主动免疫治疗对不明原因反复种植妊娠失败结局的影响及分析

Effect of lymphocyte immunotherapy on unexplained recurrent implantation failure and analysis of its related factors

  • 摘要: 目的 探讨主动免疫治疗对不明原因反复种植失败患者妊娠结局的影响并进行相关因素分析。方法 收集2016年1-12月于山西省妇幼保健院生殖医学中心就诊,有胚胎种植失败史,接受异体外周血淋巴细胞主动免疫治疗后进行冷冻胚胎移植手术的108例病例作为研究组,同期常规冷冻胚胎移植的6 324例病例为对照组,分析组间妊娠率、流产率差异,组内不孕类型、内膜方案、年龄对妊娠结局的影响。结果 研究组平均年龄为(32.41±4.43)岁,对照组年龄为(32.05±2.66)岁,两组差异无统计学意义(P> 0.05)。研究组与对照组临床妊娠率分别为52.78%和42.03%(P=0.025),流产率分别为31.58%和15.50%(P=0.001)。研究组内原发不孕组和继发不孕组临床妊娠率分别为51.22%和53.73%(P> 0.05),流产率分别为19.05%和38.89%(P> 0.05);研究组内激素替代周期组、自然周期组和促排卵周期组临床妊娠率分别为54.10%、51.51%和50.00%(P> 0.05),流产率分别为27.27%、47.06%和14.29%(P> 0.05);研究组<30岁、30~36岁和≥37岁患者的妊娠率分别为71.96%、50.00%和29.41%(P for trend=0.005),流产率分别为27.27%、30.00%和60.00%(P> 0.05)。结论 不明原因胚胎反复种植失败患者接受淋巴细胞主动免疫治疗后,临床妊娠率较同期解冻患者高,但流产率也高。临床妊娠率随年龄增加而降低,不孕方式、不同内膜准备方案不影响解冻胚胎移植的妊娠结局。

     

    Abstract: Objective To explore the effect of lymphocyte immunotherapy on unexplained recurrent implantation failure and analyze its related factors. Methods One hundred and eight cases with history of embryo implantation failure who were treated with allogenic peripheral blood lymphocytes in reproductive medicine center of Shanxi Maternal and Child Health Hospital from January to December in 2016 were collected as study group, and another 6324 cases received conventional frozen embryo transfer during the same period were taken as control group. The difference in pregnancy rate and abortion rate between the two groups was analyzed, and the influence of infertility type, intima scheme and age on pregnancy outcome was also analyzed. Results The average age of the study group was(32.41±4.43) years, and it was(32.05±2.66) years in the control group, without significant difference(P> 0.05). The clinical pregnancy rates of the study group and the control group were 52.78% and 42.03%, and the abortion rates were 31.58% and 15.50%(P< 0.05, respectively). Then the study group was divided into primary infertility group and secondary infertility group, the clinical pregnancy rates of these two subgroups were 51.22% and 53.73%, and the abortion rates were 19.05% and 38.89%, without significant difference(P> 0.05); Classifying study group into hormone replacement therapy group, nature cycle group and induced ovulation group, the clinical pregnancy rates of three subgroups were 54.10%, 51.51% and 50.00%, and the abortion rates were 27.27%, 47.06% and 14.29%, without significant difference(all P> 0.05); Classifying study group into < 30 years, 30-36 years and ≥ 37 years subgroups, the clinical pregnancy rates of three subgroups were 71.96%, 50.00% and 29.41%(P for trend <0.05), and the abortion rates were 27.27%, 30.00% and 60.00%(P> 0.05). Conclusion Patients with unexplained recurrent implantation failure have a higher clinical pregnancy rate after lymphocyte immunotherapy, while they still have a higher abortion rate than patients in the control group. The clinical pregnancy rate decreases with age. Infertility type and different endometrial preparation schemes have no effect on the pregnancy outcome.

     

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