中药周期疗法联合阿司匹林与强的松对反复种植失败患者在FET周期中临床结局的影响

Effect of Chinese medicine cyclical therapy combined with aspirin and prednisone on clinical outcome of patients with recurrent implantation failure in the FET cycle

关键词:  反复种植失败  中药周期疗法  阿司匹林  强的松  冻融胚胎移植  妊娠结局  肾虚证

Key words:  recurrent implantation failure  traditional Chinese medicine cycle therapy  aspirin  prednisone  frozen thawing embryo transfer  pregnancy outcome  kidney deficiency syndrome

摘要:

[目的] 探讨中药周期疗法联合阿司匹林与强的松对反复种植失败（RIF）患者在冻融胚胎移植（FET）周期中临床结局的影响。[方法] 选择2017年1月-2017年6月就诊于安徽省立医院的RIF患者（符合肾虚证）178例作为研究对象，使用随机数字表进行分组，分为A组（对照组）（42例）、B组（阿司匹林+强的松组）（68例）、C组（中药+阿司匹林+强的松组）（68例），A组予以常规FET周期激素替代周期内膜准备方案，B组在A组的基础上于移植后予以小剂量阿司匹林、强的松常规治疗，C组在B组基础上于进周期前予以中药周期治疗3个周期。比较3组患者的一般临床资料、黄体酮注射日内膜厚度及类型、临床结局。[结果] 3组患者年龄、不孕年限、BMI、基础性激素FSH、LH、E₂、既往移植失败周期数、既往移植胚胎数、本周期移植胚胎数、本周期移植优质胚胎数、移植胚胎类型、流产率、多胎妊娠率比较差异无统计学意义（P>0.05）；C组黄体酮注射日内膜厚度及A+B型内膜明显优于A组及治疗前（P<0.01）；B组A+B型内膜较A组及治疗前增加（P<0.05）。C组胚胎种植率、生化妊娠率、临床妊娠率、早期流产率较B组及C组有改善趋势，但差异无统计学意义（P>0.05）；C组35岁以下RIF患者临床妊娠率明显高于A组，差异有统计学意义（P<0.05）。[结论] 中药周期疗法联合阿司匹林与强的松能够改善子宫内膜厚度及类型，提高子宫内膜容受性，有利于胚胎着床，尤以35岁以下明显。

Abstract:

[Objective] To explore the effect of Chinese medicine cyclical therapy combined with aspirin and prednisone on the clinical outcomes of patients with recurrent implantation failure in the FET cycle. [Methods] From January 2017 to June 2017, the 178 patients with RIF (kidney deficiency syndrome) admitted to Anhui Provincial Hospital were selected as the study subjects forrandomised analysis, and were randomly divided into group A, group B and group C. Group A (control group) received routine FET cycle endometrial preparation. Group B (aspirin and prednisone group) received low-dose aspirin and prednisone after transplantation on the basis of group A. Group C(traditional Chinese medicine +aspirin and prednisonegroup) was treated with Chinese medicine on the basis of group B for 3 cycles before entering the cycle. The general clinical data, thickness and type of endometrial thickness and types of clinical outcomes were compared between the three groups. [Results] There was no significant difference in age, infertility, BMI, basal sex hormone FSH, LH, E₂, number of previous failure cycles, number of embryos previously transplanted, number of embryos transplanted during this cycle, the number of high quality embryos transplanted in this period, embryo transfer type, abortion rate and multiple pregnancy rate between the three groups(P>0. 05). The thickness of endometrium and type A+B endometrium in group C were significantly better than group A and before treatment (P<0. 01). Type A+B endometrium in group B increased compared with group A and before treatment (P<0. 05). The embryo implantation, biochemical pregnancy, clinical pregnancy and abortion rate in group C were better than those in group B and group C, but the difference was not statistically significant (P>0. 05). In group C, the clinical pregnancy rate of RIF patients under 35 years old was significantly higher than that in group A (P<0. 05). [Conclusion] Chinese medicine cyclical therapy combined with aspirin and prednisone can improve endometrial thickness and type, improve endometrial receptivity and is beneficial to embryo implantation, especially under 35 years old.