宫腔灌注PRP联合IVF-FET在慢性子宫内膜炎患者中的临床应用价值  

Clinical application value of intracavitary PRP infusion combined with IVF-FET in patients with chronic endometritis

作　　者：张晓彤 郝晓园 方锐 胡舒瑶 马琳昆 赵亚琦 韩卫 ZHANG Xiaotong;HAO Xiaoyuan;FANG Rui;HU Shuyao;MA Linkun;ZHAO Yaqi;HAN Wei(Department of Laboratory Medicine,The Second Affiliated Hospital of Xuzhou Medical University,Xuzhou Mining Group General Hospital,Xuzhou 221006,China;Department of Obstetrics and Gynecology,The Second Affiliated Hospital of Xuzhou Medical University,Xuzhou Mining Group General Hospital,Xuzhou 221006,China;Center for Reproductive Genetics,The Second Affiliated Hospital of Xuzhou Medical University,Xuzhou Mining Group General Hospital,Xuzhou 221006,China;Department of Blood Transfusion,The Second Affiliated Hospital of Xuzhou Medical University,Xuzhou Mining Group General Hospital,Xuzhou 221006,China)

机构地区：[1]徐州医科大学第二附属医院徐州矿务集团总医院检验科,江苏徐州221006 [2]徐州医科大学第二附属医院徐州矿务集团总医院妇产科,江苏徐州221006 [3]徐州医科大学第二附属医院徐州矿务集团总医院生殖遗传中心,江苏徐州221006 [4]徐州医科大学第二附属医院徐州矿务集团总医院输血科,江苏徐州221006

出　　处：《中国输血杂志》2025年第3期382-387,共6页Chinese Journal of Blood Transfusion

基　　金：徐州医科大学附属医院科技发展基金项目(XYFY202246)。

摘　　要：目的 分析宫腔灌注富血小板血浆(platelet-rich plasma, PRP)联合体外受精-冻融胚胎移植(in vitro fertilization-frozen-thawed embryo transfer, IVF-FET)在慢性子宫内膜炎患者中的临床应用价值。方法 采用随机对照试验(randomized controlled trial, RCT)模型,选取2022年1月至2024年1月在本院行人工周期冻胚移植的慢性子宫内膜炎(chronic endometritis, CE)患者60例为研究对象,根据随机原则将实验组分为A组(常规冻胚移植)、B组(常规冻胚移植+PRP宫腔灌注1次)、C组(常规冻胚移植+PRP宫腔灌注2次)各20例。比较3组患者转化期和移植期子宫内膜厚度,移植期子宫动脉搏动指数(pulsatility index, PI)、子宫动脉阻力指数(resistance index, RI)和收缩期峰值流速/舒张末期峰值流速(systolic peak velocity/end-diastolic velocity, S/D),移植期血清IL-2、IL-4、IL-6、IL-10、TNF水平和3组患者生化妊娠率、临床妊娠率、活产率、早期流产率等指标。结果 转化期3组患者子宫内膜厚度比较,差异无统计学意义(P>0.05)。移植期C组和B组患者子宫内膜厚度均高于A组[9.54(8.96~10.22)和8.90(8.34~9.72)vs 8.37(7.89~8.75)mm,P均<0.05],C组患者子宫内膜厚度高于B组(Z=3.733,P<0.05)。移植期C组和B组患者子宫内膜厚度均高于同组转化期,差异具有统计学意义(Z=2.191、2.462,P均<0.05)。C组和B组患者移植期PI、RI和S/D均低于A组[PI:1.87(1.77~1.97)、1.94(1.88~2.15)vs 2.43(2.35~2.49);RI:0.75(0.73~0.77)、0.78(0.75~0.81)vs 0.84(0.83~0.86);S/D:2.61(2.33~3.42)、3.01(2.20~3.93)vs 3.72(3.06~4.49),P均<0.05]。C组患者移植期PI、RI均低于B组,差异有统计学意义(P均<0.05)。C组和B组患者移植期IL-2水平均高于A组[3.88(2.71,5.01)、3.59(2.73,4.38)vs 3.16(2.11,3.25)(ng/L),P均<0.05];IL-4、IL-6、IL-10、TNF-α水平均低于A组,差异有统计学意义(IL-4:Z=1.428、2.421;IL-6:Z=1.754、2.435;IL-10:Z=1.754、2.854;TNF-α:Z=1.961、1.765,P均<0.05)。C组患者移植期IL-6水低于B组,差�Objective To evaluate the clinical application value of intrauterine perfusion with platelet-rich plasma(PRP)combined with in vitro fertilization-frozen-thawed embryo transfer(IVF-FET)in patients with chronic endometritis(CE).Methods A randomized controlled trial(RCT)was conducted,enrolling 60 CE patients undergoing artificial cycle frozen embryo transfer at our hospital from January 2022 to January 2024.Participants were randomly divided into three groups:Group A(routine frozen embryo transfer,n=20),Group B(routine frozen embryo transfer+one PRP intrauterine perfusion,n=20),and Group C(routine frozen embryo transfer+two PRP intrauterine perfusions,n=20).Endometrial thickness during the transformation and transplantation phases,uterine artery pulsatility index(PI),resistance index(RI),systolic peak velocity/end-diastolic velocity(S/D)ratio during transplantation,serum levels of IL-2,IL-4,IL-6,IL-10,and TNF-αduring transplantation,as well as biochemical pregnancy rate,clinical pregnancy rate,live birth rate,and early miscarriage rate were compared across groups.Results No significant differences in endometrial thickness were observed among the three groups during the transformation phase(P>0.05).During the transplantation phase,endometrial thickness in Groups C and B was significantly higher than in Group A[9.54(8.96-10.22)and 8.90(8.34-9.72)vs 8.37(7.89-8.75)mm,P<0.05],with Group C showing greater thickness than Group B(Z=3.733,P<0.05).Endo-metrial thickness in Groups C and B during transplantation was significantly increased compared to their respective transfor-mation phases(Z=2.191,2.462;P<0.05).Groups C and B exhibited lower PI,RI,and S/D values than Group A[PI:1.87(1.77-1.97),1.94(1.88-2.15)vs 2.43(2.35-2.49);RI:0.75(0.73-0.77),0.78(0.75-0.81)vs 0.84(0.83-0.86);S/D:2.61(2.33-3.42),3.01(2.20-3.93)vs 3.72(3.06-4.49);P<0.05].Group C demonstrated lower PI and RI than Group B(P<0.05).IL-2 levels in Groups C and B were higher than in Group A[3.88(2.71-5.01),3.59(2.73-4.38)vs 3.16(2.11-3.25)ng/L,P<0.05],while IL-4

关 键 词：宫腔灌注 自体富血小板血浆 体外受精-冻融胚胎移植 慢性子宫内膜炎 妊娠结局 

分 类 号：R457.1[医药卫生—治疗学] R711.32[医药卫生—临床医学]