子宫内膜异位症与自然流产相关性探讨

发布时间：2018-04-05 19:23

本文选题：EMS　切入点：自然流产　出处：《安徽医科大学》2017年硕士论文

【摘要】：研究背景自然流产是一种较为常见的妊娠并发症,引起自然流产的病因很多,如:染色体异常、内分泌异常、免疫功能调节异常、生殖器官解剖异常、感染、环境等因素密切相关。而关于子宫内膜异位症(Endometriosis,EMS)是否与自然流产有关也成为近年来的研究热点。EMS是妇科常见的激素依赖性疾病,是指子宫内膜组织(包括腺体和间质)出现在子宫体以外的部位。基础研究资料显示EMS可通过多种机制影响卵巢排卵、受精卵着床以及胚胎发育等妊娠过程,包括解剖结构的改变、激素水平紊乱、子宫内膜容受性异常、免疫功能异常等机制。子宫内膜异位症可致盆腔粘连形成,改变了盆腔解剖结构,对排卵造成机械性干扰,使激素水平紊乱,加上腹膜及体腔一些因子对精子吞噬能力增强,均可导致不孕以及体外受精-胚胎移植(In vitro fertilization and embryo transfer,IVF-ET)的失败。有研究观察到EMS与相关免疫环境改变有密切关系,EMS免疫环境的改变会导致垂体-卵巢功能发生异常,垂体分泌孕激素的能力下降导致黄体功能不足,亦会导致EMS患者腹腔液及子宫内膜中前列腺素的增加,影响排卵以及受精卵着床,同时异常升高的细胞因子和自身抗体对受精以及胚胎着床、胎盘形成产生影响,进而导致妊娠率下降而流产率升高。曾有报道指出EMS的自然流产率较高,约11-63%,但Fitz Simmon、Pittaway等人均未观察到EMS与流产具有相关性,由于流行病学研究资料有限,对于EMS与自然流产是否存在相关性尚无定论,仍需我们进一步研究。因此,本文回顾性比较分析单纯EMS因素不孕患者与单纯输卵管因素不孕患者行IVF-ET各个环节的差异,目的在于探讨子宫内膜异位症与自然流产是否存在相关性及其导致自然流产的原因,为提高妊娠率、降低自然流产率提供研究基础。目的探讨子宫内膜异位症与自然流产的相关性及发生机制。方法回顾性比较安徽省立医院生殖中心2014年01月至2015年01月20-35岁564例因EMS与457例因单纯输卵管因素不孕行IVF-ET患者的获卵数、受精率、优质胚胎率,分别对行新鲜周期和冷冻周期胚胎移植的EMS组和输卵管因素组两组患者的临床妊娠率、自然流产率以及活产率等指标进行统计分析。结果1)EMS组与输卵管因素组患者的年龄、不孕年限、BMI、基础生殖激素三项FSH、LH、E2差异均无统计学意义(P0.05),CA-125、手术距IVF时间、IVF术前自然流产率差异具有统计学差异(P0.05);2)EMS组与输卵管因素组患者的促排Gn用量差异无统计学意义(P0.05),而输卵管因素组患者获卵数、受精率和优质胚胎率均高于EMS因素组,差异均具有统计学意义(P0.05);3)EMS组与输卵管因素组患者在新鲜周期与冷冻周期移植子宫内膜厚度、优质胚胎移植率差异均无统计学意义(P0.05),而种植率差异均有统计学意义(P0.05);4)行新鲜周期胚胎移植两组患者的生化妊娠率、临床妊娠率、双胎妊娠率、双胎流产率和异位妊娠差异均无统计学意义(P0.05),EMS组患者自然流产率高于输卵管因素组患者,但活产率低于输卵管因素组,差异均具有统计学意义(P0.05);冻胚移植周期的两组患者生化妊娠率、临床妊娠率、自然流产、双胎妊娠率、双胎流产率和异位妊娠差异无统计学意义,活产率EMS组低于输卵管因素组,差异具有统计学意义(P0.05)。结论单纯EMS不孕患者行IVF-ET后的获卵数、种植率、优质胚胎率、活产率低,自然流产率较高,而临床妊娠率与单纯输卵管不孕患者比较并无明显差异,但仍具有下降的趋势,表明EMS可通过影响患者的胚胎质量等方面,导致患者的不良妊娠结局,提示控制EMS的进展有助于提高妊娠率,降低自然流产率,改善患者的妊娠结局。
[Abstract]:The research background of natural abortion is a common complication of pregnancy, the cause of spontaneous abortion, such as chromosomal abnormalities, endocrine disorders, immune function abnormalities, abnormal anatomy of reproductive organs, infection, environment and other factors are closely related. On endometriosis (Endometriosis, EMS) is also related with spontaneous abortion.EMS has become a research hotspot in recent years is a common gynecological hormone dependent disease, refers to endometrial tissue (glands and stroma) in uterine tissue outside. The basic research data shows that the EMS can be through a variety of mechanisms affecting ovulation, implantation and embryo development during pregnancy, including anatomical changes the level of hormone disorder, endometrial receptivity abnormalities, immune dysfunction and so on. The mechanism of endometriosis can cause pelvic adhesions, modified pelvic anatomy, to Ovulation caused by mechanical interference, the hormone level disorder, plus some factors on sperm and peritoneal cavity phagocytosis, which can lead to infertility and in vitro fertilization and embryo transfer (In vitro fertilization and embryo transfer, IVF-ET). The failure has been observed between EMS and immune environment is closely related to the immune environment change, EMS the change will lead to abnormal ovarian function pituitary, pituitary secretion of progesterone decreased ability leads to inadequate luteal function, will also lead to the increase of prostaglandin EMS in peritoneal fluid of patients with endometrial and the effects of ovulation and implantation of the fertilized egg, and abnormal increase of cytokines and antibodies on fertilization and embryo implantation, placental formation, and the pregnancy rate and abortion rate decreased to increase. There have been reports that the EMS of the spontaneous abortion rate is higher, about 11-63%, but Fitz Simmon, Pittaway