低分子肝素钙在多次着床失败患者中的应用  

Low-Molecular-Weight Heparin in Women with Repeated Implantation Failure

作　　者：熊正方[1] 党小红[1] 李冰[1] 王莉云[1] 

机构地区：[1]青海省人民医院,青海西宁810007

出　　处：《实用妇产科杂志》2015年第8期614-617,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨低分子肝素钙对体外受精-胚胎移植(IVF-ET)中多次着床失败(移植优质胚胎≥3次,均未妊娠)患者再次助孕临床妊娠结局的影响。方法:选择2010年1月至2014年10月在我院生殖中心行IVF-ET助孕中多次着床失败,并要求再次助孕患者共134例。再次助孕胚胎移植周期数为198周期,自胚胎移植日起,根据用药知情同意原则行随机对照研究,研究组62例87周期给予低分子肝素钙+常规黄体支持,对照组72例111周期只给予常规黄体支持。观察两组患者妊娠结局。结果:两组患者年龄、体重指数、吸烟率、基础FSH值、血栓前状态(D-Di异常升高者)构成比、移植胚胎数及质量比较,差异均无统计学意义(P>0.05)。研究组和对照组胚胎着床率(17.9%vs 10.8%)、临床妊娠率(29.9%vs 16.2%)比较,差异有统计学意义(P<0.05)。年龄≥35岁患者中,研究组胚胎着床率(16.8%vs 8.2%)、临床妊娠率(25.0%vs 10.6%)高于对照组,差异有统计学意义(P<0.05),而在年龄<35岁患者中两组临床结局差异无统计学意义(P>0.05);当D-Di≥1.5mg/L时,研究组的胚胎着床率(19.3%vs 7.8%)、临床妊娠率(63.6%vs 34.5%)均显著高于对照组,差异有统计学意义(P<0.05);而当D-Di<1.5 mg/L时,两组临床结局差异无统计学意义(P>0.05)。结论:低分子肝素钙能提高多次种植失败患者再次助孕移植后的临床妊娠率,改善临床妊娠结局,尤其是高龄、高凝状态的不孕患者。Objective： To explore the effect of Low-wolecular-reight heparin on outcomes of IVF-ET in women with repeated implantation failure（ RIF without pregnant while transplant quality embryos≥3 times）. Methods： From January 2011 to October 2012,134 women with RIF（ ET ≥ 3 times and the embryos were planted failure） who planned to perform ET again were included in the study,the number of new embryo transfer cycles is 198 cycles.There was 87 cycles（ 62 cases） in study group received Low-wolecular-reight heparin（ LMWH） and conventional luteal support on ET day of new embryo transfer cycles,while 111 cycles（ 72 cases） in control group only received conventional luteal support. The outcomes of IVF-ET were compared between these two groups. Results： There were no significant differences between theses two groups in the age of the patients,BMI,smoking rates,basal level of FSH,thrombophilia constituent ratio,and the number and quality of embryo transplant（ P〈0. 05）. There were significant differences in embryo implantation rate（ 17. 9% vs 10. 8%）,clinical pregnancy rate（ 29. 9% vs 16. 2%）between study group and control group（ P〈0. 05）. In women≥35 years old the embryo implantation rate and pregnancy rate were 16. 8% and 25. 0% respectively,significantly higher than the control group（ 8. 2%,10. 6% respectively）（ P〈0. 05）,while no difference was found in women35 years old（ P〈0. 05）. When D-Di≥1. 5 mg / L,the embryo implantation rate and clinical pregnancy rate（ 19. 3%,63. 6%） were significantly higher than those of the control group（ 7. 8%,34. 5%）（ P〈0. 05）,while no difference was found in women when the D-Di1. 5 mg / L（ P〈0. 05）. Conclusions： Low-wolecular-reight heparin（ LMWH） can improve the clinical pregnancy rate and clinical pregnancy outcomes of IVF-ET in women with RIF,especially in the elderly infertile patients with thrombophilia.

关 键 词：体外受精-胚胎移植 低分子肝素钙 反复着床失败 血栓前状态 妊娠结局 

分 类 号：R321[医药卫生—人体解剖和组织胚胎学]