反复种植失败患者进行宫腔灌注自体PBMCs和PRP对妊娠结局的影响

The impact of intrauterine infusion of autologous PBMCs and PRP on pregnancy outcomes in patients with repeated implantation failure

目的分析进行宫腔灌注自体外周血单个核细胞(PBMCs)和富集血小板血浆(PRP)对反复种植失败(RIF)患者妊娠结局的影响。方法选取2021年3月至2023年6月在湖南省妇幼保健院行冻胚周期的96例反复种植失败患者,采用简单随机法分组,分成对照组(19例),PBMCs组(31例),PRP组(46例)。对照组未予宫腔灌注治疗;PBMCs组宫腔灌注PBMCs;PRP组宫腔灌注PRP。比较三组的一般情况、转化日内膜厚度、移植日内膜厚度、胚胎种植率和临床妊娠率。结果三组年龄、BMI、不孕年限、月经周期、血清基础卵泡刺激素(FSH)、基础雌二醇(E2)、移植周期数、移植胚胎数、移植优质胚胎数比较差异均无统计学意义(均P>0.05)。对照组、PRP组、PBMCs组转化日内膜厚度比较差异无统计学意义(均P>0.05)。PRP组移植日内膜厚度大于对照组及PBMCs组(均P<0.05),对照组、PBMCs组移植日内膜厚度比较差异无统计学意义(P>0.05)。PRP组与PBMCs组的胚胎种植率和临床妊娠率均高于对照组,且差异有统计学意义(均P<0.05)。PRP组的胚胎种植率和临床妊娠率与PBMCs组比较差异无统计学意义(均P>0.05)。患者在宫腔灌注治疗中均未发生感染、腹痛和阴道流血等不良反应。结论RIF患者在再次胚胎移植前宫腔灌注自体PBMCs或PRP可显著提高胚胎的种植率及临床妊娠率,改善助孕结局;宫腔灌注自体PRP较PBMCs对改善RIF患者临床助孕结局方面无明显优势;但更有益于子宫内膜厚度的改善。

Objective To analyze the impact of intrauterine infusion of autologous peripheral blood mononuclear cells(PBMCs)and enriched platelet plasma(PRP)on pregnancy outcomes in patients with recurrent implantation failure(RIF).Methods A total of 96 patients with repeated implantation failures who underwent frozen embryo cycles at Hunan Provincial Maternal and Child Health Care Hospital from March 2021 to June 2023 were selected and randomly divided into a control group(19 cases),PBMCs group(31 cases),and PRP group(46 cases).The control group did not receive uterine cavity infusion treatment;Intrauterine perfusion of PBMCs in the PBMCs group;The uterine cavity of the PRP group was infused with PRP.We compared the general situation,endometrial thickness on the day of conversion,endometrial thickness on the day of transplantation,embryo implantation rate,and clinical pregnancy rate among three groups.Results There was no statistically significant difference in age,body mass index(BMI),years of infertility,menstrual cycle,serum basal follicle stimulating hormone(FSH),basal estradiol(E2),number of transfer cycles,number of transferred embryos,and number of high-quality embryos among the three groups(all P>0.05).There was no statistically significant difference in endometrial thickness on the conversion day among the control group,PRP group,and PBMCs group(all P>0.05).The endometrial thickness on the day of transplantation in the PRP group was greater than that in the control group and PBMCs group(all P<0.05),and there was no statistically significant difference in endometrial thickness on the day of transplantation between the control group and PBMCs group(all P>0.05).The embryo implantation rate and clinical pregnancy rate of the PRP group and PBMCs group were higher than those of the control group,and the difference was statistically significant(all P<0.05).There was no statistically significant difference in embryo implantation rate and clinical pregnancy rate between the PRP group and the PBMCs group(all P>0.05).The patients did not experience any adverse reactions such as infection,abdominal pain,or vaginal bleeding during intrauterine infusion therapy.Conclusions Infusing autologous PBMCs or PRP into the uterine cavity before re embryo transfer in RIF patients can significantly improve embryo implantation rate and clinical pregnancy rate,and can improve assisted pregnancy outcomes;Intrauterine infusion of autologous PRP has no significant advantage over PBMCs in improving clinical pregnancy outcomes in patients with RIF;But it is more beneficial for improving the thickness of the endometrium.