者阴道菌群微生态失调,临床应加强对不孕症患者阴道菌群微生态分析,采取针对性诊疗措施纠正微生态失调,以提高胚胎解冻移植成功率。

Objective: To analyze the difference of vaginal microecological characteristics of the infertile patients with repeated embryo transfer failure and the infertile patients with successful embryo transfer for the first time. Methods: 77 infertile patients with repeated embryo transfer failure were selected in observation group from February 2016 to October 2019, and 80 infertile patients with successful embryo transfer for the first time were selected in control group during the same period. The differences of vaginal microecological morphology and functional characteristics of the patients were compared between the two groups. Results: The vaginal secretion flora diversity(grade I and IV), flora density(grade I and IV), and the positive rate of trichomonal test of the patients in the observation group were significant higher than those of the patients in the control group(P<0.05), but there was no significant difference in fungal detection result of the patients between the two groups(P>0.05). The proportion of the patients with lactobacillus as dominant bacteria and the Nugent score of the patients in the observation group were significant lower than those of the patients in the control group. The percentage of patients with vaginal PH >4.6, leukocyte esterase positive, acetylglucosaminidase positive, sialidase positive, and β-glucuronidase positive of vaginal secretion, and the level of hydrogen peroxide in vaginal secretion of the patients in the observation group were significant higher than those of the patients in the control group. The proportion of vaginal microecological dysregulation(55.8%) of the patients in the observation group was significant higher than that(13.8%) of the patients in the control group(all P<0.05). The detection rates of intermediate type BV, BV, AV and TV of the patients in the observation group were significant higher than those of the patients in the control group(P<0.05), but there was no significant difference in the detection rates of VVC, BV+VVC, and intermediate type BV and VVC of the patients between the two groups(P>0.05). Conclusion: The infertility patients with repeated failure of embryo transfer have the microecological imbalance of vaginal flora,so the analysis of vaginal microflora of the infertile patients should be strengthened,and targeted treatment measures should be taken to correct their vaginal microecological imbalance in clinical practice,so as to improve the success rate of thawing embryo transfer.