本文選題：他莫昔芬 + 薄型子宮內(nèi)膜��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：研究背景良好的子宮內(nèi)膜容受性是胚胎著床的必要條件,其主要評(píng)價(jià)指標(biāo)包括內(nèi)膜厚度,內(nèi)膜形態(tài)和內(nèi)膜(或內(nèi)膜下)血流。薄型子宮內(nèi)膜往往預(yù)示著不良妊娠結(jié)局,是目前人工輔助生殖臨床中最棘手的問題之一。然而,目前仍然沒有公認(rèn)有效的措施來提高內(nèi)膜厚度,進(jìn)而改善妊娠結(jié)局。同時(shí),由于導(dǎo)致薄型子宮內(nèi)膜的病因多樣,如機(jī)械性損傷、感染因素、內(nèi)分泌因素等,需要尋找一個(gè)高效簡(jiǎn)便的子宮內(nèi)膜改善方法以適合不同病因的患者。凍融胚胎移植為人工輔助生殖技術(shù)中的重要手段之一,它能夠減少促排卵過程中對(duì)內(nèi)膜容受性帶來的不良影響,提供時(shí)機(jī)準(zhǔn)備子宮內(nèi)膜,以便在子宮內(nèi)膜容受性良好的條件下行胚胎種植,從而獲得滿意的妊娠結(jié)局。目的探討凍融胚胎移植(Frozen-thawed Embryo Transfer,FET)周期中,他莫昔芬用于子宮內(nèi)膜準(zhǔn)備方案,對(duì)不同原因薄型子宮內(nèi)膜患者內(nèi)膜容受性和妊娠結(jié)局的改善作用。方法回顧性分析2012年1月至2015年8月山東大學(xué)附屬生殖醫(yī)院FET中使用自然周期、直接替代周期或促排卵周期準(zhǔn)備子宮內(nèi)膜時(shí)反復(fù)出現(xiàn)內(nèi)膜薄(2次或2次以上內(nèi)膜厚度7.5mm),后改用他莫昔芬方案進(jìn)行內(nèi)膜準(zhǔn)備的267名患者(共1099個(gè)FET周期)。比較既往方案和他莫昔芬方案中子宮內(nèi)膜厚度、形態(tài)和血流。進(jìn)一步根據(jù)內(nèi)膜薄的病因分為四個(gè)亞組:宮腔粘連組(n=34)、清宮≥2次組(n=104)、雙側(cè)輸卵管梗阻(n=78)、多囊卵巢綜合征(Polycystic Ovarian Syndrome,PCOS)組(n=51),比較四個(gè)亞組的患者在接受他莫昔芬周期后子宮內(nèi)膜厚度的改善情況以及妊娠結(jié)局。結(jié)果和既往周期相比,他莫昔芬可以將內(nèi)膜厚度由自然周期的6.04±0.83mm提高至7.81±1.49mm,由激素替代周期的6.22±1.06提高至8.12±1.63mm,由促排卵周期的6.31±0.97mm提高至7.96±1.46mm,其差異均具有統(tǒng)計(jì)學(xué)意義(P均0.001);但對(duì)內(nèi)膜形態(tài)沒有明顯改善(P值分別為0.298,0.500,0.494)。同時(shí),對(duì)63個(gè)患者的內(nèi)膜血流分析顯示,他莫昔芬對(duì)血流沒有顯著影響(P=0.254)。進(jìn)一步分析,宮腔粘連、清宮史≥2次、雙側(cè)輸卵管梗阻以及PCOS四個(gè)亞組在他莫昔芬周期平均內(nèi)膜厚度分別為7.13±1.16mm,8.13±1.49mm,7.83±1.30mm,9.24±1.65mm,差異均具有統(tǒng)計(jì)學(xué)意義(P0.001),PCOS組的子宮內(nèi)膜厚度明顯高于其他3個(gè)亞組。同時(shí),PCOS組可以獲得最低的周期取消率和最良好的妊娠結(jié)局:四組移植取消率依次為45.24%(19/42)、28.24%(37/131)、39.81%(41/103)、14.04%(8/57),差異有統(tǒng)計(jì)學(xué)意義(P=0.001);生化妊娠率依次為43.48%(10/23),48.94%(46/94),44.07%(26/59),71.43%(35/49),差異具有統(tǒng)計(jì)學(xué)意義(P=0.019);臨床妊娠率依次為43.48%(10/23),32.98%(38/94),38.98%(23/59),63.27%(31/49),差異有統(tǒng)計(jì)學(xué)意義(P=0.041);活產(chǎn)率依次為 30.43%(7/23),32.98%(31/94),18.64%(11/59),53.06%(26/49),差異有統(tǒng)計(jì)學(xué)意義(P=0.002)。二元logistic回歸顯示,內(nèi)膜厚度、年齡,移植胚胎數(shù)和活產(chǎn)結(jié)局相關(guān)。結(jié)論1、凍融胚胎移植周期中他莫昔芬可以顯著增加薄型子宮內(nèi)膜患者的內(nèi)膜厚度;2、他莫昔芬對(duì)內(nèi)膜形態(tài)和內(nèi)膜血流沒有明顯作用;3、年齡、內(nèi)膜厚度、胚胎移植數(shù)與凍融胚胎移植周期中是否活產(chǎn)相關(guān);4、他莫昔芬對(duì)多種病因?qū)е碌谋⌒蛢?nèi)膜均有不同程度的改善,其中PCOS患者的效果最為顯著,并獲得較理想的妊娠結(jié)局。
[Abstract]:Well studied endometrium receptivity is a necessary condition for the implantation of the embryo. The main evaluation indexes include the thickness of the endometrium, the morphology of the endometrium and the blood flow of the intima (or intima). The thin endometrium often indicates the bad pregnancy outcome. It is one of the most difficult problems in the artificial assisted reproductive clinic. However, it is still not recognized at present. It is effective to improve the thickness of the endometrium and improve the pregnancy outcome. At the same time, due to the various causes of the endometrium, such as mechanical damage, infection factors, endocrine factors, and so on, a efficient and simple method of endometrial improvement is needed to fit for patients with different causes. One of the most important measures in the process is that it can reduce the adverse effects on the endometrial receptivity during ovulation, and provide the opportunity to prepare the endometrium so that the embryo can be planted under the condition of the endometrium with good tolerance, so as to obtain a satisfactory pregnancy outcome. The purpose of this study is to explore the period of Frozen-thawed Embryo Transfer (FET). In addition, tamoxifen is used for endometrial preparation, the