子宫内膜CD138阳性细胞对胚胎移植失败患者再次移植妊娠率的影响研究

Effect of endometrial CD138 positive cells on pregnancy rate of implantation in patients with embryo transfer failure

目的了解慢性子宫内膜炎的宫腔镜表现与内膜CD138细胞免疫组化阳性的关系,分析胚胎移植后种植失败的风险因素。方法回顾性分析2021年12月至2022年6月因胚胎移植后种植失败在我院行宫腔镜检查的不孕症患者资料。以组织病理学诊断标准作为金标准,评价宫腔镜表现(微小息肉、内膜充血和间质水肿)与组织病理学(内膜CD138免疫组化阳性)的相关性。再次胚胎移植后比较种植成功(妊娠)与种植失败(未妊娠)患者的相关指标差异,通过Logistic回归分析胚胎移植中种植失败的影响因素。结果共有224例患者纳入研究,内膜活检结果显示CD138阳性者49例(21.9%)。微小息肉与CD138阳性的相关系数为0.576(P<0.001),而内膜充血、间质水肿与CD138阳性无相关性(P>0.05)。胚胎移植后种植成功(妊娠者)111例(49.5%)。Logistic回归分析发现年龄[OR=0.73,95%CI(0.65,0.93),P<0.001]、移植日内膜厚度[OR=1.23,95%CI(1.09,1.35),P=0.03]和CD138阳性[OR=0.23,95%CI(0.07,0.44),P=0.01]是影响胚胎种植结局的独立危险因素。结论病理发现CD138阳性细胞是胚胎种植失败的独立影响因素。宫腔镜检查与内膜CD138免疫组化结果相关性不佳,无法替代内膜CD138免疫组化。

Objective:To understand the relationship between the hysteroscopic manifestations and the immunohistochemical positive CD138 cells in the chronic endometritis,and to analyze the risk factors of implantation failure after embryo transfer.Methods:The data of the infertile patients who underwent hysteroscopy due to implantation failure after embryo transfer in our hospital were retrospectively.Using histopathological diagnostic criteria as the gold standard,the correlation between hysteroscopic manifestations(minimal polyps,endometrial congestion and interstitial edema)and histopathological findings(immunohistochemistry positive of endometrial CD138)was evaluated.Comparing The differences in relevant indicators between patients with successful implantation(pregnancy)and those with failed implantation(non-pregnancy)after re-implantation of embryo.Logistic regression analysis was made to find the independent risk factor for embryo implantation failure.Results:A total of 224 patients was included,and 49 patients(21.9%)were CD138 positive in endometrial biopsy.The correlation coefficient of the association between minimal polyps and CD138 positive was 0.576(P<0.001).However,there was no correlation between endometrial congestion,interstitial edema and CD138 positivity.After embryo transfer,implantation was successful in 111 patients(49.5%).Logistic regression analysis found age[OR=0.73,95%CI(0.65,0.93),P<0.001],endometrial thickness≥8 mm on transfer day[OR=1.23,95%CI(1.09,1.35),P=0.03]and CD138 positivity[OR=0.23,95%CI(0.07,0.44),P=0.01]were the independent risk factors for embryo implantation.Conclusions:Pathological findings suggest that it is an independent risk factor for predicting embryo implantation failure that CD138 positive cells were detected by pathological examination.The correlation between the results of hysteroscopy examination and endometrial CD138 immunohistochemistry is not good,and it cannot replace endometrial CD138 immunohistochemistry.