生殖医学杂志

目的探讨宫腔灌注生长激素(GH)对薄型子宫内膜患者的子宫内膜厚度、血流及妊娠结局的影响。方法收集2019年5～12月在我院生殖中心因子宫内膜薄而取消鲜胚移植计划行冻融胚胎移植(FET)的38例患者为研究对象,按入组日期单、双日随机分为宫腔灌注组[19例,采用激素替代治疗(HRT)准备内膜+宫腔灌注GH]和对照组(19例,单纯HRT准备内膜)。比较两组患者在既往排卵期及黄体转化当天的子宫内膜厚度及内膜血流阻力指数(RI)、搏动指数(PI)、收缩期与舒张期流速之比(S/D)、内膜血流灌注类型等情况,并随访妊娠结局。结果宫腔灌注组治疗前子宫内膜厚度显著低于对照组(P<0.05),治疗后的子宫内膜厚度、容积均较治疗前显著增加(P<0.05),且子宫内膜厚度增长与子宫内膜容积增长幅度均显著高于对照组(P<0.05);宫腔灌注组治疗后A+B型内膜比例(94.7%)较治疗前(78.9%)略增高,但尚无显著性差异(P>0.05)。宫腔灌注组治疗前内膜血流参数S/D显著大于对照组(P<0.05);治疗后的内膜血流灌注类型Ⅰ、Ⅱ型比例较治疗前显著增加(P<0.05)。两组FET囊胚移植及总的胚胎移植HCG阳性率、临床妊娠率、胚胎着床率比较均无显著性差异(P>0.05),但宫腔灌注组的HCG阳性率(47.4%vs. 42.1%)、临床妊娠率(36.8%vs. 31.6%)、囊胚着床率(33.3%vs. 30.4%)略高于对照组。结论对于薄型子宫内膜患者,宫腔灌注GH能增加子宫内膜厚度及容积,改善内膜血流灌注,可能对改善子宫内膜容受性及妊娠结局有积极作用。

Objective:To investigate the effect of intrauterine perfusion of growth hormone(GH) on the endometrial thickness and blood flow and pregnancy outcome in patients with thin endometrium.Methods:Thirty eight patients with thin endometrium who canceled the fresh embryo transfer and performed frrozen-thawed embryo transfer(FET) were collected as the research object in the reproductive center of our hospital from May to December 2019. The patients were randomly divided into two groups according to grouping single and double days:the patients received hormone replacement therapy(HRT) for preparing endometrium+perfusion GH to uterine cavity in the perfusion group(n=19) and the patients were used HRT alone to prepare the endometrium in the control group(n=19). The endometrial thickness and blood flow resistance index(RI) & pulsatile index(PI)at the previous ovulation period and the day of luteal transformation,ratio of systolic to diastolic flow rate(S/D),endometrial blood perfusion type,etc. were compared between the two groups of patients,and the pregnancy outcomes of the patients were followed-up.Results:The endometrial thickness before treatment in the perfusion group was significantly thinner than control group(P<0.05). The endometrial thickness and volume of perfusion group was significantly increased after therapy(P<0.05). The amplification of the endometrial thickness and volume in perfusion group was significantly more than those of control group(P<0.05). The rate of type A+B of endometrium after therapy in perfusion group(94.7%) was higher than that before therapy(78.9%),but it was not significantly different(P>0.05). The S/D before therapy in the perfusion group was significantly higher than that of control group(P<0.05). The type Ⅰ and Ⅱ of blood flow after therapy was significantly higher than before therapy in the perfusion group(P>0.05). The HCG positive rate(47.4% vs. 42.1%),clinical pregnancy rate(36.8% vs. 31.6%),blastocyst implantation rate(33.3% vs. 30.4%)in the perfusion group were slightly higher than the control group,but which were not significantly different(P>0.05).Conclusions:Intrauterine perfusion of GH can increases endometrial thickness and volume,and improves blood flow of endometrium,which may have a positive effect on improving endometrial receptivity and pregnancy outcomes.