低分子肝素抗凝对IVF-ET反复着床失败者妊娠结局的影响

Effect of low molecular weight heparin anticoagulation therapy on IVF-ET pregnancy outcome in patients with repeated implantation failure

目的探讨低分子肝素抗凝治疗对体外受精-胚胎移植(IVF-ET)反复着床失败者妊娠结局的影响。方法回顾性分析2018年10月至2020年10月于宝鸡市妇幼保健院进行IVF-ET反复着床失败的258例不孕患者的临床资料。按照处理手段的不同分组,其中94例常规移植后仅给予常规黄体支持者纳入对照组,164例在对照组的基础上给予低分子肝素抗凝治疗者纳入研究组。比较两组患者不同时间点的子宫动脉血流阻力指数(RI)、D-二聚体及妊娠结局。结果植入胚胎14 d时,两组患者的RI和D-二聚体比较差异均无统计学意义(P>0.05);植入胚胎28 d与45 d时,研究组患者的RI、D-二聚体分别为1.55±0.10、(0.32±0.10)μg/mL和1.43±0.10、(0.32±0.09)μg/mL,明显低于对照组的1.62±0.13、(0.49±0.16)μg/mL和1.46±0.12、(0.51±0.15)μg/mL,差异均有统计学意义(P<0.05);研究组患者的早期流产率、总流产率分别为10.98%、13.41%,明显低于对照组的21.28%、24.47%,活产率为84.76%,明显高于对照组的73.40%,差异均有统计学意义(P<0.05),而两组患者的晚期流产率和异位妊娠率比较差异均无统计学意义(P>0.05)。结论低分子肝素抗凝治疗应用于IVF-ET反复着床失败患者能够提升妊娠活产率、降低流产率,值得推广应用。

Objective To explore the effect of low molecular weight heparin anticoagulation therapy on the pregnancy outcome of in vitro fertilization-embryo transfer(IVF-ET)in patients with repeated implantation failure.Methods The clinical data of 258 patients with repeated implantation failure in IVF-ET in Baoji Maternal and Child Health Hospital from October 2018 to October 2020 were retrospectively analyzed.According to different treatment methods,94 patients who received only conventional corpus luteum support after conventional transplantation were included in the control group,and 164 patients who received low molecular heparin anticoagulation therapy on the basis of the control group were included in the study group.The uterine artery blood flow resistance index(RI),D-dimer,and pregnancy outcome of the two groups at different time points were compared and analyzed.Results At 14 days after embryo implantation,the RI and D-dimer showed no statistically significant difference between the study group and the control group(P>0.05);at 28 days and 45 days after embryo implantation,RI and D-dimer in the study group were 1.55±0.10,(0.32±0.29)μg/mL and 1.43±0.10,(0.32±0.27)μg/mL,which were significantly lower 1.62±0.13,(0.49±0.45)μg/mL and 1.46±0.12,(0.51±0.46)μg/mL in the control group(P<0.05);the early abortion rate and total abortion rate of the study group were 10.98%and 13.41%,which were significantly lower than 21.28%and 24.47%of the control group,and the live birth rate was 84.76%,which was significantly higher than 73.40%in the control group,all with statistically significant differences(P<0.05);the late abortion rate and ectopic pregnancy rate showed no statistically significant difference between the two groups(P>0.05).Conclusion Low molecular weight heparin anticoagulation therapy applied to patients with repeated implantation failure undergoing IVF-ET can increase the rate of live births and reduce the rate of miscarriage.It is one of the effective ways to improve pregnancy outcomes,which is worthy of popularization.