反复种植失败患者子宫内膜CD138阳性对体外受精-胚胎移植妊娠结局的影响  

Effect of endometrial CD138 positive on pregnancy outcome in vitro fertilization-embryo transfer in patients with repeated implantation failure

作　　者：王佩玉[1] 杨海燕[1] 金聪聪[1] 林佳[1] 金武敏 李剑敏[2] 黄学锋[1] WANG Peiyu;YANG Haiyan;JIN Congcong;LIN Jia;JIN Wumin;LI Jianmin;HUANG Xuefeng(Reproductive Medicine Center,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,China;Department of Pathology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,China)

机构地区：[1]温州医科大学附属第一医院生殖医学中心,浙江温州325015 [2]温州医科大学附属第一医院病理科,浙江温州325015

出　　处：《温州医科大学学报》2024年第5期355-362,共8页Journal of Wenzhou Medical University

基　　金：温州市基础性科研项目(Y2020482)。

摘　　要：目的:研究不明原因反复种植失败(RIF)患者子宫内膜CD138阳性对体外受精-胚胎移植周期临床妊娠结局的影响。方法:选取2019年7月至2023年5月温州医科大学附属第一医院收治的不明原因RIF患者332例(352个周期),行子宫内膜活检,免疫组化法查CD138阳性细胞。根据检测结果分成CD138阳性组和CD138阴性组,并按照每20个高倍镜视野(20 HPFs)下CD138阳性的数量分成1~5个/20 HPFs组,6~20个/20 HPFs组和>20个/20 HPFs组。对部分CD138阳性患者进行抗生素治疗,并随访妊娠结局。结果:在352个周期中,181个周期CD138检测阳性,阳性率为51.42%。其中1~5个/20 HPFs组有72个周期(39.78%),6~20个/20 HPFs组有63个周期(34.81%),>20个/20 HPFs组有46个周期(25.41%)。多因素Logistic回归分析结果显示,CD138阳性是影响临床妊娠的因素之一(OR=-0.474,95%CI=0.395~0.98,P=0.041)。CD138阳性组的临床妊娠率、胚胎种植率显著低于CD138阴性组(P<0.05)。当CD138阳性细胞数>20个/20 HPFs时,临床妊娠率和胚胎种植率显著低于CD138阴性组(P<0.05)。当C138个数少于5个/20 HPFs时,抗生素治疗和未治疗组妊娠结局差异无统计学意义(P>0.05)。CD138阳性患者抗生素治疗后持续阳性时,其临床妊娠率、胚胎种植率和活产率显著低于初检阴性和治疗后转阴患者(P<0.05);治疗后转阴患者和初检阴性患者的临床妊娠率、胚胎种植率和活产率差异无统计学意义(P>0.05)。结论:子宫内膜的CD138阳性细胞数>20个/20 HPFs降低了胚胎种植率、临床妊娠率,抗生素治疗后转阴可以改善妊娠结局,但持续阳性将影响妊娠结局。少量的CD138阳性(<5个/20 HPFs)对妊娠结局无明显影响。Objective:To study the effect of endometrial CD138 positive test on the clinical pregnancy outcome of in vitro fertilization-embryo transfer(IVF-ET)in patients with unexplained repeated implantation failure(RIF).Methods:A total of 332 patients(352 cycles)with unexplained RIF were selected for endometrial biopsy,immunohistochemical detection of CD138 positive cells in the First Affiliated Hospital of Wenzhou Medical University from July 2019 to May 2023.According to the detection results,they were divided as CD138-positive group and negative group.And according to the number of CD138-positive cell under 20 high-power field(20 HPFs),they were further divided into 1-5/20 HPFs group,6-20/20 HPFs group and>20/20 HPFs group.Some of the CD138 positive patients were treated with antibiotics,and the pregnancy outcome was followed up.Results:In 352 cycles,181 cycles were positive for CD138,with the positive rate of 51.42%.Among them,there were 72 cycles in 1-5/20 HPFs group(39.78%),63 cycles in 6-20/20 HPFs group(34.81%),and 46 cycles in>20/20 HPFs group(25.41%).Multivariate Logistic regression analysis showed that CD138 positive was one of the factors reducing clinical pregnancy rate(OR=-0.474,95%CI=0.395-0.98,P=0.041).The clinical pregnancy rate and embryo implantation rate in CD138 positive group were significantly lower than those in negative group(P<0.05).When the number of CD138 positive cells was more than 20 for per 20HPFs,the clinical pregnancy rate and embryo implantation rate were significantly lower than those in the negative group(P<0.05).When the number of C138 was less than 5 for per 20 HPFs,there was no significant difference in pregnancy outcomes between antibiotic treatment and untreated groups.Patients with persistent CD138 cell positive after antibiotic treatment had significantly lower rate of clinical pregnancy embryo implantation and live birth than patients with initial negative of CD138 cell(P<0.05).Patients who turned negative of CD138 cell after treatment had similar clinical pregnancy rate,embry

关 键 词：反复种植失败 慢性子宫内膜炎 CD138阳性细胞 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]