山东大学学报 (医学版) ›› 2024, Vol. 62 ›› Issue (7): 84-90.doi: 10.6040/j.issn.1671-7554.0.2024.0557
杜娟,李秀芳,李元美,王慧丹
DU Juan, LI Xiufang, LI Yuanmei, WANG Huidan
摘要: 目的 探讨孕康颗粒对冻融胚胎移植(frozen-thawed embryo transfer, FET)周期妊娠结局的影响。 方法 回顾性分析2021年1月至2023年12月于山东大学附属生殖医院实施FET的2 610个周期的临床资料。根据患者是否服用孕康颗粒分为治疗组(n=782)和对照组(n=1 828),比较两组间的妊娠结局,同时根据FET方案分为自然周期、激素替代周期、促排卵周期及降调节激素替代周期4个亚组,进行亚组分析。结果 〓治疗组的临床妊娠率(55.88%)高于对照组(51.58%),差异有统计学意义[OR(95%CI)=1.26(1.04~1.53), P=0.016],两组患者的其他妊娠结局差异均无统计学意义。根据冻胚移植方案进一步行亚组分析,促排卵方案治疗组临床妊娠率(63.08%)高于对照组(44.57%),差异有统计学意义[OR(95%CI)=1.89(1.02~3.50), P=0.044]。持续妊娠率(53.85%)高于对照组(32.57%),差异有统计学意义[OR(95%CI=2.33(1.26~4.33), P=0.007]。在自然周期方案、激素替代方案、降调节激素替代方案中,两组患者的妊娠结局差异均无统计学意义。 结论 FET周期中,尤其是促排卵方案的FET周期中,孕康颗粒可提高临床妊娠率,持续妊娠率,改善妊娠结局。
中图分类号:
[1] Shi Y, Sun Y, Hao C, et al. Transfer of fresh versus frozen embryos in ovulatory women[J]. N Engl J Med, 2018, 378(2): 126-136. [2] 曾珣, 秦朗. 生殖医学孕产妇的全程一体化管理[J]. 中国计划生育和妇产科, 2022, 14(2): 10-14. ZENG Xun, QIN Lang. Whole-process integrated management of pregnant women in reproductive medicine[J]. Chinese Journal of Family Planning & Gynecotokology, 2022, 14(2): 10-14. [3] Barbara L, Carol C, Laura M, et al. The ART of frozen embryo transfer: back to nature![J]. Gynecol Endocrinol Off J Int Soc Gynecol Endocrinol, 2020, 36(6): 479-483. [4] 宗丽萍. 不同内膜准备方案对冻胚移植患者妊娠期母婴并发症的影响[D]. 济南: 山东大学, 2020. [5] 李凤,张园,王琳,等. 子宫内膜与辅助生殖技术——从基础研究到临床转化[J]. 中国细胞生物学学报, 2024, 46(4): 711-723. LI Feng, ZHANG Yuan, WANG Lin, et al. Endometrium and assisted reproductive rechnology—from basic research to clinical translation[J]. Chinese Journal of Cell Biology, 2024, 46(4): 711-723. [6] Singh M, Chaudhry P, Asselin E. Bridging endometrial receptivity and implantation: network of hormones, cytokines, and growth factors[J]. J Endocrinol, 2011, 210(1): 5-14. [7] 徐瑜, 徐雯, 李崎. 补肾中药改善辅助生殖技术中卵巢功能及子宫内膜容受性的临床应用研究[J]. 现代医学与健康研究电子杂志, 2023, 7(14): 79-82. [8] Gong X, Yu Y, Tong Q, et al. Effects of “Bu Shen Huo Xue Decoction” on the endometrial morphology and expression of leukaemia inhibitory factor in the rat uterus during the oestrous cycle[J]. Evid Based Complement Alternat Med, 2013, 2013: 496036. doi:10.1155/2013/496036. [9] Orvieto R, Meltcer S, Volodarski M, et al. Luteal phase support for patients undergoing frozen-thawed embryo transfer cycles: the required progesterone dose[J]. Clin Exp Obstet Gynecol, 2007, 34(1): 25-26. [10] 杨美艳, 李爽, 刘会玲,等. 复方中药提高子宫内膜容受性的研究进展[J/OL]. 吉林医药学院学报. https://doi.org/10.13845/j.cnki.issn1673-2995.20240416.008. YANG Meiyan, LI Shuang, LIU Huiling, et al. Research progress on compound Chinese medicine improving endometrial receptivity[J/OL]. Journal of Jilin Medical University. https://doi.org/10.13845/j.cnki.issn1673-2995.20240416.008. [11] 陈艳花, 李仲云, 张雪洛, 等. 三种不同黄体支持方案在自然周期冻胚移植中的影响[J]. 中国药物与临床, 2019, 19(21): 3713-3715. CHEN Yanhua, LI Zhongyun, ZHANG Xueluo, et al. Effects of three different luteal support schemes on natural cycle frozen embryo transfer[J]. Chinese Remedies & Clinics, 2019, 19(21): 3713-3715. [12] 彭敏. 