他莫昔芬联合人绒毛膜促性腺激素对反复种植失败患者冻融周期子宫内膜容受性的影响  

Effects of Tamoxifen Combined with Human Chorionic Gonadotropin on Endometrial Receptivity in Patients with Repeated Implantation Failure during Freeze-Thaw Cycles

作　　者：周璟 马宁 周知 王梦月[2] 周永江 ZHOU Jing;MA Ning;ZHOU Zhi;WANG Mengyue;ZHOU Yongjiang(Reproductive center, Hainan Women and Children’s Medical Center, Hainan Haikou 570206, China;Reproductive center, Second People’s Hospital of Yunnan, Yunnan Kunming 650021, China;College of Prevention, School of Public Health, Hainan Medical College, Hainan Haikou 571199, China)

机构地区：[1]海南省妇女儿童医学中心生殖中心,海南海口570206 [2]云南省第二人民医院生殖中心,云南昆明650021 [3]海南医学院公共卫生学院预防系,海南海口571199

出　　处：《中国医院用药评价与分析》2020年第4期414-417,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：2015年度海南省自然科学基金项目(No.20158277)。

摘　　要：目的:探讨他莫昔芬联合人绒毛膜促性腺激素(HCG)对反复种植失败(repeated implantation failure,RIF)患者冻融周期子宫内膜容受性的影响。方法:回顾性选取2017年7月至2019年6月海南省妇女儿童医学中心RIF(≥3次)再次进行冻融胚胎移植的188例患者的临床资料,根据子宫内膜准备方法不同分为观察组105例和对照组83例。观察组患者采用他莫昔芬联合HCG宫腔灌注,对照组患者采用来曲唑联合HCG宫腔灌注。比较两组患者子宫内膜厚度与内膜下血流情况[搏动指数(PI)、阻力指数(RI)]、子宫内膜血流分型、HCG日与移植日激素[黄体生成素(LH)、雌二醇(E2)及孕酮]水平及妊娠结局的差异。结果:移植日,两组患者子宫内膜厚度较促排卵前增加,且观察组患者明显大于对照组,差异均有统计学意义(P<0.05);两组患者PI、RI均较促排卵前降低,观察组患者明显低于对照组,差异均有统计学意义(P<0.05)。观察组子宫内膜血流A型患者占比为80.95%(85/105),明显高于对照组的40.96%(34/83),差异有统计学意义(P<0.05)。观察组患者HCG日与移植日的E2水平明显高于对照组,HCG日LH水平明显低于对照组,差异均有统计学意义(P<0.05)。观察组患者胚胎着床率、临床妊娠率明显高于对照组,差异均有统计学意义(P<0.05)。结论:他莫昔芬联合HCG治疗可有效改善RIF患者冻融周期子宫内膜容受性,增加子宫内膜厚度,提高妊娠率。OBJECTIVE:To probe into the effects of tamoxifen combined with human chorionic gonadotropin(HCG)on endometrial receptivity in patients with repeated implantation failure(RIF)during freeze-thaw cycles.METHODS:The clinical data of 188 patients with RIF(≥3 times)undergoing freeze-thaw embryo transfer in our hospital from Jul.2017 to Jun.2019 were retrospectively analyzed.All patients were divided into the observation group(n=105)and the control group(n=83)according to different endometrial preparation schemes.The observation group was given tamoxifen combined with HCG intrauterine infusion,while the control group received letrozole combined with HCG intrauterine infusion.Differences of endometrial thickness and subendometrial blood flow[pulsatility index(PI),resistance index(RI)],endometrial blood flow type,hormone levels on HCG day and transplantation day[luteinizing hormone(LH),estradiol(E2)and progesterone]levels and pregnancy outcomes of two groups were compared.RESULTS:On transplantation day,the endometrial thickness of two groups increased significantly compared with that before ovulation induction,and the observation group was significantly larger than the control group,with statistically significant difference(P<0.05).The PI and RI of two groups were lower than those before ovulation induction,and the observation group was significantly lower than the control group,with statistically significant difference(P<0.05).The proportion of type A endometrial blood flow in the observation group was 80.95%(85/105),significantly higher than 40.96%(34/83)in the control group,with statistically significant difference(P<0.05).E2 on HCG day and E2 on transplantation day in the observation group were significantly higher than those in the control group,and LH on HCG day was lower than that in the control group,the differences were statistically significant(P<0.05).The implantation rate and clinical pregnancy rate of the observation group were significantly higher than those of the control group,with statistically signific

关 键 词：他莫昔芬 人绒毛膜促性腺激素 反复种植失败 冻融周期 子宫内膜容受性 妊娠结局 

分 类 号：R984[医药卫生—药品]