免疫及抗凝治疗对复发性流产患者胚胎移植妊娠结局的影响  

Effect of immune and anticoagulant therapy on pregnancy outcome of embryo transfer in patients with recurrent spontaneous abortion

作　　者：张丹[1] 郭帅帅[2] 林琳[2] 冯小静[1] 

机构地区：[1]沈阳市妇婴医院产科,110011 [2]沈阳市妇婴医院生殖中心,110011

出　　处：《中国现代药物应用》2017年第24期28-30,共3页Chinese Journal of Modern Drug Application

基　　金：沈阳市科技计划项目(项目编号:F15-199-1-23)

摘　　要：目的探讨免疫及抗凝治疗对复发性流产患者胚胎移植妊娠结局的影响。方法 73例接受体外受精胚胎移植(IVF-ET)后并临床确诊为复发性流产,排除其他常见原因后进行封闭抗体(BA)、抗心磷脂抗体(ACA)、抗核抗体(ANA)、抗β2-糖蛋白1抗体、淋巴细胞亚群、甲状腺过氧化酶抗体和甲状腺球蛋白抗体测定,其中有一项异常、间隔6周复查仍为异常患者,根据治疗方法不同分为免疫组(32例)和传统组(41例)。免疫组患者除孕早期接受黄体酮和地屈孕酮治疗外,另接受免疫[淋巴细胞免疫和(或)强的松和(或)丙种球蛋白]及抗凝(低分子肝素和阿司匹林)治疗,传统组患者不接受免疫及抗凝治疗,仅孕早期应用黄体酮和地屈孕酮治疗。比较两组患者临床妊娠率、活产率及产科并发症发生率。结果免疫组临床妊娠率为81.3%,显著高于传统组的46.3%,差异具有统计学意义(P<0.05)。免疫组活产率为71.9%,显著高于传统组的26.8%,差异具有统计学意义(P<0.05)。免疫组产科并发症总发生率为13.0%,低于传统组的45.5%,差异具有统计学意义(P<0.05)。结论免疫和抗凝治疗能够显著提高复发性流产患者胚胎移植的妊娠率及活产率,降低妊娠期并发症发生率。Objective To discuss the effect of immune and anticoagulant therapy on pregnancy outcome of embryo transfer in patients with recurrent spontaneous abortion.Methods A total of 73 patients undergoing in vitro fertilization and embryo transfer（IVF-ET） was diagnosed as recurrent spontaneous abortion.After exclusion of other common causes,they received blocking antibody（BA） and anticardiolipin antibody（ACA）,antinuclear antibody（ANA）,anti-β2-glycoprotein 1 antibody,lymphocyte subsets,thyroid peroxidase antibodies and thyroglobulin antibodies determination.Patients had 1 anomaly,and an interval of 6 weeks were still abnormal were divided by different treatment methods into immune group（32 cases） and traditional group（41 cases）.The immune group received immune [lymphocyte immune and/or prednisone and/or gamma globulin] and anticoagulant（low molecular heparin and aspirin） therapy,in addition to progesterone and dydrogesterone therapy in the early pregnancy.The traditional group only received progesterone and dydrogesterone therapy without immune and anticoagulant therapy.Comparison were made on clinical pregnancy rate,live birth rate and obstetric complication rate between two groups.Results The immune group had obviously higher clinical pregnancy rate as 81.3% than 46.3% in the traditional group,and the difference was statistically significant（P0.05）.The immune group had obviously higher live birth rate as 71.9% than 26.8% in the traditional group,and the difference was statistically significant（P0.05）.The immune group had lower incidence of total obstetric complication rate as 13.0% than 45.5% in traditional group,and the difference was statistically significant（P0.05）.Conclusion Immune and anticoagulant therapy can obviously improve pregnancy rate and live birth rate of patients with recurrent spontaneous abortion,and reduce the incidence of complications during pregnancy.

关 键 词：复发性流产 胚胎移植 免疫 抗凝 妊娠结局 影响 

分 类 号：R714.8[医药卫生—妇产科学]