摘要
目的:探讨针刺治疗对肾虚肝郁型体外受精(IVF)-胚胎移植(ET)反复移植失败(RIF)患者子宫内膜容受性、焦虑抑郁状态及妊娠结局的影响。方法:纳入70例肾虚肝郁型IVF-ET反复移植失败拟再行冻融胚胎移植(FET)患者,随机分为治疗组和对照组,每组各35例。所有纳入患者均按照激素替代方案进行FET内膜准备;治疗组患者在此基础上于月经第2天起行针刺治疗,隔日1次,直至移植日,且移植后30 min行针刺1次。比较两组患者的临床妊娠率及胚胎种植率;并检测黄体酮注射日和移植日的子宫内膜厚度及子宫内膜血流、形态分型,检测移植日子宫内膜螺旋动脉搏动指数(PI)、阻力指数(RI);采用焦虑自评量表(SAS)及抑郁自评量表(SDS)评价患者的焦虑及抑郁状态。结果:①临床妊娠率、胚胎种植率:且治疗组的临床妊娠率、胚胎种植率均明显高于对照组,差异有统计学意义(P<0.05)。②子宫内膜厚度及形态:黄体酮注射日,两组患者的子宫内膜厚度比较,差异无统计学意义(P>0.05);与对照组比较,治疗组患者的子宫内膜形态分型中A型比例增加(P<0.05)。移植日,与对照组比较,治疗组患者的子宫内膜厚度增加(P<0.05),且治疗组患者的子宫内膜形态分型中C型比例增加(P<0.05)。③子宫内膜血流:移植日,治疗组患者的子宫内膜血流阳性率为60.00%,显著优于对照组(P<0.05);治疗组患者的子宫内膜血流参数PI、RI均低于对照组(P<0.05,P<0.01)。④SAS和SDS评分:治疗后,治疗组患者的SAS评分降低(P<0.05),且治疗组患者的SAS评分低于对照组(P<0.05);治疗前后两组患者的SDS评分比较,差异均无统计学意义(P>0.05)。结论:针刺可能通过改善子宫内膜厚度、形态及内膜下血流参数,改善患者的焦虑状态,从而在一定程度上改善肾虚肝郁型IVF-ET反复移植失败患者的子宫内膜容受性,提高胚胎种植率及临床妊娠率。
Objective:To investigate the influence of acupuncture on the endometrial receptivity,emotion of anxiety and depression,and pregnancy outcome in kidney deficiency and liver stagnation syndrome patients with repeated implantation failure(RIF)of in vitro fertilization(IVF)-embryo transfer(ET).Methods:Seventy IVF-ET patients of RIF with syndrome of kidney deficiency and liver stagnation who were scheduled to undergo freeze-thawed embryo transfer(FET)were included and randomly divided into the treatment group and control group,35 cases in each group.All the patients were performed the FET endometrial preparation according to the hormone replacement program.On the basis of above,the patients in the treatment group were treated with acupuncture once every other day,from the second day of menstruation until the transplantation day,and 30 minutes after transplantation,acupuncture was conducted only once.The clinical pregnancy rate and embryo implantation rate of the two groups were compared;the endometrial thickness,endometrial blood flow and morphological classification were detected on the progesterone injection day and transplantation day,the endometrial spiral artery pulsation index(PI)and resistance index(RI)were detected on the transplantation day;and the anxiety and depression status of patients were assessed by self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Results:(1)Clinical pregnancy rate and embryo implantation rate:The clinical pregnancy rate and embryo implantation rate of the treatment group were significantly higher than those of the control group,with statistically significant differences between the two groups(P<0.05).(2)Endometrial thickness and morphology:On the progesterone injection day,there was no statistically significant difference in the endometrial thickness between the two groups(P>0.05);compared with the control group,the proportion of type A in the endometrial morphological classification was increased in the treatment group(P<0.05).On the transplantation day,compared wi
作者
马娟娟
张勤华
MA Juanjuan;ZHANG Qinhua(Department of Integrated Chinese and Western Medicine,Shanghai First Maternity and Infant Hospital,Shanghai 200120,China)
出处
《上海中医药大学学报》
CAS
2019年第5期32-38,共7页
Academic Journal of Shanghai University of Traditional Chinese Medicine
基金
国家自然科学基金资助项目(81202715)
上海市科委科研计划项目(15401930500)
关键词
体外受精-胚胎移植
针刺
反复移植失败
焦虑抑郁状态
子宫内膜容受性
妊娠结局
in vitro fertilization-embryo transfer
acupuncture
repeated implantation failure
anxiety and depression
endometrial receptivity
pregnancy outcome
