冻融胚胎移植周期内膜准备方案与妊娠期高血压疾病相关性研究  

Relationship between endometrial preparation protocols and risk of hypertensive disorders in pregnancy in the frozen-thawed embryo transfer cycles

作　　者：胡耀晖 姚田 马钊 HU Yao-hui;YAO Tian;MA Zhao(Medical Department of Ningxia Liupanshan Senior High School,Yinchuan 750000;General Medicine Department of the First People’s Hospital of Yinchuan,Yinchuan 750000;Obstetrics Department of Xi’an Fourth Hospital,Xi’an 710000;Gynecology Department of Ningxia Hui Autonomous Region People’s Hospital,Yinchuan 750000)

机构地区：[1]宁夏六盘山高级中学医务科,银川750000 [2]银川市第一人民医院全科医学科,银川750000 [3]西安市第四医院产科,西安710000 [4]宁夏回族自治区人民医院妇科,银川750000

出　　处：《生殖医学杂志》2023年第11期1662-1667,共6页Journal of Reproductive Medicine

摘　　要：目的探讨冻融胚胎移植(FET)周期中内膜准备方案与妊娠期高血压疾病的相关性。方法回顾性队列研究分析2014年1月至2021年12月期间在宁夏回族自治区人民医院和西安市第四医院接受FET助孕治疗的9191例不孕症患者的临床资料,仅纳入首个FET周期且获得持续妊娠(妊娠≥20周)的患者。根据FET周期内膜准备方案不同分为自然周期组(1540个周期)和人工周期组(7651个周期),比较两组患者的一般资料及促排卵、胚胎移植情况;又根据所获胚胎数不同,分为单胎妊娠组(7445个周期)和多胎妊娠组(1746个周期),比较单胎妊娠和多胎妊娠组中人工周期和自然周期方案的妊娠结局(主要观察指标为妊娠期高血压疾病发生率,次要指标为妊娠期糖尿病、前置胎盘、贫血、早产等发生率)。结果人工周期组和自然周期组的女方年龄、男方年龄、女方体质量指数、基础窦卵泡数、初产妇比例存在显著性差异(P<0.05)。人工周期组FET前子宫内膜厚度、移植胚胎数目及不同类型胚胎移植比例与自然周期组有显著性差异(P<0.05)。单胎妊娠的7445个周期中,妊娠期高血压疾病发病率为5.99%(446/7445);其中,人工周期组妊娠期高血压疾病发生率显著高于自然周期组(6.36%vs.4.26%,P<0.05)。多胎妊娠的1746个周期中,妊娠期高血压疾病发病率为10.37%(181/1746);其中,人工周期组妊娠期高血压疾病发生率略高于自然周期组(10.86%vs.7.08%),但差异无统计学意义(P>0.05)。在校正了女方年龄、男方年龄、体质量指数、基础窦卵泡数、产次和移植胚胎数等基线资料后,人工周期仍是妊娠期高血压疾病的危险因素[OR=1.52,95%CI(1.163,1.960),P=0.002]。结论在FET周期的内膜准备方案中,人工周期与自然周期相比,可能有更高的妊娠期高血压疾病发生风险,但仍需要大样本随机对照研究加以探讨验证。Objective:To investigate the relationship between different endometrial preparation protocols and risk of hypertensive disorders in pregnancy(HDP)in the frozen-thawed embryo transfer(FET)cycles.Methods:Infertile patients who underwent the first FET cycle and achieved ongoing pregnancy(gestational age≥20weeks)from January 2014to December 2021in Ningxia Hui Autonomous Region People’s Hospital and Xi’an Fourth Hospital were analyzed retrospectively.All patients were divided into two groups according to the endometrial preparation protocols:natural cycle group(NC group,n=1540)and hormone replacement cycle group(HRT group,n=7651),and the general information,ovulation induction,and embryo transfer between two groups of patients were compared.According to the different number of embryos obtained,they were divided into singleton pregnancy group(7445cycles)and multiple pregnancy group(1746 cycles).The pregnancy outcomes(the main observation index was the incidence of HDP,and the secondary indexes were the incidence of diabetes,placenta previa,anemia,preterm delivery,etc.during pregnancy)between the HRT cycle and natural cycle in singleton pregnancy and multiple pregnancy groups.Results:There were significant differences between the HRT group and the NC group in terms of female age,male age,female body mass index(BMI),basal antral follicle count(AFC),and proportion of primiparous women(P<0.05).There were significant differences in endometrial thickness,number of transferred embryos,and proportion of different types of embryo transfer between the HRT group and the NC group before FET(P<0.05).In 7445cycles of singleton pregnancy,the incidence of HDP was 5.99%(446/7445).Among them,the incidence of HDP in the HRT group was significantly higher than that in the NC group(6.36%vs.4.26%,P<0.05).In 1746cycles of multiple pregnancy,the incidence rate of HDP was 10.37%(181/1746),the incidence of HDP in the HRT group was slightly higher than that in the NC group(10.86%vs.7.08%),but the difference was not significant(P>0.05).Afte

关 键 词：冻融胚胎移植 内膜准备方案 妊娠期高血压疾病 人工周期 自然周期 

分 类 号：R394.1[医药卫生—医学遗传学] R711.6[医药卫生—基础医学]