应用低分子肝素对≥2次着床失败患者妊娠结局的影响  

Effect of application of low molecular weight heparin on pregnancy outcomes among patients with≥2 times implantation failures

作　　者：姚文 远孝琼 姚青云 覃丹俞 李倪捷 黄勇 李豫峰[1] YAO Wen;YUAN Xiao-qiong;YAO Qing-yun;QIN Dan-yu;LI Ni-jie;HUANG Yong;LI Yu-feng(Reproductive Medical Center,Tongji Hospital,Tongji Medical College of Huazhong University of Science&Technology,Wuhan 453000)

机构地区：[1]华中科技大学同济医学院附属同济医院生殖医学中心,武汉453000

出　　处：《生殖医学杂志》2022年第12期1633-1639,共7页Journal of Reproductive Medicine

摘　　要：目的研究应用低分子肝素(LMWH)对≥2次胚胎着床失败患者冻融胚胎移植(FET)周期妊娠结局的影响。方法回顾性分析2018年1月至2020年12月于我院生殖医学中心行FET、既往有≥2次胚胎着床失败的1547例患者(共2140个解冻周期)的临床资料。根据是否使用LMWH分为LMWH组(n=182)和未使用LMWH的对照组(n=10x0E䥺Symbol`@@0x0F958)。比较两组患者的基础资料、胚胎移植情况及妊娠结局;采用倾向性评分匹配(PSM)法匹配两组样本量后,分析匹配后LMWH对妊娠结局的影响。结果两组患者的年龄、不孕年限、不孕因素、体质量指数(BMI)、移植胚胎类型比较均无显著性差异(P>0.05)。LMWH组的基础FSH水平和移植日子宫内膜厚度均显著高于对照组,而基础窦卵泡计数(AFC)则显著低于对照组(P<0.05)。两组患者的活产率比较无显著性差异(P>0.05);LMWH组的HCG阳性率、着床率、临床妊娠率和流产率均显著高于对照组(P<0.01)。PSM后,结果仍显示两组的活产率无显著性差异(44.51%vs.38.19%,P>0.05),LMWH组的HCG阳性率(85.71%vs.58.52%)、着床率(57.63%vs.41.46%)、临床妊娠率(72.53%vs.49.73%)、流产率(38.64%vs.22.10%)均显著高于对照组(P<0.05)。结论应用LMWH可以提高≥2次胚胎移植失败患者的HCG阳性率、着床率、临床妊娠率及流产率,但对活产率没有明显影响。临床医生在应用LMWH来改善≥2次胚胎移植失败患者的妊娠结局时需要关注其增高流产率的风险。Objective:To study the effect of application of low molecular weight heparin(LMWH)on reproductive outcomes of frozen-thawed embryo transfer(FET)cycle among patients with≥2 times implantation failures.Methods:The clinical data of 1547 patients(2140 cycles)with≥2 times implantation failures who underwent FET in the Reproductive Medical Center of Tongji Hospital from January 2018 to December 2020 were retrospectively analyzed.They were divided into LMWH group(n=182)and control group(n=1958)according to whether LMWH was used or not.The basic data,embryo transfer and pregnancy outcome were compared between the two groups.The influence of LMWH on pregnancy outcome was analyzed after the sample size of the two groups was matched by the propensity score matching(PSM)method.Results:There were no significant differences in age,years of infertility,infertility factors,body mass index(BMI)and type of embryo transfer between the two groups(P>0.05).The basal FSH and endometrial thickness on the transplantation day in LMWH group were significantly higher than those in the control group,while the basal antral follicle count(AFC)was significantly lower than that in the control group(P<0.05).There was no significant difference in live birth rate between the two groups(P>0.05).The HCG positive rate,implantation rate,clinical pregnancy rate and abortion rate in LMWH group were significantly higher than those in control group(P<0.01).After PSM,the results still showed that there was no significant difference in the live birth rate between the two groups(44.51%vs.38.19%,P>0.05).The HCG positive rate(85.71%vs.58.52%),implantation rate(57.63%vs.41.46%),clinical pregnancy rate(72.53%vs.49.73%),and abortion rate(38.64%vs.22.10%)in LMWH group were significantly higher than those in the control group(P<0.05).Conclusions:Application of LMWH can increase the HCG positive rate,implantation rate,clinical pregnancy rate,and abortion rate in patients with≥2 times implantation failures.However,application of LMWH has no effect on the live bi

关 键 词：低分子肝素 胚胎着床失败 活产率 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]