反复胚胎种植失败人群子宫内膜种植窗移位的影响因素分析  

Analysis of the influencing factors of endometrial implantation window displacement in the patients with repeated implantation failures

作　　者：付平芳 磨丹 岑长双 梁丁宇 陈雨欣 赵洪 杨一华 FU Pingfang;MO Dan;CEN Changshuang;LIANG Dingyu;CHEN Yuxin;ZHAO Hong;YANG Yihua(Reproductive Medicine Center,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院生殖医学中心,南宁530021

出　　处：《广西医科大学学报》2024年第8期1151-1156,共6页Journal of Guangxi Medical University

基　　金：国家自然科学基金资助项目(No.82360308);广西自然科学基金资助项目(No.2019GXNSFFA245013);广西医科大学杰出青年人才培养计划(No.桂医大人[2020]46号);广西医科大学第一附属医院女性生育力保存创新团队专项基金资助项目(No.YYZS2021001)。

摘　　要：目的:分析接受辅助生殖助孕女性中反复移植失败人群影响子宫内膜种植窗移位的母体因素。方法:回顾性分析2019年4月至2023年3月在广西医科大学第一附属医院生殖医学中心诊断为反复种植失败并行种植窗子宫内膜活检的患者的临床资料。根据病理结果将患者分为容受期(分泌期)组和非容受期(增殖期)组。分析影响子宫内膜向分泌期转化的母体临床因素,采用单因素及多因素logistic回归分析法分析影响子宫内膜种植窗移位的因素。采用免疫组织化学染色法检测两组子宫内膜孕激素受体(PR)及容受性指标HOXA-10蛋白表达。结果:与分泌期组比较,增殖期组血孕酮水平降低,多囊卵巢综合征(PCOS)发生率和子宫内膜炎发生率增高(均P<0.05)。多因素logistic回归分析结果显示,合并低血孕酮水平、PCOS、子宫内膜炎均为子宫内膜种植窗发生移位的独立危险因素(均P<0.05)。免疫组织化学染色显示,PR在增殖期组腺上皮和间质中的H评分均高于分泌期组,HOXA-10在增殖期组腺上皮和间质中的H评分均低于分泌期组(均P<0.05)。结论:母体合并PCOS、子宫内膜炎、低血孕酮水平是造成反复胚胎种植失败人群子宫内膜种植窗移位和容受性下降的危险因素。Objective:To analyze the maternal factors influencing the endometrial implantation window in wom-en experiencing repeated transplant failures with assisted reproductive technology.Methods:A retrospective anal-ysis was conducted on patient case data from the Reproductive Medicine Center of the First Affiliated Hospital of Guangxi Medical University,focusing on individuals diagnosed with repeated implantation failures and undergo-ing endometrial biopsy during the implantation window between April 2019 and March 2023.Patients were cate-gorized into the receptive phase(secretory phase)group and non-receptive phase(proliferative phase)group based on the pathological findings.Maternal clinical factors impacting the transition of the endometrium to the se-cretory phase were analyzed.Univariate and multivariate logistic regression analysis were used to analyze the fac-tors affecting the endometrial implantation window.Immunohistochemical staining was utilized to assess the pro-tein expression of progesterone receptor(PR)and the receptive indicator HOXA10 in the endometrium across the two groups.Results:Compared with the secretory phase group,the serum progesterone levels in proliferative phase group were decreased,and the incidence of polycystic ovary syndrome(PCOS)and endometritis were in-creased(all P<0.05).Multivariate logistic regression analysis indicated that combined with low serum progester-one levels,PCOS and endometritis were independent risk factors for the displacement of the endometrial implan-tation window(all P<0.05).Immunohistochemical staining showed that the H scores of PR in the glandular epi-thelium and stroma of the proliferative phase group were higher than those in the secretory phase group,and the H scores in HOXA-10 in the proliferative group were lower than those in the secretory phase group(all P<0.05).Conclusion:Maternal comorbidity with PCOS,endometritis and low serum progesterone levels are risk factors for displacement of the endometrial implantation window and decreased receptivity in indi

关 键 词：反复种植失败 子宫内膜种植窗 母体因素 孕酮 

分 类 号：R714.8[医药卫生—妇产科学]