摘要
目的 研究抗生素联合宫腔灌注对反复种植失败(RIF)合并慢性子宫内膜炎(CE)患者的作用及机制.方法 选取2021 年1 月—2022 年5 月行辅助生殖助孕的RIF 160 例,根据是否合并CE分为CE组和非CE组,每组80 例,比较2 组的基线资料并分析影响RIF患者CE的相关因素.将80 例RIF合并CE按随机数字表法分为A组与B组,每组40 例,A组口服抗生素治疗,B组口服抗生素联合宫腔灌注治疗.比较A、B组治疗前后宫腔液中炎性因子[白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)]水平及超声下子宫动脉血流参数[搏动指数、血流分支、子宫内膜-肌层交界区(EMI)低回声区占肌层比例],统计治疗后A、B组胚胎着床率、临床妊娠率、生化妊娠率、早期流产率.结果 年龄较大、宫腔内占位性病变、输卵管积水、子宫腺肌症、不孕年限较长、多次人工流产、继发性不孕、宫腔镜检查异常可能是RIF患者CE的影响因素(P＜0.05,P＜0.01).与治疗前比较,治疗后A、B组宫腔液中IL-6、IL-8、TNF-α水平降低,搏动指数、EMI低回声区占肌层比例也降低,且B组均低于A组;治疗后A、B组血流分支均增加,且B组多于A组(P＜0.05).与A组比较,B组胚胎着床率、临床妊娠率较高(P＜0.05),生化妊娠率、早期流产率比较差异无统计学意义(P＞0.05).结论 年龄较大、宫腔占位性病变、输卵管积水、子宫腺肌症、不孕年限较长、多次人工流产、继发性不孕、宫腔镜检查异常可能是引起RIF患者CE的影响因素.抗生素联合宫腔灌注治疗可减轻RIF合并CE患者机体炎症反应,改善妊娠率.
Abstract
Objective To study the effect and mechanism of antibiotics combined with intrauterine perfusion on pa-tients with repeated implantation failure(RIF)complicated with chronic endometritis(CE).Methods A total of 160 pa-tients with RIF who underwent assisted reproduction and assisted pregnancy from January 2021 to May 2022 were selected and divided into CE group(n=80)and non-CE group(n=80)according to combination of CE.The baseline data of the two groups were compared and the related factors affecting CE in RIF patients were analyzed.Eighty patients with RIF combined with CE were divided into group A and group B according to random number table method,with 40 cases in each group.Group A was treated with oral antibiotics,and group B was treated with oral antibiotics combined with intrauterine perfusion.The lev-els of inflammatory factors[interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)]in uterine fluid of groups A and B before and after treatment were compared,and the flow parameters of uterine artery under ultrasound[pulse index,blood flow branches,and the proportion of low echo area in endometrial-myometrial interface(EMI)in myometral lay-er]were compared.The implantation rate,clinical pregnancy rate,biochemical pregnancy rate and early abortion rate of groups A and B after treatment were analyzed.Results Older age,intrauterine space occupying lesion,hydrosalpinx,uterine adenomyosis,prolonged infertility,multiple induced abortions,secondary infertility and abnormal hysteroscopy might be the influencing factors of CE in RIF patients(P＜0.05,P＜0.01).Compared with those before treatment,the levels of IL-6,IL-8 and TNF-α in uterine fluid of groups A and group B were decreased after treatment,and pulse index and the proportion of low echo area in EMI in myometral layer was also decreased,and lower in group B than in group A.After treatment,blood flow branches in groups A and B were increased,which was more in group B than in group A(P＜0.05).Compared with group A,the implantation rate and clinical pregnancy rate of group B were higher(P＜0.05),and the biochemical pregnancy rate and early abortion rate had no significant difference(P＞0.05).Conclusion Older age,intrauterine space occupying disease,hydrosalpinx,uterine adenomyosis,prolonged infertility,multiple induced abortions,secondary infertility and abnor-mal hysteroscopy are the factors that may cause CE in RIF patients.Antibiotics combined with intrauterine perfusion can re-duce inflammatory response and improve pregnancy rate in patients with RIF and CE.
基金项目
河北省医学科学研究项目(2022)(20220270)
医院科学技术"孵育"计划(2022)(FYJHQN-06)
维普
万方数据