重组人生长激素在FET周期中治疗薄型子宫内膜的应用

Effects of recombinant human growth hormone on patients with thin endometrium undergoing frozen-thawed embryo transfer

目的 探讨重组人生长激素(rhGH)在冻融胚胎移植(FET)周期中治疗薄型子宫内膜的应用价值。方法 收集2018年1月至2020年12月在本院生殖医疗中心行FET治疗的薄型子宫内膜患者74例为研究对象。计算样本量后根据激素替代治疗(HRT)启动时间的不同分为3组:宫腔灌注组(HRT+宫腔灌注rhGH,24例)、皮下注射组(HRT+皮下注射rhGH,25例)和对照组(仅行HRT,25例)。比较3组患者的一般资料、移植胚胎情况、治疗前后子宫内膜参数及妊娠结局。结果 3组患者间一般资料比较均无显著性差异(P>0.05),移植胚胎类型和平均移植胚胎数亦无显著性差异(P>0.05)。3组患者间治疗前子宫内膜厚度、体积、内膜类型、内膜血流类型、血流参数等均无显著性差异(P>0.05)。治疗后,宫腔灌注组和皮下注射组的内膜厚度、内膜厚度增幅显著高于对照组(P<0.05),皮下注射组的内膜体积增幅显著高于对照组(P<0.05)。宫腔灌注组治疗后的内膜厚度、内膜体积、内膜下血流指数(FI)均显著高于治疗前(P<0.05);皮下注射组治疗后的内膜厚度、内膜体积、内膜FI和内膜下血管化指数(VI)显著高于治疗前(P<0.05)。3组患者间胚胎着床率、临床妊娠率、早期流产率等均无显著性差异(P>0.05)。结论 HRT联合宫腔灌注或皮下注射rhGH均能显著增加薄型子宫内膜患者的内膜厚度和体积,改善内膜的血流灌注;且两种rhGH给药方式的疗效相似。

Objective:To evaluate the application value of recombinant human growth hormone(rhGH) supplementation in the treatment of thin endometrium.Methods:Seventy-four patients with thin endometrium who underwent frozen-thawed embryo transfer(FET) in the reproductive medical center of our hospital from January 2018 to December 2020 were collected as the research objects. After calculating the sample size, according to the different working schedule of hormone replacement therapy(HRT) protocol, they were divided into three groups: intrauterine perfusion group(HRT+intrauterine infusion of rhGH,n=24),subcutaneous injection group(HRT+subcutaneous injection rhGH,n=25) and control group(only HRT,n=25). The general data, embryo transfer, endometrial parameters and pregnancy outcomes of the three groups were compared.Results:There was no significant difference in general information, type and number of embryos transferred and average number of embryos transferred among three groups(P>0.05).There was no significant difference in endometrial thickness and volume, endometrial type, endometrial blood flow type and blood flow parameters among the three groups before treatment(P>0.05). After treatment, the endometrial thickness and thickness increase in intrauterine perfusion group and subcutaneous injection group were significantly higher than those in control group(P<0.05). The increase of endometrial volume in subcutaneous injection group was significantly higher than that in control group(P<0.05). Endometrial thickness and volume and sub-endometrial blood flow index(FI) were significantly increased after treatment compared with those before treatment in intrauterine perfusion group(P<0.05). Endometrial thickness and volume, endometrial FI and sub-endometrial vascularization index(VI) were significantly higher after treatment than those before treatment in the subcutaneous injection group(P<0.05). There were no significant differences in embryo implantation rate, clinical pregnancy rate, early abortion rate, etc. among the three groups(P>0.05).Conclusions:HRT combined with intrauterine perfusion or subcutaneous injection of rhGH can significantly increase the thickness and volume of endometrium in patients with thin endometrium, improve blood perfusion of endometrium. And the efficacy of intrauterine perfusion and subcutaneous injection were similar.