宫腔灌注HCG联合地屈孕酮对复发性流产患者外周血淋巴细胞水平和妊娠结局的影响

Effect of intrauterine infusion of HCG combined with dydrogestone on peripheral blood lymphocyte level and pregnancy outcome in patients with recurrent spontaneous abortion

目的:了解宫腔灌注人绒毛膜促性腺激素(HCG)联合地屈孕酮对复发性流产(RSA)患者的外周血淋巴细胞水平变化和妊娠结局的影响。方法:选取2019年1月~2020年10月深圳市宝安区妇幼保健院就诊的RSA患者43例作为研究对象,分为研究组(n=19)与对照组(n=24),对照组给予地屈孕酮,研究组在对照组基础上给予宫腔灌注HCG,分析两组治疗前后着床期外周血淋巴细胞、雌二醇(E2)、孕酮(P)及3个周期的临床妊娠结局。结果:两组患者在年龄、不良孕产次数以及排卵日子宫内膜厚度上比较差异无统计学意义(P>0.05);治疗前两组在着床期E_(2)及P比较差异无统计学意义(P>0.05),治疗后研究组与对照组的血清E_(2)、P均较治疗前升高,且治疗后的研究组的E_(2)及P较对照组升高,差异均有统计学意义(P<0.05);治疗前及治疗后两组在着床期外周血B淋巴细胞、NK细胞、CD3^(+)T细胞、CD3^(+)CD8^(+)T细胞以及CD4^(+)/CD8^(+)T细胞比较差异均无统计学意义(P>0.05),但研究组外周血CD3^(+)CD4^(+)T细胞百分比较治疗前升高,差异均有统计学意义(P<0.05);研究组的临床妊娠率高于对照组,孕早期自然流产率低于对照组,两组比较差异均有统计学意义(P<0.05)。结论:宫腔灌注HCG联合地屈孕酮治疗RSA可以通过提升着床期的雌、孕激素值以及增加外周血淋巴细胞中的CD3^(+)CD4^(+)T细胞百分比提升RSA患者临床妊娠率及降低流产的风险。

Objective To investigate the effect of intrauterine infusion of HCG combined with dydrogestone on the changes of peripheral blood lymphocyte level and pregnancy outcome in patients with RSA.Method 43 RSA patients who were treated in our hospital were selected as the research objects from January 2019 to October 2020,and they were divided into the research group(n=19)and the control group(n=24).the control group was treated with diprogesterone group,the research group was treated with intrauterine infusion of HCG combined with diprogesterone group.The clinical pregnancy outcomes of peripheral blood lymphocytes,estradiol and progesterone during implantation and three cycles before and after treatment were analyzed.Results There was no significant difference between the two groups in age,times of adverse pregnancy and endometrial thickness on ovulation day(P>0.05);Before treatment,there was no significant difference in E_(2) and P content between the two groups during implantation(P>0.05).After treatment,the serum E_(2) and P content of the research group and the control group were higher than those before treatment,and the E_(2) and P content of the research group after treatment were higher than those of the control group,with significant differences(P<0.05);Before and after treatment,there was no significant difference in peripheral blood B lymphocytes,NK cells,CD3^(+)T cells,CD3^(+)CD8^(+)T cells and CD4^(+)/CD8^(+)T cells between the two groups during implantation(P>0.05),but the percentage of CD3^(+)CD4^(+)T cells in peripheral blood of the research group was higher than that before treatment,and the difference was statistically significant compared with that of the control group(P<0.05);The clinical pregnancy rate of the research group was higher than that of the control group,and the spontaneous abortion rate in the first trimester was lower than that of the control group,there was significant difference between the two groups(P<0.05).Conclusion Intrauterine HCG infusion combined with dydrogestone in the treatment of RSA can improve the clinical pregnancy rate of RSA patients and reduce the risk of abortion by increasing the estrogen and progesterone levels during the implantation phase and increasing the percentage of CD3^(+)CD4^(+)T cells in peripheral blood lymphocytes.