本文選題：宮腔灌注 + 胞飲突�。� 參考：《新鄉(xiāng)醫(yī)學院》2014年碩士論文

【摘要】：背景 復發(fā)性流產(RSA)大多數(shù)為早期流產,發(fā)病因素復雜,其中子宮內膜容受性起關鍵作用。而胞飲突對評估子宮內膜容受性和標志著床窗口具有確定意義。人絨毛膜促性腺激素(hCG)可以促進母-胎界面血管形成,增強母-胎間免疫耐受,利于胚胎入侵；也可通過延遲子宮內膜蛻膜化進程及延長子宮內膜著床窗等提高子宮內膜容受性。本實驗以RSA患者為研究對象,分析排卵期宮腔灌注hCG后對RSA患者著床窗子宮內膜容受性及早期流產率的影響。 目的 掃描電子顯微鏡(SEM)觀察宮腔灌注hCG后RSA患者著床窗子宮內膜胞飲突的發(fā)育情況,分析胞飲突的發(fā)育情況與E2、P之間的關系；探討宮腔灌注hCG聯(lián)合不同方案黃體支持對RSA患者早期流產率的影響。 方法 1.88例(失訪9例)RSA隨機分為3組,對照組(n=29)、研究組1(n=25)、研究組2(n=25)。每個月經周期兩個研究組均于排卵前2日及排卵日分別給予hCG500IU宮腔灌注1次。對照組排卵期不做處理。 2.第1個月經周期,三組均于排卵后D6-D8天取少許子宮內膜,行SEM觀察。取內膜日患者空腹靜脈采血3m1,檢測血清E2、P濃度。 3.第2、3、4個月經周期,三組患者均于排卵期指導受孕,并給予黃體酮膠囊100mgbid po至排卵后16天,抽血測hCG確定妊娠。妊娠者：對照組和研究組1予黃體酮注射液20mg qd im至妊娠12周；研究組2給予黃體酮注射液20mg qd im+樂孕寧口服液10ml tid po至妊娠12周。 結果 1.三組研究對象的年齡、不良孕產史次數(shù)、子宮內膜厚度(排卵日)差異均無統(tǒng)計學意義(P0.05)。 2.第1個月經周期,三組著床窗E2水平比較,差異無統(tǒng)計學意義(P0.05)；研究組1、組2著床窗P水平(25.44±2.35ng/ml)、(26.45±2.94ng/ml)與對照組(19.87±4.45ng/ml)比較,差異有統(tǒng)計學意義(P0.05)；研究組1、組2成熟期胞飲突表達率為68.00%、64.00%,與對照組相比,差異均有統(tǒng)計學意義(P0.05)。 3.排卵后16天研究組1、組2和對照組血清β-hCG陽性總例數(shù)分別為11、12和11,三組妊娠率比較,差異無統(tǒng)計學意義(P0.05)；妊娠6周研究組1、組2血清P與對照組比較,差異均有統(tǒng)計學意義(P0.05)。妊娠12周研究組1、組2和對照組流產率分別為18.18%、0.00%、36.36%,研究組1、組2流產率均較對照組明顯降低,且研究組1與對照組相比,差異有統(tǒng)計學意義(P0.05)。 結論 1.RSA患者著床窗胞飲突發(fā)育不良,排卵期宮腔灌注hCG可促進成熟期胞飲突的發(fā)育,使成熟期胞飲突的數(shù)量增加。 2.排卵期宮腔灌注hCG,指導受孕,并給予黃體酮應用至妊娠12周比單純給予黃體酮可以更有效的降低RSA患者的早期流產率。 3.排卵期宮腔灌注hCG,指導受孕同時給予黃體酮應用,妊娠后聯(lián)合應用黃體酮和樂孕寧口服液可以更安全有效的預防和治療RSA患者早期流產的發(fā)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 鹵2.35 ng / ml, 26.45 鹵2.94 ng / ml) and that in the control group was 19.87 鹵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.
【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R714.21

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