improvement of endometrial receptivity and pregnancy outcome in patients with different causes of thin endometrium. Methods a retrospective analysis of the use of the natural cycle in FET, a affiliated reproductive Hospital of Shandong University from January 2012 to August 2015, was used to replace the weeks or the period of ovulation preparation for endometrium. Endometrial thin (2 or more than 2 times intima thickness 7.5mm) and 267 patients (a total of 1099 FET cycles) prepared by tamoxifen scheme. The endometrium thickness, morphology and blood flow in the tamoxifen scheme were compared in four subgroups: the intrauterine adhesion group (n=34) and the uterine cavity more than 2 times (or more than 2 times). N=104), bilateral fallopian tube obstruction (n=78), polycystic ovary syndrome (Polycystic Ovarian Syndrome, PCOS) group (n=51). Compared with the four subgroups, the endometrial thickness improvement and pregnancy outcome after the tamoxifen cycle were compared with the previous cycle. Tamoxifen could make the thickness of the endometrium from 6.04 + 0.83M to the natural cycle. M increased to 7.81 + 1.49mm, increased from 6.22 + 1.06 of the hormone replacement cycle to 8.12 + 1.63mm, increased from 6.31 + 0.97mm to 7.96 + 1.46mm, and the difference was statistically significant (P 0.001), but the morphology of the endometrium was not significantly improved (P value was 0.298,0.500,0.494). At the same time, the analysis of the intima flow of 63 patients showed that Tamoxifen had no significant influence on blood flow (P=0.254). Further analysis, intrauterine adhesions, uterine cavity history more than 2 times, bilateral fallopian tube obstruction and PCOS four subgroups in the tamoxifen cycle average intimal thickness was 7.13 + 1.16mm, 8.13 + 1.49mm, 7.83 + 1.30mm, 9.24 + 1.65mm, the difference was statistically significant (P0.001), PCOS group endometrium The thickness of the PCOS group was significantly higher than that of the other 3 subgroups. At the same time, the lowest cycle cancellation rate and the best pregnancy outcome were obtained: the four groups were 45.24% (19/42), 28.24% (37/131), 39.81% (41/103), 14.04% (8/57), and the difference was statistically significant (P=0.001); the rate of biochemical pregnancy was 43.48% (10/23), 48.94% (46/94), 44.07% (26/59). 71.43% (35/49), the difference was statistically significant (P=0.019); the clinical pregnancy rate was 43.48% (10/23), 32.98% (38/94), 38.98% (23/59), 63.27% (31/49), and the difference was statistically significant (P=0.041); the survival rate was 30.43% (7/23), 32.98% (31/94), 18.64% (11/59), 53.06% (26/49). The difference was statistically significant (P=0.002). Two yuan regression showed significant regression. Conclusion 1, tamoxifen could significantly increase the intimal thickness of endometrium in patients with thin endometrium during the period of freeze-thaw embryo transfer; 2, tamoxifen had no significant effect on intimal morphology and intimal flow; 3, age, intima thickness, embryo transfer number and frozen thawing embryo transfer cycle 4, tamoxifen improved the thin endometrium caused by a variety of causes, of which PCOS patients had the most significant effect and achieved an ideal pregnancy outcome.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.8

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 田小龍;陳薪;許麗娟;葉德盛;劉玉東;王楠;郭萍萍;陳士嶺;;他莫昔芬用于薄型子宮內(nèi)膜患者凍融胚胎移植時(shí)子宮內(nèi)膜準(zhǔn)備的研究[J];中國實(shí)用婦科與產(chǎn)科雜志;2015年08期

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本文編號(hào)：1977467