冻融胚胎移植前CD38、CD138联合筛查慢性子宫内膜炎对妊娠结局的影响

Effect on pregnancy outcome of women screening chronic endometritis by CD38 and CD138 before frozen-thawed embryo transfer

目的探索既往胚胎移植未孕患者宫腔镜子宫内膜活检和CD38、CD138联合筛查慢性子宫内膜炎(chronic endometritis,CE),治疗后再次胚胎移植的妊娠结局。方法采用回顾性队列研究,收集2015年1月1日至2018年12月31日期间,在北京大学第三医院妇产科生殖医学中心有胚胎移植未孕史、在下次冻融胚胎助孕前行宫腔镜子宫内膜活检的共2073例患者临床资料。依据子宫内膜病理结果将患者分为CE组(CD38和CD138同时阳性)、非CE组(CD38和CD138同时阴性)、可疑组(CD38和CD138其一阳性)、未查组(HE染色未提示CE,也未行免疫组织化学筛查),以活产率为主要终点指标,分析比较各组冻融胚胎移植妊娠结局,并对相关因素进行分析。结果患者组间一般情况,包括年龄、体质量指数、不孕年限、既往移植未孕次数、基础卵泡刺激素、窦卵泡计数等差异均无统计学意义(均P>0.05),未查组宫腔镜手术至胚胎移植间隔较短[4(3,6)个月、4(2,6)个月、4(3,6)个月和3(2,6)个月,P<0.001],每周期移植胚胎数较少[2(1,2)枚、2(1,2)枚、2(1,2)枚和1(1,2)枚,P=0.037],差异有统计学意义,各组临床妊娠率、持续妊娠率、早期流产率、活产率差异均无统计学意义(均P>0.05),但非CE组临床妊娠率、持续妊娠率、活产率较高。多因素回归分析显示,药物治疗后CE不影响活产结局(OR=0.789,95%CI=0.579~1.075,P=0.133)。结论CD38、CD138联合确诊CE患者建议在胚胎移植前进行必要的药物治疗,药物治疗后患者妊娠结局与非CE患者相当,其一指标阳性即CD38或CD138阳性不予药物治疗,对妊娠结局无明显影响。

Objective To explore the pregnancy outcome of women with previous unpregnant embryo transfer(ET)cycles and screening chronic endometritis(CE)by hysteroscopic endometrial biopsy,CD38 and CD138 before the next frozen-thawed embryo transfer(FET).Methods A retrospective cohort study was conducted in Reproductive Center of Peking University Third Hospital from January 1st,2015 to December 31st,2018,including 2073 patients with previous unpregnant ET cycles and receiving hysteroscopic endometrial biopsy before FET.According to the pathological results of endometrium,the patients were divided into CE group(both CD38 and CD138 were positive),non-CE group(both CD38 and CD138 were negative),suspected group(one of CD38 or CD138 was positive),and unexamined group(no sign of CE in H&E stains or in the immunohistochemistry screening).The pregnancy outcomes after FET were compared among groups and logistic regression analysis was performed for live birth.Results There were no statistical differences in age,body mass index,duration of infertility,number of previous embryo transfer failures,basic follicle-stimulating hormone,number of antral follicles and endometrial thickness on the day of transfer among the four groups(all P>0.05).Unexamined group had the shortest interval between hysteroscopy and embryo transfer and less transferred embryos per cycle,and the differences were statistically significant[4(3,6)months,4(2,6)months,4(3,6)months and 3(2,6)months,P<0.001;2(1,2),2(1,2),2(1,2)and 1(1,2),P=0.037].The pregnancy outcome of FET cycle was similar among the four groups including clinical pregnancy rate,ongoing pregnancy rate,early miscarriage rate and live birth rate(all P>0.05).Clinical pregnancy rate,ongoing pregnancy rate and live birth rate were higher in non-CE group without statistical difference(P>0.05).Multivariate regression analysis showed that treated CE did not affect live birth(OR=0.789,95%CI=0.579-1.075,P=0.133).Conclusion Antibiotic treatment is recommended for patients with CE diagnosed by both CD38 and CD138 positive results,and the FET outcome of those patients is similar to patients without CE after treatment.Patients with either CD38 or CD138 positive have no adverse effects on pregnancy outcomes without treatment.