口服地屈孕酮对子宫内膜植入窗期超微结构的影响:一项前瞻性研究  

Effect of oral dydrogesterone on ultrastructure during the window of implantation: a prospective study

作　　者：杨天云 杨清美 姬萌霞 舒崇医 郭晓燕 舒静[2] Yang Tianyun;Yang Qingmei;Ji Mengxia;Shu Chongyi;Guo Xiaoyan;Shu Jing(The Second Clinical Medical College,Zhejiang Chinese Medical University,Hangzhou 310053,China;Center for Reproductive Medicine,Zhejiang Provincial People's Hospital(Affiliated People's Hospital of Hangzhou Medical College),Hangzhou 310014,China)

机构地区：[1]浙江中医药大学第二临床医学院,杭州310053 [2]浙江省人民医院(杭州医学院附属人民医院)生殖医学中心,杭州310014

出　　处：《中华生殖与避孕杂志》2023年第5期506-512,共7页Chinese Journal of Reproduction and Contraception

基　　金：白求恩·中青年医生优才培养计划(XJ-2019-024)。

摘　　要：目的探讨地屈孕酮(dydrogesterone,DYD)对植入窗期子宫内膜超微结构的影响。方法前瞻性研究分析2020年7月至2022年7月期间于浙江省人民医院生殖医学中心行体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)并符合纳排标准的患者资料,并对患者的子宫内膜进行扫描与透射电子显微镜检测。对因男性因素行IVF-ET的20例患者进行自身对照研究,比较自然周期和DYD 40 mg/d转化周期植入窗期子宫内膜超微结构的差异。同时采用自身对照研究,筛选原因不明反复种植失败(recurrent implantation failure,RIF)行IVF-ET患者(n=43),比较不同剂量DYD(40 mg/d与80 mg/d)转化后内膜超微结构的变化。结果男性因素不孕患者自然周期与DYD转化周期的子宫内膜在转化日的超声厚度测量、回声分型和在植入窗期的胞饮突评分、核仁通道系统(nucleolar channel system,NCS)阳性率、分泌状态评分、线粒体数目和形态评分差异均无统计学意义(均P>0.05)。RIF患者DYD 80 mg/d组的胞饮突评分(-46.26±19.97)、NCS阳性率[65.12%(28/43)]和线粒体形态评分[0(0,1)]均显著高于DYD 40 mg/d组[-67.62±15.94,P<0.001;39.53%(17/43),P=0.043;0(0,0),P=0.023],而两组间子宫内膜厚度、回声类型、分泌状态评分及线粒体数目差异均无统计学意义(均P>0.05)。结论口服DYD转化内膜可以构建与自然周期类似的植入窗期子宫内膜超微结构。80 mg/d DYD剂量可以改善RIF患者子宫内膜的胞饮突成熟度评分、NCS阳性率和线粒体形态评分。Objective To investigate the effect of dydrogesterone(DYD)on the ultrastructure of the endometrium in the window of implantation.Methods We prospectively studied endometrium tissues of patients who underwent in vitro fertilization and embryo transfer(IVF-ET)from July 2020 to July 2022 at the Center for Reproductive Medicine of Zhejiang Provincial People's Hospital.The ultrastructure of mid-luteal endometrium was examined by scanning electron microscopy and transmission electron microscopy.Firstly,we used self-control study to compare the ultrastructure of endometrium between the natural cycle group and the DYD 40 mg/d group in 20 patients with male factor infertility.Secondly,we used self-control study to compare the ultrastructure of the endometrium between the DYD 40 mg/d group and the DYD 80 mg/d group in 43 patients with recurrent implantation failure(RIF).Results There were no significant differences in endometrial thickness,ultrasound grading,positivity rate of nucleolar channel system(NCS),pinopode score and secretor status score,in addition to number and morphology score of mitochondria,between the natural cycle group and the DYD 40 mg/d group(all P>0.05).In RIF patients,the DYD 80 mg/d group rendered significantly higher pinopode score(-46.26±19.97),NCS positivity rate[65.12%(28/43)]and mitochondrial morphology score[0(0,1)]than those in the DYD 40 mg/d group[-67.62±15.94,P<0.001;39.53%(17/43),P=0.043;0(0,0),P=0.023],while other characteristics were not significantly different between the two groups(all P>0.05).Conclusion The ultrastructure of endometrium in DYD supplementation cycle was similar to that in the natural cycle.Increasing the dosage of DYD significantly improved pinopode maturity,NCS positivity rate and mitochondrial morphology of the endometrium in RIF patients.

关 键 词：地屈孕酮 子宫内膜 超微结构 反复种植失败 植入窗期 

分 类 号：R714.8[医药卫生—妇产科学]