地屈孕酮联合粒细胞集落刺激因子治疗薄型子宫内膜不孕患者的临床研究

Clinical trial of dydrogesterone combined with granulocyte colony-stimulating factor in the treatment of patients with thin endometrial infertility

目的观察地屈孕酮联合粒细胞集落刺激因子(G-CSF)对薄型子宫内膜(TE)不孕患者血流参数和性激素水平的影响。方法将TE不孕患者随机分为对照组和试验组。所有患者均进行冻融胚胎移植治疗,对照组在阴道超声监测排卵后给予地屈孕酮,每次10 mg,每天2次,服用至排卵后第14天停药;试验组在对照组治疗的基础上,给予G-CSF,阴道超声监测子宫内膜厚度和血流动力学参数等无异常3 d后进行胚胎移植。比较2组患者的血流参数、超声参数、子宫内膜形态、性激素水平[促卵泡生成素(FSH)、黄体生成素(LH)、雌二醇(E_(2))、孕酮(P)]和妊娠情况。结果试验组入组49例,对照组入组49例。治疗后,试验组和对照组的子宫内膜厚度分别为(9.59±1.35)和(7.89±1.14)mm,卵泡直径分别为(19.35±1.58)和(17.75±1.42)mm,子宫体积分别为(92.68±7.85)和(85.69±6.74)cm3,PI分别为1.29±0.27和1.74±0.32,RI分别0.32±0.09和0.50±0.11,收缩期峰值流速/舒张末期流速(S/D)分别2.03±0.28和2.21±0.25,P分别为(45.98±5.75)和(39.15±5.78)nmol·L^(-1),E2分别为(462.58±58.42)和(339.45±45.97)pg·mL^(-1),FSH分别为(12.18±2.58)和(9.42±1.42)U·L^(-1),LH分别为(29.42±4.18)和(22.25±3.40)U·L^(-1),在统计学上差异均有统计学意义(均P<0.05)。试验组的临床妊娠率(51.02%)和着床率(57.14%)均显著高于对照组(30.61%、36.73%),在统计学上差异均有统计学意义(均P<0.05)。结论地屈孕酮联合G-CSF可改善TE不孕患者血流参数和子宫内膜厚度、性激素水平,提高患者胚胎种植率。

Objective To explore the effects of dydrogesterone combined with granulocyte colony-stimulating factor(G-CSF)on blood flow parameters and sex hormone levels in patients with thin endometrial(TE)infertility.Methods TE infertility patients were randomly divided into control group and treatment group.All patients were treated with freezing-thawing embryo transfer.The control group was treated with desdrogesterone after ovulation monitoring by vaginal ultrasound,10 mg each time,bid,and stopped until the 14th day after ovulation.In treatment group,G-CSF was given on the basis of control group,and the endometrial thickness and hemodynamic parameters were monitored by vaginal ultrasound 3 days later,and then embryo transfer was performed.Blood flow parameters,ultrasound parameters,endometrial morphology,sex hormone levels[follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E_(2)),progesterone(P)] and pregnancy status were compared between the two groups.Results There were 49 cases in treatment group and 49 cases in control group.Afer treatment,endometrial thickness in treatment group and control group were(9.59±1.35)and(7.89±1.14)mm;follicle diameter were(19.35±1.58)and(17.75±1.42)mm;uterine volume were(92.68±7.85)and(85.69±6.74)cm^(2);PI were 1.29±0.27 and 1.74±0.32;RI were 0.32±0.09and 0.50±0.1l;peak systolic/end-diastolic velocity(S/D)were 2.03±0.28 and 2.21±0.25;P were(45.98±5.75)and(39.15±5.78)nmol·L^(-1);E_(2) were(462.58±58.42)and(339.45±45.97)pg·mL^(-1);FSH were(12.18±2.58)and(9.42±1.42)U·L^(-1);LH were(29.42±4.18)and(22.25±3.40)U·L^(-1) there were statistically significant differences between the two groups(all P<0.05).The clinical pregnancy rate(51.02%)and implantation rate(57.14%)in treatment group were higher than those in control group(30.61%and 36.73%),and the differences were statistically significant(all P<0.05).Conclusion Dydrogesterone combined with G-CSF can improve blood flow parameters,endometrial thickness and sex hormone levels in TE infertility patients,and help to increase the embryo implantation rate.