环孢素A在不明原因反复种植失败患者中的应用研究  

Study on the Application of Cyclosporine A in Patients with Unexplained Repeated Implantation Failure

作　　者：王艺璇 宋家美 别嘉 苏娅[1] 陈静思[1] 汪宗玉 孟昱时[1] WANG Yixuan;SONG Jiamei;BIE Jia(Department of Reproductive Medicine,The Second Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650032,China)

机构地区：[1]昆明医科大学第二附属医院生殖医学科,云南昆明650032

出　　处：《实用妇产科杂志》2024年第11期918-922,共5页Journal of Practical Obstetrics and Gynecology

基　　金：云南省“万人计划”名医专项人才项目(编号:云卫人发[2019]35);云南省教育厅科学研究基金项目(编号:2022J0240)。

摘　　要：目的:探讨环孢素A(CsA)在不明原因反复种植失败(URIF)患者中的临床疗效,分析患者外周血淋巴细胞亚群在CsA治疗后的变化。方法:选取2021年9月30日至2022年3月1日在昆明医科大学第二附属医院生殖医学科接受冻融胚胎移植(FET)的105例URIF患者,按是否服用CsA分为CsA组(n=52)和对照组(n=53),比较两组患者妊娠结局及淋巴细胞亚群的变化。结果:CsA组患者胚胎种植率和临床妊娠率均显著高于对照组,差异有统计学意义(48.91%vs.32.56%,P=0.027;53.85%vs.32.08%,P=0.024);CsA组早期流产率与对照组比较(10.71%vs.23.53%)差异无统计学意义(P=0.25);CsA组CD3^(-)CD16^(+)CD56^(+)百分比治疗后明显降低[(16.15±5.37)%vs.(18.23±7.10)%,P=0.012],与对照组比较亦降低[(16.15±5.37)%vs.(18.67±5.16)%,P=0.018]。结论:CsA治疗能显著提高URIF患者冻融胚胎移植的临床妊娠率和胚胎种植率,其疗效可能是促进外周血淋巴细胞分布向着有利于胚胎着床的方向偏移,尤其是通过下调CD3-CD16^(+)CD56^(+)百分比而实现的,在辅助生殖领域有一定的应用前景。Objective:To investigate the clinical efficacy of Cyclosporine A(CsA)in patients with unexplained repeated implantation failure(URIF),and to analyze the changes of peripheral blood lymphocyte subsets after CsA treatment.Methods:105 patients with URIF who underwent frozen-thawed embryo transfer(FET)in the Department of Reproductive Medicine in The Second Affiliated Hospital of Kunming Medical University from September 30,2021 to March 1,2022 were selected.After informed consent,the patients were divided into CsA group(n=52)and control group(n=53)according to whether they received CsA treatment or not.Pregnancy outcomes and changes in lymphocyte subset were compared between the two groups.Results:The embryo implantation rate and clinical pregnancy rate in CsA group were higher than those in the control group,the difference was statistically significant(48.91%vs.32.56%,P=0.027;53.85%vs.32.08%,P=0.024).The CsA group had a lower early abortion rate than the control group(10.71%vs.23.53%),but the difference was not statistically significant(P=0.25).The percentage of CD3^(-)CD16^(+)CD56^(+)in CsA group was significantly decreased after treatment[(16.15±5.37)%vs.(18.23±7.10)%,P=0.012],it was also lower than that in the control group[(16.15±5.37)%vs.(18.67±5.16)%,P=0.018].Conclusions:CsA treatment can significantly improve the clinical pregnancy rate and embryo implantation rate of frozen-thawed embryo transfer in patients with URIF,which may be achieved by promoting the distribution of peripheral blood lymphocytes to the direction of embryo implantation,especially by down-regulating the percentage of CD3-CD16^(+)CD56^(+).CsA has a certain application prospect in the field of assisted reproduction.

关 键 词：环孢素A 不明原因反复种植失败 临床妊娠率 胚胎种植率 淋巴细胞亚群 

分 类 号：R714.5[医药卫生—妇产科学]