抗生素治疗对胚胎反复着床失败合并子宫内膜炎患者妊娠结局的影响

Effects of antibiotic treatment on pregnancy outcomes in woman with repeated implantation failure

目的探讨抗生素治疗对胚胎反复着床失败(RIF)合并子宫内膜炎(CE)患者冻融胚胎移植(FET)妊娠结局的影响。方法回顾性分析2018年1月至2019年12月在武汉大学人民医院生殖中心就诊的331例RIF患者临床资料,收集患者黄体中期子宫内膜标本,根据CD138免疫组化染色结果判定浆细胞浸润情况给予抗生素治疗,再根据患者CE转归情况分为CE持续强阳性组(n=5)、CE弱阳组(n=27)、CE转阴组(n=82)及非CE组(n=217),其中CE弱阳组、CE转阴组、非CE组行FET,比较行FET 3组患者的基本资料、胚胎移植情况及临床妊娠结局。结果331例RIF患者中合并CE者为114例,检出率为34.44%(114/331),其中强阳检出率为25.98%(86/331),弱阳检出率为8.46%(28/331),经抗生素治疗后转阴率为71.93%(82/114)。3组患者的年龄、体质量指数(BMI)、窦卵泡计数(AFC)、抗苗勒管激素(AMH)水平、不孕年限、不孕类型、既往移植周期数、移植日内膜厚度以及移植胚胎个数均无显著性差异(P>0.05)。妊娠结局中,与CE弱阳组比较,CE转阴组的HCG阳性率(85.37%vs.48.14%)、临床妊娠率(75.61%vs.40.74%)、着床率(51.72%vs.25.49%)及活产率(62.20%vs 37.04%)均显著升高(P<0.05);非CE组的HCG阳性率(68.20%vs.48.14%)和着床率(43.19%vs.25.49%)也显著升高(P<0.05),临床妊娠率(60.37%vs.40.74%)和活产率(56.68%vs.37.04%)有升高趋势,但差异尚未有统计学意义(P>0.05);CE转阴组与非CE组相比,HCG阳性率(85.37%vs.68.20%)、临床妊娠率(75.61%vs.60.37%)及流产率(16.13%vs.3.82%)均显著升高(P<0.05),两组间的临床着床率和活产率差异无统计学意义(P>0.05)。结论对于反复种植失败的患者建议完善CE相关检查,抗生素治疗能显著改善CE转阴者FET周期妊娠结局。

Objective:To evaluate the effect of antibiotic therapy on pregnancy outcomes in woman with recurrent implantation failure(RIF)and chronic endometritis(CE).Methods:The clinical date of 331 RIF patients in Renming Hospital of Wuhan University form January 2018 to December 2019 were retrospectively analyzed.The endometrial samples were collected in the middle luteal phase.According to the results of CD138 immunohistochemical staining to determine the plasma cell infiltration,the patients were given antibiotic treatment.According to the endometritis treatment outcome,the patients were divided into three groups:CE continuous strong positive group[CE(+)group,n=5],CE weak positive group[CE(±)group,n=27],CE turned negative group[CE(-)group,n=82]and non-CE group(n=217).Among them,the patients in CE(+)group,CE(±)group and non-CE group were received the frozen-thawed embryo transfer(FET).The basic data,embryo transfer and clinical pregnancy outcomes of the three groups were compared.Results:Among 331 RIF patients,114 patients were combined with CE,and the detection rate was 34.44%(114/331).Among them,the strong positive rate was 25.98%(86/331),the weak positive rate was 8.46%(28/331).The turned negative rate after antibiotic treatment was 71.93%(82/114).There were no significant differences in age,body mass index(BMI),antral follicle count(AFC),anti-Mullerian hormone(AMH),duration of infertility,type of infertility,number of previous transfer cycles,endometrial thickness on the day of transfer and number of embryos transferred among the three groups(P>0.05).Compared with the CE(±)group,the HCG positive rate(85.37%vs.48.14%),clinical pregnancy rate(75.61%vs.40.74%),implantation rate(51.72%vs.25.49%)and the live birth rate(62.20%vs 37.04%)in the CE(-)group were significantly increased(P<0.05).The positive rate of HCG(68.20%vs.48.14%)and implantation rate(43.19%vs.25.49%)in non-CE group were also significantly increased(P<0.05),while the clinical pregnancy rate(60.37%vs.40.74%)and live birth rate(56.68%vs.37.04%)had an increasing trend,but the difference was not significant(P>0.05).Compared with the non-CE group,the HCG positive rate(85.37%vs.68.20%)and clinical pregnancy rate(75.61%vs.60.37%)and miscarriage rate(16.13%vs.3.82%)in the CE(-)group were significantly increased(P<0.05),while the clinical implantation rate and live birth rate had no significantly different(P>0.05).Conclusions:For patients with repeated implant failure,it is recommended to improve the CE examination.Antibiotic treatment can significantly improve the pregnancy outcome of FET cycle in patients with turned negative CE.