自身免疫性疾病对辅助生殖技术成功率影响的现状分析  

Analysis of current situation of influence of autoimmune diseases on success rate of assisted reproductive technology

作　　者：高云 何巧花 于岚 张少娣 张宇晖 张翠莲 GAO Yun;HE Qiao-hua;YU Lan;ZHANG Shao-di;ZHANG Yu-hui;ZHNAG Cui-lian(Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院(河南省生殖医院,郑州大学人民医院),郑州450003

出　　处：《医药论坛杂志》2021年第2期17-19,22,共4页Journal of Medical Forum

基　　金：河南省医学科技攻关计划项目(201702210);郑州市科技创新团队(113PCXTD435)。

摘　　要：目的通过对生殖中心自身免疫性疾病对辅助生殖技术成功率影响的现状分析,寻求提高辅助生殖技术成功率的有效方法。方法回顾性收集2017年1月—2018年12月因不孕不育问题就诊于河南省人民医院生殖医学中心的进行辅助生殖技术的妇女,对其辅助生殖的成功率情况进行统计和分析。结果 2 678例进行辅助生殖的妇女中,410例经受了种植失败(Recurrent Implantation Failure,RIF)和复发性流产(recurrent spontaneous abortion,RSA),其中诊断自身免疫性疾病无靶器官损害的患者189例(46.10%),系统性红斑狼疮的比例最高(25.40%)。综合使用抗栓治疗小剂量阿司匹林和低分子肝素、免疫调节治疗羟氯喹、小剂量糖皮质激素、免疫球蛋白治疗可有效提高辅助生殖成功率,各种自身免疫性疾病的成功率差异无统计学意义(P>0.05),但高龄患者成功率低(P<0.01)。结论自身免疫性因素在辅助生殖的RSA和RIF中发挥重要作用,及时发现免疫性病因,进行抗栓和免疫调节治疗可有效改善辅助生殖的妊娠结局。Objective To analyze the current situation of the effect of autoimmune diseases on the success rate of assisted reproductive technology in reproductive centers, we seek effective ways to improve the success rate of assisted reproductive technology.Methods A retrospective study was conducted to collect women who were treated in the Reproductive Medicine Center of Henan People’s Hospital for infertility from January 2017 to December 2018. The success rate of assisted reproduction was analyzed.Results In the 2678 women undergoing assisted reproduction, 410 experienced implantation failure(RIF) and recurrent spontaneous abortion(RSA), 189(46.10%) were diagnosed as autoimmune diseases and the highest proportion(25.40%) was systemic lupus erythematosus. Combining antithrombotic therapy with low-dose aspirin and low-molecular-weight heparin, immunomodulatory therapy with hydroxychloroquine, low-dose glucocorticoid and immunoglobulin, can effectively improve the success rate of assisted reproduction. There is no significant difference in the success rate of various autoimmune diseases(P>0.05). But the success rate of elderly patients was low(P<0.01).Conclusion Autoimmune factors play an important role in RSA and RIF of assisted reproduction. Timely detection of immune causes and antithrombotic and immunomodulatory therapy can effectively improve pregnancy outcomes of assisted reproduction.

关 键 词：自身免疫病 辅助生殖技术 种植失败 复发性流产 低分子肝素 

分 类 号：R321[医药卫生—人体解剖和组织胚胎学]