et al. Were observed in EMS and abortion have correlation, due to limited data for epidemiological studies, whether a correlation exists between EMS and spontaneous abortion is inconclusive, we still need to further study. Therefore, review comparing pure EMS factors of infertility patients with tubal infertility patients with all aspects of IVF-ET in this paper, the purpose is to discuss the endometrium ectopic spontaneous abortion and whether there is a correlation and the causes of spontaneous abortion, in order to improve the pregnancy rate, reducing the rate of spontaneous abortion provides research foundation. Objective: To investigate the correlation between endometriosis and spontaneous abortion and its mechanism. Methods Retrospective comparison of the reproductive center of Anhui Provincial Hospital from 2014 01 to 2015 01 months at the age of 20-35 in 564 cases with EMS and 457 patients with simple tubal infertility treated with IVF-ET oocytes, fertilization rate, good embryo rate, respectively, of fresh The two groups of clinical group EMS and tubal factors of cycle and frozen embryo transfer cycle tube group pregnancy rate, spontaneous abortion rate and live birth rate and other indicators were statistically analyzed. Results: 1) EMS group and tubal factor group with age, duration of infertility, BMI, reproductive hormone based three FSH, LH, E2 difference there was no statistical significance (P0.05), CA-125, IVF from the time of surgery, preoperative IVF spontaneous abortion rate had a significant difference (P0.05); 2) EMS group and tubal factor group excretion amount of Gn had no significant difference (P0.05), and tubal factor group of oocytes, fertilization rate and the rate of high quality embryos were higher than those of EMS group, the differences were statistically significant (P0.05); 3) EMS group and tubal factor group in the cycle of fresh and frozen period of transplantation of endometrial thickness, high quality embryo rate differences were not statistically significant (P0.05), and the implantation rate difference There was statistical significance (P0.05); 4) fresh embryo transfer cycle of two groups of patients with biochemical pregnancy rate, clinical pregnancy rate, twin pregnancy rate, the difference double embryo abortion rate and ectopic pregnancy were not statistically significant (P0.05), EMS group of patients with spontaneous abortion rate is higher than that of tubal factor group, but lower than the live birth rate tubal factor group, the differences were statistically significant (P0.05); two patients with biochemical pregnancy rate of frozen thawed embryo transfer cycles, the clinical pregnancy rate, spontaneous abortion, twin pregnancy rate, no statistically significant difference between twins abortion rate and ectopic pregnancy, live birth rate in EMS group was lower than that of tubal factor group, the difference was statistically significant (P0.05). Conclusion EMS infertility patients after IVF-ET oocytes, the implantation rate, good embryo rate, live birth rate low, spontaneous abortion rate is higher, and the clinical pregnancy rate with tubal infertility patients compared no significant difference, but still has decreased The trend indicates that EMS can lead to adverse pregnancy outcomes through influencing the quality of embryo and so on. It suggests that controlling the progress of EMS can improve pregnancy rate, reduce spontaneous abortion rate and improve pregnancy outcome.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.71;R714.21

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