自体血小板富集血浆宫腔灌注对高龄伴子宫内膜炎患者解冻胚胎移植妊娠结局的影响

Effects of autologous platelet-rich plasma intrauterine perfusion on pregnancy outcomes of thawed embryo transfer in aged patients with endometritis

目的探讨自体血小板富集血浆(PRP)宫腔灌注对高龄伴子宫内膜炎患者解冻胚胎移植妊娠结局的影响。方法回顾性分析2018年1月至2021年11月海南省妇女儿童医学中心诊治的166例行宫腔镜及子宫内膜活检提示子宫内膜炎的冷冻胚胎移植患者的临床资料。按治疗方法将其分为对照组(口服盐酸多西环素标准治疗,并行冷冻胚胎解冻移植,n=78)与观察组(在对照组基础上联合PRP宫腔灌注治疗,n=88)。比较两组治疗后在解冻胚胎移植周期中的妊娠结局、子宫内膜厚度、子宫动脉搏动指数(PI)、子宫动脉阻力指数(RI)及子宫内膜组织CD138浆细胞转阴率。结果观察组胚胎种植率、临床妊娠率显著高于对照组,早期流产率显著低于对照组,差异具有统计学意义(P<0.05);两组异位妊娠率、流产患者年龄比较,差异无统计学意义(P>0.05);观察组子宫内膜厚度显著大于对照组,PI、RI显著低于对照组,差异具有统计学意义(P<0.05);观察组治疗后CD138转阴率显著高于对照组,差异具有统计学意义(P<0.05)。结论高龄伴子宫内膜炎患者在解冻胚胎移植前行PRP宫腔灌注,能有效改善其的子宫内膜容受性,抑制炎症反应,从而提高临床妊娠率,改善临床结局。

Objective To investigate the effects of autologous platelet-rich plasma(PRP)intrauterine perfusion on pregnancy outcomes of thawed embryo transfer in aged patients with endometritis.Methods Clinical data of 166 patients with frozen embryo transplantation who underwent hysteroscopy and endometrial biopsy indicating endometritis were retrospectively analyzed in Hainan Women and Children′s Medical Center from January 2018 to November 2021.According to treatment methods,patients were divided into control group(oral doxycycline hydrochloride standard treatment,combined with frozen embryo thawing and transplantation,n=78)and observation group(combined with PRP intrauterine perfusion therapy on the basis of the control group,n=88).The pregnancy outcomes,endometrial thickness,uterine artery beat index(PI),uterine artery resistance index(RI),and endometrial tissue CD138 plasma cell negative conversion rate between the two groups were compared.Results The embryo implantation rate and clinical pregnancy rate in observation group were significantly higher than the control group,and the early abortion rate was significantly lower than the control group(P<0.05).There was no difference in the ectopic pregnancy rate and the age of abortion patients between two groups(P>0.05).The endometrial thickness was significantly higher in the observation group than in the control group,and the PI and RI were significantly lower than those in the control group(P<0.05).The CD138 negative conversion rate after treatment was significantly higher in the observation group than in the control group(P<0.05).Conclusions PRP intrauterine perfusion before thawed embryo transfer in aged patients with endometritis can improve their endometrial receptivity and inhibit the inflammatory response,thus improving the clinical pregnancy rate and clinical outcome.