反复着床失败患者慢性子宫内膜炎的诊治价值

Value of diagnosis and treatment of chronic endometritis in patients with recurrent implantation failure

目的探索反复着床失败(recurrent implantation failure,RIF)患者合并慢性子宫内膜炎(chronic endometritis,CE)经过抗生素治疗后行冻融胚胎移植(frozen-thawed embryo transfer,FET)的妊娠结局。方法采用回顾性队列研究分析2018年1月至2021年12月期间于华中科技大学同济医学院附属同济医院生殖医学中心就诊的496例RIF患者,在下次冻融胚胎助孕前行宫腔镜检查及子宫内膜组织活检。依据内膜组织病理学检查结果和后续的治疗方案,共纳入患者494例,分为CE治愈组(CD138强阳性经抗生素治疗后转阴,n=103)、可疑CE组(CD138弱阳性,n=76)、非CE组(CD138阴性,n=230)、对照组(宫腔镜检查+诊断性刮宫,未进行CE组织病理学筛查,n=85),分析比较各组患者宫腔镜术后首次FET的妊娠结局。结果 RIF人群中CE的发病率为25.5%(105/411),宫腔镜诊断CE的灵敏度为55.2%,特异度为83.0%。CE患者在经过1个周期抗生素治疗后转阴率为86.7%(91/105),2个周期治疗后转阴率为98.1%(103/105)。通过多因素logistic回归分析去除年龄、卵巢储备功能、既往移植周期数、FET周期移植胚胎数、胚胎类型以及优质胚胎数等混淆因素后,与对照组相比,CE治愈组FET周期临床妊娠率得到明显改善(OR=2.625,95%CI:1.104~6.239,P=0.029)。结论 RIF患者应重视CE的筛查,如果确诊为CE,建议在胚胎移植前给予药物治疗,有利于改善FET周期的妊娠结局。

Objective To explore the pregnancy outcomes of frozen-thawed embryo transfer(FET)after antibiotic treatment in patients with recurrent implantation failure(RIF)and chronic endometritis(CE).Methods A retrospective cohort study was conducted to analyze 496 women with RIF undergoing hysteroscopy and endometrial biopsy before the next FET in Reproductive Medicine Center of Tongji Hospital,Tongji Medicine College,Huazhong University of Science and Technology from January 2018 to December 2021.According to the pathological results of endometrial biopsy and subsequent treatment,the patients were divided into cured CE group(strong positive CD138 was converted to negative after antibiotic treatment,n=103),suspected CE group(weak positive CD138,n=76),non-CE group(negative CD138,n=230)and control group(hysteroscopy and diagnostic only,no CE-related histopathological screening,n=85).The pregnancy outcomes after FET were compared among the four groups.Results The prevalence of CE in the patients with RIF was 25.5%(105/411),and the sensitivity of hysteroscopy for the diagnosis of CE was 55.2%and the specificity was 83.0%.The conversion rate of patients with CE was 86.7%(91/105)after 1 cycle of antibiotic treatment and 98.1%(103/105)after 2 cycles of treatment.After removing the confounding factors of age,ovarian reserve function,number of previous transfer cycles,number and type of embryos transferred in FET cycle,and number of high-quality embryos,multivariate regression analysis showed that the clinical pregnancy rate of the cured CE group improved significantly after antibiotic treatment(OR=1.841,95%CI:1.123-3.020,P=0.029).Conclusion Patients with RIF should be screened for CE,and if CE is diagnosed,pharmacological treatment is recommended prior to embryo transfer,which is beneficial to improve pregnancy outcomes in FET cycles.