PBMCs宫腔灌注对PCOS患者冻融胚胎移植周期妊娠结局的影响

Effect of PBMCs intrauterine perfusion on pregnancy outcome of frozen-thawed embryo transfer cycle in PCOS patients

目的探讨外周单个核细胞(PBMCs)宫腔灌注对多囊卵巢综合征(PCOS)患者冻融胚胎移植(FET)周期妊娠结局的影响。方法选择2017年1月至2019年12月在秦皇岛市妇幼保健院生殖医学科行冻融胚胎移植的PCOS患者382例为研究对象,随机分为试验组(n=192)和对照组(n=190)。所有入选患者选择诱导排卵方案准备内膜,排卵后3 d进行胚胎移植。试验组排卵前抽取自体外周血分离单个核细胞,与HCG混合共培养24 h,于移植前3 d宫腔灌注,对照组于移植前3 d使用培养液宫腔灌注。两组患者分别于宫腔灌注前、移植前留取宫腔液,用Bio-Plex悬液芯片系统检测宫腔液内子宫内膜容受性相关细胞因子的表达。结果试验组与对照组的年龄、不孕年限、体重指数(BMI)、基础性激素、抗缪勒管素(AMH)差异无统计学意义。试验组宫腔灌注后宫腔液中单核细胞趋化蛋白-1(MCP-1)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-2的水平较治疗前下降,而IL-10、调节激活正常T细胞表达分泌因子(RANTES)水平较治疗前升高,差异有统计学意义。而对照组,宫腔灌注前后MCP-1、TNF-α、RANTES、IL-2、IL-10水平无显著变化。两组的移植优胚率、异位妊娠率无显著差异,试验组的着床率、临床妊娠率升高,早期流产率降低(P<0.05)。结论PBMCs宫腔灌注可能通过调整相关细胞因子的表达改善了PCOS患者FET周期的妊娠结局。

Objective To investigate the effect of peripheral blood mononuclear cells(PBMCs)intrauterine perfusion on the pregnancy outcome of freeze-thaw embryo transfer(FET)cycle in the patients with polycystic ovary syndrome(PCOS).Methods Three hundreds and eighty two patients with PCOS undergoing FET in the reproductive medicine department of Qinhuangdao Municipal Maternal and Child Health Care Hospital from April 2017 to December 2019 were selected as the study subjects and divided into the experimental group(n=192)and control group(n=190).All selected patients chose the ovulation induction scheme to prepare the endometrium and the embryo transfer was performed on 3 d after ovulation.In the experimental group,the mononuclear cells were isolated from peripheral blood before ovulation,mixed with HCG and co-cultured for 24 h,and perfused in the uterine cavity on 3 d before transplantation.The control group was perfused with culture solution on 3 d before transplantation.The uterine fluid was collected before intrauterine perfusion and transplantation,and the expression of endometrial receptivity related cytokines in uterine fluid was detected by Bio-Plex suspension chip system.Results There was no statistically significant difference in the age,infertility years,BMI,basic hormones and AMH between the experimental group and control group.After intrauterine perfusion,the levels of MCP-1,TNF-αand IL-2 in uterine cavity fluid of the experimental group were decreased compared with those before treatment,while the levels of IL-10 and RANTES were increased,and the differences were statistically significant.But there was no significant change in the levels of MCP-1,TNF-α,RANTES,IL-2,IL-10 before and after the uterine perfusion in the control group.There was no significant difference in the rate of optimal embryo transplantation and ectopic pregnancy rate between the two groups.The implantation rate and clinical pregnancy rate in the experimental group were increased,while the early abortion rate was decreased(P<0.05).Conclusion Intrauterine perfusion of PBMCs may improve the pregnancy outcome of FET cycles in PCOS patients by regulating the expression of related cytokines.