目的:探讨淋巴细胞免疫治疗习惯性流产及不明原因流产的疗效及护理。方法:对习惯性流产及不明原因流产患者,采用丈夫或第三者(男性)健康肘静脉血20 m l分离淋巴细胞行主动免疫治疗,并设单纯静脉滴注丙种球蛋白治疗者作对照组,观察两组...目的:探讨淋巴细胞免疫治疗习惯性流产及不明原因流产的疗效及护理。方法:对习惯性流产及不明原因流产患者,采用丈夫或第三者(男性)健康肘静脉血20 m l分离淋巴细胞行主动免疫治疗,并设单纯静脉滴注丙种球蛋白治疗者作对照组,观察两组患者妊娠成功率、婴幼儿生长情况及经济费用情况。结果:两组治疗效果及经济费用比较差异具有显著性(P<0.01),两组婴幼儿生长情况比较无显著性差异(P>0.05)。结论:淋巴细胞主动免疫疗法可提高患者免疫反应性,有提高妊娠率,降低经济费用,对婴幼儿生长无影响等优点,不失为治疗习惯性流产的一种简单好方法。展开更多
Background:Empiric therapy for patients with unexplained recurrent pregnancy loss(URPL)is not precise.Some patients will ask for assisted reproductive technology due to secondary infertility or advanced maternal age.T...Background:Empiric therapy for patients with unexplained recurrent pregnancy loss(URPL)is not precise.Some patients will ask for assisted reproductive technology due to secondary infertility or advanced maternal age.The clinical outcomes of URPL patients who have undergonein vitro fertilization-embryo transfer(IVF-ET)require elucidation.The IVF outcome and influencing factors of URPL patients need further study.Methods:A retrospective cohort study was designed,and 312 infertile patients with URPL who had been treated during January 2012 to December 2015 in the Reproduction Center of Peking University Third Hospital were included.By comparing clinical outcomes between these patients and those with tubal factor infertility(TFI),the factors affecting the clinical outcomes of URPL patients were analyzed.Results:The clinical pregnancy rate(35.18%vs.34.52%in fresh ET cycles,P=0.877;34.48%vs.40.27%in frozen-thawed ET cycles,P=0.283)and live birth rate(LBR)in fresh ET cycles(27.67%vs.26.59%,P=0.785)were not significantly different between URPL group and TFI group.URPL group had lower LBR in frozen-thawed ET cycles than that of TFI group(23.56%vs.33.56%,P=0.047),but the cumulative LBRs(34.69%vs.38.26%,P=0.368)were not significantly different between the two groups.The increased endometrial thickness(EMT)on the human chorionic gonadotropin day(odds ratio[OR]:0.848,95%confidence interval[CI]:0.748-0.962,P=0.010)and the increased number of eggs retrieved(OR:0.928,95%CI:0.887-0.970,P=0.001)were protective factors for clinical pregnancy in stimulated cycles.The increased number of eggs retrieved(OR:0.875,95%CI:0.846-0.906,P<0.001),the increased two-pronucleus rate(OR:0.151,95%CI:0.052-0.437,P<0.001),and increased EMT(OR:0.876,95%CI:0.770-0.997,P=0.045)in ET day were protective factors for the cumulative live birth outcome.Conclusion:After matching ages,no significant differences in clinical outcomes were found between the patients with URPL and the patients with TFI.A thicker endometrium and more retrieved oocytes increase the展开更多
Objective:To explore the roles of advanced paternal age(APA)and abnormal paternal weight on embryo quality and pregnancy outcomes for unexplained recurrent pregnancy loss(uRPL)couples who underwent preimplantation gen...Objective:To explore the roles of advanced paternal age(APA)and abnormal paternal weight on embryo quality and pregnancy outcomes for unexplained recurrent pregnancy loss(uRPL)couples who underwent preimplantation genetic testing for aneuploidies(PGT-A).Methods:This study included 779 uRPL couples who underwent their first PGT-A cycles between 2014 and 2018.Male patients’aging and nutritional status were quantified by paternal age and body mass index(BMI).Routine semen parameters and sperm DNA fragmentation index(DFI)were used to reflect the seminal quality.Blastocyst formation rate and aneuploidy rate were used to reflect the embryo quality.Cycle cancellation rate,implantation rate,pregnancy loss rate,and live birth rate were measured to evaluate the treatment efficiency from IVF.To remove the interference