地屈孕酮与补肾中药联合对促排卵助孕周期黄体支持的影响评价[J]. 中外女性健康研究, 2018(4): 130. PENG Min. Evaluation of the effect of dydrogesterone combined with Chinese herbs for tonifying kidney on luteal support in ovulation induction and pregnancy assistance cycle[J]. Womens Health Research, 2018(4): 130. [13] 居香娣. 孕康颗粒联合克罗米酚和绒促性素治疗排卵障碍性不孕症临床分析[J]. 亚太传统医药, 2014, 10(4): 124-125. JU Xiangdi. Clinical analysis of Yunkang Granule combined with clomiphene citrate and chorionic gonadotropin in the treatment of ovulatory infertility[J]. Asia-Pacific Traditional Medicine, 2014, 10(4): 124-125. [14] 郑叶, 杜彦博, 王慧丹, 等. 不同黄体支持方案在激素替代周期冻胚移植中的临床疗效及成本分析[J]. 中华生殖与避孕杂志, 2022, 42(1): 17-23. ZHENG Ye, DU Yanbo, WANG Huidan, et al. Clinical efficacy and cost-effectiveness analysis in patients with hormone replacement for frozen-thawed embryo transfer under different luteal support scheme[J]. Chinese Journal of Reproduction and Contraception, 2022, 42(1): 17-23. [15] Pouget O, Scalici E, Hoa-Ferrieres A, et al. Comparison of frozen embryo transfer outcomes at blastocyst stage according to freezing method and type of endometrial preparation[J]. Gynecol Obstet Fertil, 2015, 43(3): 219-224. [16] Mackens S, Santos-Ribeiro S, van de Vijver A, et al. Frozen embryo transfer: a review on the optimal endometrial preparation and timing[J]. Hum Reprod, 2017, 32(11): 2234-2242. [17] 王茜, 何忆清, 李哲靓, 等. 基于网络药理学探讨逍遥散调控多囊卵巢综合征子宫内膜容受性的作用机制及实验验证[J]. 湖南中医药大学学报, 2023, 43(1): 69-79. WANG Xi, HE Yiqing, LI Zheliang, et al. Mechanism exploration of Xiaoyao Powder regulating endometrial receptivity in PCOS based on network pharmacology and its experimental verification[J]. Journal of Hunan University of Chinese Medicine, 2023, 43(1): 69-79. [18] Yu N, Yan W, Wang Y, et al. Effect of Zhuyun recipe on endometrial pinopode expression in mice with embryonic implantation dysfunction and ovulation stimulation[J]. Exp Ther Med, 2015, 9(2): 488-492. [19] Song Y, Zhou F, Tan X, et al. Bushen Huoxue recipe attenuates early pregnancy loss via activating endometrial COX2-PGE2 angiogenic signaling in mice[J]. BMC Complement Med Ther, 2021, 21(1): 36. doi:10.1186/s12906-021-03201-9. [20] Shen M, Liu Y, Ma X, et al. Erbu Zhuyu Decoction improves endometrial angiogenesis via uterine natural killer cells and the PI3K/Akt/eNOS pathway a mouse model of embryo implantation dysfunction[J]. Am J Reprod Immunol, 2023, 89(1): e13634. doi:10.1111/aji.13634. [21] 顾尚静. 补肾化痰方对肥胖型多囊卵巢综合征不孕患者子宫内膜容受性的影响分析[J]. 世界临床医学, 2017, 11(1): 121-122. [22] 刁丛, 葛新苗, 刘蓬, 等. 孕康口服液联合地屈孕酮及低分子肝素治疗复发性流产合并血栓前状态孕妇的疗效[J]. 中国医师杂志, 2023, 25(8): 1170-1175. DIAO Cong, GE Xinmiao, LIU Peng, et al. The efficacy of Yunkang oral liquid combined with dexamethasone and low-molecular-weight heparin in the treatment of recurrent miscarriage complicated with prethrombotic state in pregnant women[J]. Journal of Chinese Physician, 2023, 25(8): 1170-1175. [23] 何琦, 谷先锋. 