子宫内膜潜伏期结核患者IVF/ICSI妊娠结局的影响因素分析  

Influencing factors on pregnancy outcome of IVF/ICSI in patients with endometrial latent tuberculosis

作　　者：潘丹 杨元利 李罗娟 李娜 王婷 周寒鹰 师娟子 刘项 PAN Dan;YANG Yuan-li;LI Luo-juan;LI Na;WANG Ting;ZHOU Han-ying;SHI Juan-zi;LIU Xiang(Northwest Women’s&Children’s Hospital,Xi’an 710004;Xi’an Chest Hospital,Xi’an 710100;Chenggu County Hospital of Shaanxi Province,Hanzhong 723200)

机构地区：[1]西北妇女儿童医院,西安710004 [2]西安市胸科医院,西安710100 [3]陕西省城固县医院,汉中723200

出　　处：《生殖医学杂志》2023年第10期1457-1462,共6页Journal of Reproductive Medicine

基　　金：陕西省中医药管理局科研课题(临床类研究课题)(2019-ZZ-LC045)。

摘　　要：目的探究子宫内膜潜伏期结核患者经过规范抗结核治疗后的IVF/ICSI妊娠结局的影响因素。方法本研究为配对病例对照研究,收集2017年1月至2021年12月期间在西北妇女儿童医院进行IVF/ICSI助孕治疗的患者资料,根据是否合并子宫内膜潜伏期结核,分为内膜潜伏期结核组(n=74)及对照组(n=370),比较两组间的基本资料、促排卵情况以及新鲜周期移植后的临床妊娠结局,并对年龄、窦卵泡数(AFC)、体质量指数(BMI)、宫腔粘连、子宫内膜潜伏期结核、HCG日内膜厚度、移植胚胎个数、移植胚胎形态等影响妊娠结局的主要因素行Logistic多因素分析。结果两组患者间年龄、BMI、基础FSH水平、总Gn剂量、HCG日孕酮水平、IVF受精比例、临床妊娠率、早产率、活产率、双胎率等比较均无统计学差异(P>0.05)。与对照组相比,内膜潜伏期结核组患者不孕年限长、AFC少、原发不孕及输卵管病变占比大,拮抗剂方案占比高、Gn天数少、HCG日E 2值低及内膜薄,获卵数、可用胚胎数及优质胚胎数均少,移植单胚胎占比低、移植囊胚占比低,差异均有统计学意义(P<0.05)。在校正了年龄、AFC、BMI、宫腔粘连、HCG日内膜厚度等相关混杂因素后,内膜潜伏期结核经治疗后不影响新鲜周期活产率[OR=1.078,95%CI(0.591,1.969),P=0.806];而宫腔粘连[OR=0.495,95%CI(0.257,0.953),P=0.035]及HCG日内膜厚度[OR=1.13,95%CI(1.031,1.239),P=0.009]是活产率的独立影响因素。结论子宫内膜潜伏期结核患者,经过规范抗结核治疗后其IVF/ICSI妊娠结局与正常人群无明显差异。对于结核高危因素者,IVF/ICSI助孕之前通过宫腔镜检查及内膜活检排除内膜潜伏期结核是必要的。Objective:To explore the influencing factors of IVF/ICSI pregnancy outcomes in patients with endometrial latent tuberculosis after standardized anti-tuberculosis treatment.Methods:This study is a matched case-control study.The data of patients who received IVF/ICSI assisted pregnancy treatment in Northwest Women’s and Children’s Hospital from January 2017 to December 2021 were collected.According to the presence or absence of endometrium latent tuberculosis,they were divided into endometrial latent tuberculosis group(n=74)and control group(n=370).The basic data,ovulation induction and clinical pregnancy outcome after fresh embryos transplantation were compared between the two groups.The main factors affecting pregnancy outcomes,such as age,antral follicle count(AFC),body mass index(BMI),intrauterine adhesions,endometrial latent tuberculosis,endometrial thickness on HCG day,number and morphology of embryos transferred were analyzed by using logistic multiple factor analysis.Results:There were no significant differences in age,BMI,basic FSH,total Gn dose,progesterone level on HCG day,IVF fertilization ratio,clinical pregnancy rate,preterm birth rate,live birth rate,and twin rate between the two groups(P>0.05).Compared with the control group,the patients with endometrial latent tuberculosis had longer infertility years,less basal AFC,higher proportion of primary infertility and fallopian tube lesions,higher proportion of antagonist protocol,less days Gn used,lower E 2 level on HCG day and thinner endometrium,fewer oocytes retrieved,available embryos and high-quality embryos,lower proportion of single embryo transfer and blastocysts transfer,and the differences were significant(P<0.05).After adjusted for confounding factors such as age,AFC,BMI,intrauterine adhesions,and endometrial thickness on HCG day,endometrial latent tuberculosis after treatment did not affect the live bath rate of fresh cycle[OR=1.078,95%CI(0.591,1.969),P=0.806],while uterine adhesions[OR=0.495,95%CI(0.257,0.953),P=0.035]and endometrial thic

关 键 词：子宫内膜潜伏期结核 宫腔粘连 体外受精/卵胞浆内单精子注射 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]