of maternal age,only the women younger than 38 years old were included.After univariate screening,interaction tests were performed in a generalized linear model(GLM)to further examine the effects of paternal age and BMI on each outcome indicator.Results:In the total population(779 cycles),there were no statistical differences in aneuploidy rate,cycle cancellation rate,implantation rate,pregnancy loss rate,and live birth rate,whether stratified by paternal age or paternal BMI.Similar results occurred in the younger men(<40 y.o.,633 cycles).Conversely,among the men with advanced age(≥40 y.o.,146 cycles),there were statistical differences between the three BMI groups in four semen parameters(total sperm number,total motility,progressive motility,and total motile sperm count),implantation rate,and live birth rate.After interaction testing,the results of GLM suggested that the interaction effect between APA and paternal obesity was associated with the low implantation rate of uRPL couples.Conclusions:For the uRPL couples seeking for PGT-A treatment,if the male patients have both advanced age and obesity,their spouses are at higher risks for embryo implantation failure.展开更多
文摘目的:探讨淋巴细胞免疫治疗习惯性流产及不明原因流产的疗效及护理。方法:对习惯性流产及不明原因流产患者,采用丈夫或第三者(男性)健康肘静脉血20 m l分离淋巴细胞行主动免疫治疗,并设单纯静脉滴注丙种球蛋白治疗者作对照组,观察两组患者妊娠成功率、婴幼儿生长情况及经济费用情况。结果:两组治疗效果及经济费用比较差异具有显著性(P<0.01),两组婴幼儿生长情况比较无显著性差异(P>0.05)。结论:淋巴细胞主动免疫疗法可提高患者免疫反应性,有提高妊娠率,降低经济费用,对婴幼儿生长无影响等优点,不失为治疗习惯性流产的一种简单好方法。
基金supported by a grant from the National Science and Technology Major Project of China(No.2017ZX09304012-012)。
文摘Background:Empiric therapy for patients with unexplained recurrent pregnancy loss(URPL)is not precise.Some patients will ask for assisted reproductive technology due to secondary infertility or advanced maternal age.The clinical outcomes of URPL patients who have undergonein vitro fertilization-embryo transfer(IVF-ET)require elucidation.The IVF outcome and influencing factors of URPL patients need further study.Methods:A retrospective cohort study was designed,and 312 infertile patients with URPL who had been treated during January 2012 to December 2015 in the Reproduction Center of Peking University Third Hospital were included.By comparing clinical outcomes between these patients and those with tubal factor infertility(TFI),the factors affecting the clinical outcomes of URPL patients were analyzed.Results:The clinical pregnancy rate(35.18%vs.34.52%in fresh ET cycles,P=0.877;34.48%vs.40.27%in frozen-thawed ET cycles,P=0.283)and live birth rate(LBR)in fresh ET cycles(27.67%vs.26.59%,P=0.785)were not significantly different between URPL group and TFI group.URPL group had lower LBR in frozen-thawed ET cycles than that of TFI group(23.56%vs.33.56%,P=0.047),but the cumulative LBRs(34.69%vs.38.26%,P=0.368)were not significantly different between the two groups.The increased endometrial thickness(EMT)on the human chorionic gonadotropin day(odds ratio[OR]:0.848,95%confidence interval[CI]:0.748-0.962,P=0.010)and the increased number of eggs retrieved(OR:0.928,95%CI:0.887-0.970,P=0.001)were protective factors for clinical pregnancy in stimulated cycles.The increased number of eggs retrieved(OR:0.875,95%CI:0.846-0.906,P<0.001),the increased two-pronucleus rate(OR:0.151,95%CI:0.052-0.437,P<0.001),and increased EMT(OR:0.876,95%CI:0.770-0.997,P=0.045)in ET day were protective factors for the cumulative live birth outcome.Conclusion:After matching ages,no significant differences in clinical outcomes were found between the patients with URPL and the patients with TFI.A thicker endometrium and more retrieved oocytes increase the
基金the National Key Research and Development Program of China(2018YFC1002804).
