排卵期宫腔灌注hCG对改善早期复发性流产患者妊娠结局的影响

发布时间：2018-05-26 10:51

本文选题：宫腔灌注 + 胞饮突　；参考：《新乡医学院》2014年硕士论文

【摘要】：背景复发性流产(RSA)大多数为早期流产,发病因素复杂,其中子宫内膜容受性起关键作用。而胞饮突对评估子宫内膜容受性和标志着床窗口具有确定意义。人绒毛膜促性腺激素(hCG)可以促进母-胎界面血管形成,增强母-胎间免疫耐受,利于胚胎入侵；也可通过延迟子宫内膜蜕膜化进程及延长子宫内膜着床窗等提高子宫内膜容受性。本实验以RSA患者为研究对象,分析排卵期宫腔灌注hCG后对RSA患者着床窗子宫内膜容受性及早期流产率的影响。目的扫描电子显微镜(SEM)观察宫腔灌注hCG后RSA患者着床窗子宫内膜胞饮突的发育情况,分析胞饮突的发育情况与E2、P之间的关系；探讨宫腔灌注hCG联合不同方案黄体支持对RSA患者早期流产率的影响。方法 1.88例(失访9例)RSA随机分为3组,对照组(n=29)、研究组1(n=25)、研究组2(n=25)。每个月经周期两个研究组均于排卵前2日及排卵日分别给予hCG500IU宫腔灌注1次。对照组排卵期不做处理。 2.第1个月经周期,三组均于排卵后D6-D8天取少许子宫内膜,行SEM观察。取内膜日患者空腹静脉采血3m1,检测血清E2、P浓度。 3.第2、3、4个月经周期,三组患者均于排卵期指导受孕,并给予黄体酮胶囊100mgbid po至排卵后16天,抽血测hCG确定妊娠。妊娠者：对照组和研究组1予黄体酮注射液20mg qd im至妊娠12周；研究组2给予黄体酮注射液20mg qd im+乐孕宁口服液10ml tid po至妊娠12周。结果 1.三组研究对象的年龄、不良孕产史次数、子宫内膜厚度(排卵日)差异均无统计学意义(P0.05)。 2.第1个月经周期,三组着床窗E2水平比较,差异无统计学意义(P0.05)；研究组1、组2着床窗P水平(25.44±2.35ng/ml)、(26.45±2.94ng/ml)与对照组(19.87±4.45ng/ml)比较,差异有统计学意义(P0.05)；研究组1、组2成熟期胞饮突表达率为68.00%、64.00%,与对照组相比,差异均有统计学意义(P0.05)。 3.排卵后16天研究组1、组2和对照组血清β-hCG阳性总例数分别为11、12和11,三组妊娠率比较,差异无统计学意义(P0.05)；妊娠6周研究组1、组2血清P与对照组比较,差异均有统计学意义(P0.05)。妊娠12周研究组1、组2和对照组流产率分别为18.18%、0.00%、36.36%,研究组1、组2流产率均较对照组明显降低,且研究组1与对照组相比,差异有统计学意义(P0.05)。结论 1.RSA患者着床窗胞饮突发育不良,排卵期宫腔灌注hCG可促进成熟期胞饮突的发育,使成熟期胞饮突的数量增加。 2.排卵期宫腔灌注hCG,指导受孕,并给予黄体酮应用至妊娠12周比单纯给予黄体酮可以更有效的降低RSA患者的早期流产率。 3.排卵期宫腔灌注hCG,指导受孕同时给予黄体酮应用,妊娠后联合应用黄体酮和乐孕宁口服液可以更安全有效的预防和治疗RSA患者早期流产的发生。
[Abstract]:Background Recurrent abortion (RSAs) is mostly early abortion, and the risk factors are complicated, among which endometrial receptivity plays a key role. However, the process is of definite significance in evaluating endometrial receptivity and marker implantation window. Human chorionic gonadotropin (hCGG) can promote the formation of blood vessels between the mother and fetus, enhance the immune tolerance between the mother and the fetus, and facilitate the invasion of the embryo. The endometrial receptivity can also be improved by delaying the process of decidualization and prolonging the implantation window. In this study, RSA patients were studied to analyze the effects of intrauterine hCG infusion during ovulation on the endometrial receptivity and early abortion rate of RSA patients. Purpose Scanning electron microscopy (SEM) was used to observe the development of the endometrium of RSA patients after intrauterine perfusion of hCG, and to analyze the relationship between the development of the process and the level of E2P. To investigate the effect of intrauterine hCG combined with luteal support on early abortion rate in patients with RSA. Method 1.88 cases (9 cases without visit) were randomly divided into 3 groups: control group (n = 29), study group (n = 1) and study group (n = 25). The two groups were given intrauterine perfusion of hCG500IU at 2 days before ovulation and on the day of ovulation respectively in each menstrual cycle. The control group was not treated during ovulation. 2. In the first menstrual cycle, a little endometrium was taken on D6-D8 day after ovulation and observed by SEM. Fasting venous blood samples were collected from patients with endometrium at 3 m 1, and serum E 2 P concentration was determined. 3. In the 3rd and 4th menstrual cycle, all the patients in the three groups were given progesterone capsule 100mgbid po to 16 days after ovulation. HCG was taken to determine pregnancy. Pregnant women: the control group and the study group 1 were given 20mg QD im to 12 weeks of gestation, while the other group 2 were given 10ml tid po to 12 weeks of gestation with 20mg QD im Leyongning oral solution. Results 1. There was no significant difference in age, history of bad pregnancy and delivery, endometrial thickness (day of ovulation) among the three groups (P 0.05). 2. In the first menstrual cycle, there was no significant difference in E _ 2 levels among the three groups (P 0.05). In the study group 1, the P level of the implantation window in group 2 was 25.44 卤2.35 ng / ml, 26.45 卤2.94 ng / ml) and that in the control group was 19.87 卤4.45 ng / ml. In the study group 1, the expression rate of the cytosolic process was 68.00 and 64.00 in the mature stage, which was significantly higher than that in the control group (P 0.05). 3. On the 16th day after ovulation, the total number of serum 尾 -hCG positive cases in group 2 and control group were 1112 and 11, respectively. There was no significant difference in pregnancy rate among the three groups, and there was no significant difference in serum P between group 2 and control group at 6 weeks after ovulation, and there was significant difference in serum P between group 2 and control group (P 0.05). At the 12th week of gestation, the abortion rate of group 2 and control group were 18.18 and 0.0036.36, respectively. The abortion rate of study group 1 and group 2 were significantly lower than that of control group, and the difference between group 1 and control group was statistically significant (P 0.05). Conclusion The patients with 1.RSA had poor development of the implantation window and hCG during ovulation could promote the development of the process in mature stage and increase the number of the process in the mature stage. 2. Intrauterine instillation of hCG during ovulation to guide pregnancy and administration of progesterone to 12 weeks of gestation were more effective than progesterone alone in reducing early abortion rate in RSA patients. 3. Intrauterine perfusion of hCGduring ovulation to guide pregnancy and administration of progesterone. Combination of progesterone and Leyongning oral solution after pregnancy can more safely and effectively prevent and treat the occurrence of early abortion in patients with RSA.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.21

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