反复胚胎种植失败与反复妊娠丢失相关母体危险因素比较  

Comparison of maternal risk factors related to repeated embryo implantation failure and repeated pregnancy loss

作　　者：茹慧波 吴纯 杨扬 董九华 王琇 王树松 杜丽荣 RU Huibo;WU Chun;YANG Yang;DONG Jiuhua;WANG Xiu;WANG Shusong;DU Lirong(Hebei Provincial Reproductive Health Hospital(Hebei Key Laboratory of Reproductive Medicine),Shijiazhuang 050071,Hebei,China)

机构地区：[1]河北省生殖健康医院(河北省生殖医学重点实验室),石家庄050071

出　　处：《中国性科学》2023年第7期37-41,共5页Chinese Journal of Human Sexuality

基　　金：河北省省级科技计划(21377799D,223777151D);河北省中医药类科研计划课题(2021205)。

摘　　要：目的对反复胚胎种植失败(RIF)与反复妊娠丢失(RPL)患者的母体危险因素进行比较,为临床科研与诊疗提供参考。方法回顾性分析2020年1月至2021年6月于河北省生殖健康医院就诊的500例患者的病历资料,经筛选符合标准的共290例,分为RIF组87例、RPL组203例,对两组母体危险因素进行分析比较。结果RIF组易栓因素(68.96%)、内分泌因素(51.72%)、自身免疫因素(33.33%)占比均显著低于RPL组(82.76%、68.47%、56.16%),其余无显著性差异。混合因素异常率比较中,RIF组1~2种混合因素异常率高于RPL组(36.78%vs.16.70%),3~4种混合因素异常率低于RPL组(47.13%vs.64.50%),差异具有统计学意义(P<0.05)。具体病因统计发现RIF组抗磷脂综合征(24.13%)、胰岛素抵抗(36.78%)发病率显著低于RPL组(37.43%、55.17%),差异具有统计学意义(P<0.05)。此外,两组免疫细胞失衡均以辅助T细胞1/辅助T细胞2(Th1/Th2)失衡、自然杀伤细胞(NK)%增高为主。结论两组患者病因构成复杂,常同时存在多种母体危险因素。与RIF相比,RPL患者病因更复杂,多伴有3~4种异常,以易栓、内分泌、自身免疫因素占比较高,其中抗磷脂综合征与胰岛素抵抗是引起不良妊娠结局的重要危险因素。叶酸代谢障碍、甲状腺功能异常、慢性子宫内膜炎、维生素D不足、免疫细胞指标异常在两组中发病率相似。Objective To compare the maternal risk factors of patients with repeated embryo implantation failure(RIF)and repeated pregnancy loss(RPL),so as to provide reference for clinical research and diagnosis.Methods The medical records of 500 RIF and RPL patients who were treated in Hebei Provincial Reproductive Health Hospital from January 2020 to June 2021 were retrospectively analyzed.After screening,290 case met the criteria,including 87 cases in RIF group and 203 cases in RPL group.The maternal risk factors were analyzed and compared in two groups.Results The proportions of thrombophilic factors(68.96%),endocrine factors(51.72%)and autoimmune factors(33.33%)in RIF group were significantly lower than those in RPL group(82.76%,68.47%,56.16%),and there was no significant difference in the rest factors.In the comparison of abnormal rate of mixed factors,the abnormal rate of 1-2 mixed factors in RIF group was higher than that in RPL group(36.78%vs.16.70%),and the abnormal rate of 3-4 mixed factors was lower than that in RPL group(47.13%vs.64.50%).The difference was statistically significant(P<0.05).The specific etiology statistics showed that the incidence rate of antiphospholipid syndrome(24.13%)and insulin resistance(36.78%)in RIF group was significantly lower than that in RPL group(37.43%and 55.17%),and the difference was statistically significant(P<0.05).In addition,the imbalance of immune cells in both groups was mainly characterized by T helper 1 cell/T helper 2 cell(Th1 Th2)imbalance and an increase in natural killer cell(NK)%.Conclusions The etiology of the two groups of patients is complex,and there are of ten multiple maternal risk factors at the same time.Compared with RIF,the etiology of RPL patients is more complex,and most of them are accompanied by 3-4 abnormalities,of which thrombophilia,endocrine and autoimmune factors account for a high proportion.Among them,antiphospholipid syndrome(APS)and insulin resistance are important risk factors for adverse pregnancy outcomes.The incidence rate of folate metabo

关 键 词：反复胚胎种植失败 反复妊娠丢失 母体因素 病因分析 免疫因素 

分 类 号：R711[医药卫生—妇产科学]