阿托西班对反复种植失败患者冻融胚胎移植临床结局的影响  

Effect of Atosiban on the Outcomes of Frozen-Thawed Embryo Transfer in Patients with Repeated Implantation Failure

作　　者：张园[1] 姜超[2] 蒋春艳[1] 钱易[1] 袁纯[1] 舒黎[1] 冒韵东[1] 刘嘉茵[1] 刁飞扬[1] 马翔[1] ZHANG Yuan;JIANG Chao;JIANG Chun-yan;QIAN Yi;YUAN Chun;SHU Li;MAO Yun-dong;LIU Jia-yin;DIAO Fei-yang;MA Xiang(Department of Reproductive Medicine,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Public Health,School of Medicine&Holistic Integrative Medicine,Nanjing University of Chinese Medicine,Nanjing 210023,China)

机构地区：[1]南京医科大学第一附属医院生殖医学科,210029 [2]南京中医药大学医学院·整合医学学院公共卫生学系

出　　处：《国际生殖健康／计划生育杂志》2023年第2期95-101,共7页Journal of International Reproductive Health/Family Planning

基　　金：国家重点研发计划(2021YFC2700404,2017YFC1001004,2016YFC1000703);国家自然科学基金(81901449,81701517);东南大学-南京医科大学联合科研攻关项目(JX102GSP2017DN26)。

摘　　要：目的:探讨不同病因反复种植失败患者冻融胚胎移植术前使用阿托西班对临床结局的影响。方法:选取2019年1月—2021年1月在南京医科大学第一附属医院生殖医学科冻融胚胎移植周期中诊断为反复种植失败的患者,利用倾向性评分匹配法共纳入230例患者的临床资料。根据胚胎移植日是否使用阿托西班分为阿托西班组和对照组各115例,阿托西班组于移植前30 min静脉推注小剂量阿托西班6.75 mg(0.9 mL),对照组未使用阿托西班。比较2组患者的胚胎种植率、临床妊娠率、异位妊娠率、流产率、早产率和活产率,并对反复种植失败的不同病因(子宫内膜异位症、免疫/凝血异常、不明原因、复合因素和其他因素)进行亚组分析,比较不同亚组人群中阿托西班组与对照组的临床结局。结果:阿托西班组和对照组胚胎种植率、临床妊娠率、异位妊娠率、流产率、早产率和活产率差异均无统计学意义(均P>0.05)。二分类Logistic回归分析结果显示,移植胚胎类型对活产率的影响差异有统计学意义(P=0.001)。对不同病因所致反复种植失败的患者进行亚组分析发现,子宫内膜异位症合并反复种植失败的亚组人群中,使用阿托西班可以显著降低流产率(P=0.036),但不增加活产率(P=0.757)。结论:使用阿托西班不能改善反复种植失败患者冻融胚胎移植周期的临床结局,不提高活产率。不建议无临床指征地使用阿托西班。Objective:To investigate the effects of atosiban on the pregnancy outcome of frozen-thawed embryo transfer in patients with repeated implantation failure with different etiologies.Methods:From January 2019 to January 2021,the patients diagnosed with repeated implantation failure in their frozen-thawed embryo transfer cycles were selected,and the clinical data of 230 patients were included by the propensity score matching method.Patients were divided into the atosiban group and the control group,according to whether atosiban was used on the day of embryo transfer.A small dose of 6.75 mg(0.9 mL)of atosiban was injected intravenously 30 minutes before embryo transfer in the atosiban group(n=115),while the control group(n=115)did not use.The implantation rate,clinical pregnancy rate,ectopic pregnancy rate,miscarriage rate,preterm birth rate and live birth rate were compared between the two groups.The different causes of repeated implantation failure(endometriosis,immunological or coagulation abnormalities,unknown causes,complex factors and other factors)were analyzed in subgroups,and the differences of clinical outcomes between the two groups were compared.Results:No significant differences were found in the implantation rate,clinical pregnancy rate,ectopic pregnancy rate,miscarriage rate,preterm birth rate and live birth rate between the two groups(both P>0.05).Multivariate analysis showed that there was a significant correlation between the type of transferred embryos and the live birth rate(P=0.001).The subgroup analysis of the different causes of repeated implantation failure showed that in the subgroup of endometriosis,the use of atosiban could significantly reduce the miscarriage rate(P=0.036),but does not increase the live birth rate(P=0.757).Conclusions:The use of atosiban cannot improve the clinical outcome of frozen-thawed embryo transfer cycle in patients with repeated implantation failure,and does not improve the live birth rate.It is not recommended to use atosiban without clinical indications.

关 键 词：反复种植失败 胚胎移植 阿托西班 子宫内膜异位症 妊娠结局 妊娠率 流产率 

分 类 号：R714.8[医药卫生—妇产科学]