文摘Objective:To explore the roles of advanced paternal age(APA)and abnormal paternal weight on embryo quality and pregnancy outcomes for unexplained recurrent pregnancy loss(uRPL)couples who underwent preimplantation genetic testing for aneuploidies(PGT-A).Methods:This study included 779 uRPL couples who underwent their first PGT-A cycles between 2014 and 2018.Male patients’aging and nutritional status were quantified by paternal age and body mass index(BMI).Routine semen parameters and sperm DNA fragmentation index(DFI)were used to reflect the seminal quality.Blastocyst formation rate and aneuploidy rate were used to reflect the embryo quality.Cycle cancellation rate,implantation rate,pregnancy loss rate,and live birth rate were measured to evaluate the treatment efficiency from IVF.To remove the interference of maternal age,only the women younger than 38 years old were included.After univariate screening,interaction tests were performed in a generalized linear model(GLM)to further examine the effects of paternal age and BMI on each outcome indicator.Results:In the total population(779 cycles),there were no statistical differences in aneuploidy rate,cycle cancellation rate,implantation rate,pregnancy loss rate,and live birth rate,whether stratified by paternal age or paternal BMI.Similar results occurred in the younger men(<40 y.o.,633 cycles).Conversely,among the men with advanced age(≥40 y.o.,146 cycles),there were statistical differences between the three BMI groups in four semen parameters(total sperm number,total motility,progressive motility,and total motile sperm count),implantation rate,and live birth rate.After interaction testing,the results of GLM suggested that the interaction effect between APA and paternal obesity was associated with the low implantation rate of uRPL couples.Conclusions:For the uRPL couples seeking for PGT-A treatment,if the male patients have both advanced age and obesity,their spouses are at higher risks for embryo implantation failure.
文摘目的·探讨不明原因复发性流产(unexplained recurrent pregnancy loss,URPL)和正常妊娠早期,泌乳素(prolactin,PRL在外周血和蜕膜基质细胞(decidual stromal cells,DSCs)中的表达差异。方法·纳入2018年3月—2019年3月于上海交通大学医学院附属仁济医院妇产科就诊的80例URPL患者、70例人工流产妇女以及190例正常妊娠妇女。采用酶联免疫吸附方法检测外周血PRL水平。采用实时定量聚合酶链式反应(quantitative real time PCR,RT-qPCR)、蛋白质免疫印迹(Western blotting,WB)及免疫组化染色(immunohistochemistry,IHC)方法检测DSCs中PRL的mRNA和蛋白表达水平。2组之间比较采用独立样本t检验,多组组间比较采用单因素方差分析。结果·排除21例胚胎染色体异常,UPRL组最终纳入59例。人工流产组纳入70例。190例正常妊娠妇女中177例完成随访,其中157例活产,被归于正常妊娠活产组,其余20例发生胚胎停育或自然流产,其中流产发生于孕10周以前的19例被归入正常妊娠流产组。正常妊娠活产组和人工流产组妇女的外周血PRL水平类似,相同孕周间差异无统计学意义,且都随着孕周增长显著升高(正常妊娠活产组:孕5-5^(+6)周vs孕6~7^(+6)周,P=0.002;孕6~7^(+6)周vs孕8~9^(+6)周,P=0.012。人工流产组:孕5-5^(+6)周vs孕6~7^(+6)周,P=0.015,孕6~7^(+6)周vs孕8~9^(+6)周,P=0.023);URPL患者的外周血PRL水平随着孕周增长无显著变化,并且从孕6周起显著低于相同孕周的正常妊娠活产妇女和人工流产妇女(孕6~7^(+6)周:P=0.018,0.024;孕8~9^(+6)周:P=0.015,0.003);正常妊娠流产组的外周血PRL水平也与相同孕周的URPL组患者类似。人工流产组妇女DSCs的PRL表达在mRNA和蛋白水平上都随着孕周增长显著升高(孕5-5^(+6)周vs孕6~7^(+6)周:RT-qPCR,P=0.020;WB,P=0.010;IHC,P=0.030。孕6~7^(+6)周vs孕8~9^(+6)周:RT-qPCR,P=0.011;WB,P=0.034;IHC,P=0.012);URPL组DSCs的PRL表达水平增长迟滞:孕6~7^(+6)周及孕8~9^(+6)周的URPL妇女DSC