孕康糖浆治疗黄体功能不全性不孕患者临床观察[J]. 中国医院药学杂志, 2012, 32(13): 1050-1052. HE Qi, GU Xianfeng. Clinical observation on the effect of Yunkang syrup for the treatment of sterility women with luteal phase deficiency[J]. Chinese Journal of Hospital Pharmacy, 2012, 32(13): 1050-1052. [24] 沈玉秀, 张丽, 王梦晓,等. 孕康颗粒联合盐酸利托君片治疗反复性流产效果及对血清孕激素、可溶性白细胞抗原G影响[J]. 中国计划生育学杂志, 2022, 30(12): 2724-2732. SHEN Yuxiu, ZHANG Li, WANG Mengxiao, et al. Curative effect of Yunkang granule combined with ritodrine hydrochloride tablet for treating women with recurrent abortion and its influences on the levels of serum progesterone and soluble leukocyte antigen G[J]. Chinese Journal of Family Planning, 2022, 30(12): 2724-2732. [25] 杜宁宁, 刘晶晶, 吴利萍. 孕康口服液联合间苯三酚注射液治疗先兆流产的临床效果[J]. 妇儿健康导刊, 2023, 2(12): 106-114. DU Ningning, LIU Jingjing, WU Liping. Clinical effect of Yunkang Oral Liquid combined with Phloroglucinol Injection in the treatment of threatened abortion[J]. Journal of Women and Childrens Health Guide, 2023, 2(12): 106-114. [26] 王中原. 冻胚移植促排卵周期中排卵与不排卵对妊娠结局的影响[D]. 济南: 山东大学, 2023. [27] Zhu L, Li Y, Xu A. Influence of controlled ovarian hyperstimulation on uterine peristalsis in infertile women[J]. Hum Reprod, 2012, 27(9): 2684-2689. [28] 徐思蕾, 陈潼, 张小建, 等. 冻融囊胚移植中囊胚形态学评分对妊娠结局和新生儿出生结局的影响[J]. 实用医院临床杂志, 2024, 21(1): 94-98. XU Silei, CHEN Tong, ZHANG Xiaojian, et al. The effect of blastocyst morphological scores on pregnancy outcomes and neonatal birth outcomes during frozen-thaw blastocyst transfer[J]. Practical Journal of Clinical Medicine, 2024, 21(1): 94-98. |
[1] | 赵圣蕊,曲慧灵,许鑫鑫,张芳芳,颜磊. 体外受精/卵胞浆内单精子注射-胚胎移植后稽留流产采用药物流产和清宫术效果比较[J]. 山东大学学报 (医学版), 2024, 62(2): 69-74. |
[2] | 刘昶,王倩男,张悦,陈忠绍,褚然,姚舒. 卵巢交界性肿瘤保留生育功能术后肿瘤预后及妊娠结局[J]. 山东大学学报 (医学版), 2023, 61(8): 61-66. |
[3] | 李军秀,袁莹莹,黄凌燕,赵君利. 子宫内膜CD38表达对胚胎移植前抗炎治疗的临床价值[J]. 山东大学学报 (医学版), 2023, 61(8): 54-60. |
[4] | 许月明,张杰,姜蕾,尹力,赵畔,许欣,郝桂敏. 扳机日孕酮升高与获卵数对辅助生殖技术新鲜周期妊娠结局的影响[J]. 山东大学学报 (医学版), 2023, 61(5): 44-50. |
[5] | 张丽霞,田一正,吕尚格,张亚男,颜磊. GnRH-a预处理对子宫内膜异位症患者替代方案冻胚移植结局的影响[J]. 山东大学学报 (医学版), 2023, 61(10): 63-68. |
[6] | 于文澔,张倩,孙梅,李鸿昌,朱月婷,姜文杰,颜军昊. 激动剂长方案与拮抗剂方案对胚胎整倍体率的影响[J]. 山东大学学报 (医学版), 2023, 61(1): 45-50. |
[7] | 吴日超,刘红,王泽,高姗姗,李秀芳,石玉华. 40岁及以上女性行体外受精-胚胎移植助孕的妊娠结局分析[J]. 山东大学学报 (医学版), 2022, 60(6): 35-39. |
[8] | 韩晓婷,高文丽,王婷,赵君利. 扳机日及其后添加重组人促黄体激素对黄体期长方案助孕结局的影响[J]. 山东大学学报 (医学版), 2022, 60(12): 31-38. |
[9] | 石玉华,王秋敏,戚丹. 辅助生殖技术前沿研究热点及进展[J]. 山东大学学报 (医学版), 2021, 59(9): 97-102. |
[10] | 邬晓琳,李萍. 激动剂长方案下促性腺激素使用时长对体外受精胚胎移植妊娠结局的影响[J]. 山东大学学报 (医学版), 2021, 59(7): 32-37. |
[11] | 宫小舒,吴日超,李秀芳,潘烨,王泽,石玉华. 603例多囊卵巢综合征患者不同促排卵内膜准备方案对冻胚移植结局的影响[J]. 山东大学学报 (医学版), 2021, 59(3): 48-54. |
[12] | 张秀清,张敬,蒋琪,李晨,刘畅,李瑞静,冯惠娟,耿玲. 腔内理疗对89例薄型子宫内膜冻融胚胎移植患者妊娠结局的影响[J]. 山东大学学报 (医学版), 2020, 58(5): 62-68. |
[13] | 宋海霞,袁彩霞,范玲玲. 体质量指数对夫精人工授精妊娠结局的影响[J]. 山东大学学报 (医学版), 2020, 58(1): 49-53. |
[14] | 周慧梅,杨佳欣,曹冬焱,沈铿,向阳,吴鸣,潘凌亚,黄惠芳,郎景和. 早期宫颈癌保留生育功能手术的治疗效果及妊娠结局[J]. 山东大学学报 (医学版), 2018, 56(5): 18-22. |
[15] | 杨冬梓,麦卓瑶. 高龄多囊卵巢综合征患者的卵巢储备特点及其助孕结局[J]. 山东大学学报(医学版), 2017, 55(1): 26-32. |
|