不孕症患者子宫内膜炎阳性与冷冻胚胎移植结局关系

Correlation between chronic endometritis of infertile patients and their outcomes after frozen embryo transfer

目的:探讨不孕症患者慢性子宫内膜炎(CE)与冷冻胚胎移植(FET)结局的相关性。方法:回顾性收集2020年1月-2021年6月本院生殖医学中心行人工周期FET的430例患者临床资料,根据子宫内膜活检情况分为CE组(n=85)及非CE组(n=345),对CE组患者予以抗生素治疗,根据转归情况分为CE转阴组(n=65)和CE持续阳性组(n=20),比较CE持续阳性组、CE转阴组、非CE组一般资料,黄体转化日子宫内膜形态学指标(子宫内膜厚度、子宫内膜容积、子宫内膜形态分型)、子宫动脉血流动力学参数[收缩期峰值血液流速(PSV)、搏动指数(PI)、阻力指数(RI)]及FET结局,采用logistics回归分析CE阳性与FET失败的相关性。结果:CE持续阳性组子宫内膜厚度(0.92±_0.09cm)、子宫内膜容积(5.40±_0.23ml)及A型子宫内膜形态比率(15.0%)均小于CE转阴组和非CE组(P<0.05),子宫动脉PSV(32.04±1.23 cm/s)低于CE转阴组和非CE组,PI(2.53±0.21)、RI(0.94±0.11)高于CE转阴组和非CE组(均P<0.05),CE转阴组与非CE组上述各指标均无差异(P>0.05);logistics回归分析,CE阳性是FET失败的独立危险因素(P<0.05)。结论:不孕症患者CE与FET失败有关,可能通过影响子宫内膜容受性而影响临床妊娠,针对CE有效治疗后可获得较好的FET结局。

Objective:To investigate the correlation between chronic endometritis(CE)of infertile patients and their outcomes after frozen embryo transfer(FET).Methods:A total of 430 patients who underwent artificial cycle frozen embryo transfer from January 2020 to June 2021 were selected as research subjects retrospectively.According to the results of endometrial biopsy,these patients were divided into group A(85 patients with CE)and group B(345 patients without CE).The patients in group A were given antibiotic treatment,and the patients in group A were divided into group Al(65 patients with CE negative conversion)and group A2(20 patients with CE positive persistence)according to the outcomes of the patients after antibiotic treatment.The general data,the endometrial morphological indicators on the day of luteal transition,such as endometrial thickness,endometrial volume,and endometrial morphotype,the values of uterine artery hemodynamic parameters,such as peak systolic velocity(PSV),pulsatility index(PI),and resistance index(RI),and the outcomes of FET of the patients were compared among group Al,group A2,and group B.Logistics regression analysis was used to analyze the correlation between the positive CE of the patients and their FET failure.Results:The endometrial thickness(0.92±0.09cm),the endometrial volume(5.40±0.23ml),the ratio(15.0%)of endometrial type A,and the value of PSV(32.04±1.23cm/s)of uterine artery of the patients in group A2 were all significantly lower than those of the patients in group A1 and group B(P<0.05).The values of PI(2.53±0.21)and RI(0.94±0.11)of uterine artery of the patients in group A2 were significantly higher than those of the patients in group A1 and group B(P<0.05).There were no significant differences in the endometrial thickness,the endometrial volume,the ratio of endometrial type A,and the values of PI,RI,and PSV of uterine artery of the patients between group Al and group B(P>0.05).Logistic regression analysis showed that positive CE of the patients was an independent risk factor of their FET failure(P<0.05).Conclusion:CE of the infertility patients is associated with their FET failure,which may affect the clinical pregnancy rate by affecting their endometrial receptivity.So,the effective treatment of CE of these patients maybe lead to better FET outcomes.