摘要
目的研究反复着床失败(recurrent implantation failure,RIF)患者中慢性子宫内膜炎(chronic endometritis,CE)的患病及治疗后妊娠结局的改善情况。方法回顾性分析2016年1月至2017年1月在北京大学第三医院生殖医学中心因RIF行宫腔镜检查及子宫内膜病理检查的287例患者的临床资料,统计CE在RIF患者中的患病情况及宫腔镜诊断CE的准确性;根据是否伴发CE将患者分为RIF-CE组(n=111例)和RIF-非CE(NCE)组(n=176例),RIF-CE组患者给予2周的抗生素治疗,RIF-NCE组除宫腔镜检查及子宫内膜活检外不予其他干预,比较两组此后第一次解冻周期移植的妊娠结局。结果RIF患者中的CE的患病率为38.7%(111/287),宫腔镜诊断CE的敏感度为55.0%(95%CI:46.1%~64.3%)、特异度为82.4%(95%CI:77.2%~88.1%)。RIF-CE治疗后,行解冻周期囊胚移植的胚胎着床率(50.0%,46/78;36.4%,59/162)和临床妊娠率(53.8%,42/78;39.3%,53/135)均显著高于RIE-NCE组,差异有统计学意义(P<0.05)。结论建议RIF患者宫腔镜联合子宫内膜病理检查筛查CE,积极治疗CE后再移植,可明显改善RIF患者的妊娠结局。
Objective To study the prevalence of chronic endometritis(CE)in patients with recurrent implantation failure(RIF)and whether the pregnancy outcomes were improved after CE treatment.Methods The clinical data of 287 patients who underwent hysteroscopy and endometrial pathology for RIF from January 2016 to January 2017 in the Reproductive Medical Center of The Peking University Third Hospital were retrospectively analyzed.The prevalence of CE in RIF patients and the accuracy of hysteroscopy diagnosis of CE were analyzed.The patients were divided into RIF-CE group(n=111)and RIF-NCE group(n=176 cases)according to whether there was concomitant CE.The RIF-CE group were treated with antibiotics for 2 weeks,and the RIF-NCE group received no other intervention except hysteroscopy and endometrial biopsy.The pregnancy outcomes of the first thawing cycle transplantation were compared between the two groups.Results The prevalence of CE in RIF patients was 38.7%(111/287).The sensitivity and specificity of hysteroscopy in diagnosing CE were 55.0%(95%CI:46.1~64.3%)and 82.4%(95%CI:77.2~88.1%).After RIF-CE treatment,the implantation rate(50.0%vs 36.4%)and the clinical pregnancy rate(53.8%vs 39.3%)of blastocyst transfer in thawing cycle were significantly higher than those in RIE-NCE group(P<0.05).Conclusion It is suggested that RIF patients should be screened for CE by hysteroscopy,and the pregnancy outcome of RIF patients can be improved by embryo transfer after active treatment of CE.
作者
杨静
马彩虹
陶立元
王洋
YANG Jing;MA Caihong;TAO Liyuan;WANG Yang(Center for Reproductive Medicine,Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)
出处
《中国妇产科临床杂志》
CSCD
北大核心
2020年第2期115-119,共5页
Chinese Journal of Clinical Obstetrics and Gynecology
基金
北京大学第三医院临床重点项目(BYSY201500).
