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反复种植失败与复发性流产的病因比较OACSTPCD

Comparison of the etiological composition between recurrent implantation failure and recurrent pregnancy loss

中文摘要英文摘要

目的 了解反复种植失败(RIF)和复发性流产(RPL)患者的病因差异.方法 选择 2018 年 6 月至 2021 年 6 月在中山大学附属第一医院生殖中心就诊的 315 例RIF患者和 376 例RPL患者为研究对象,进行一般资料及病因资料收集,比较其一般资料及病因构成差异.并采用多因素回归分析这两种疾病病因的相对风险度.结果 RIF患者慢性子宫内膜炎、子宫内膜息肉、子宫内膜异位症、子宫内膜异位症合并子宫内膜息肉、卵巢储备功能减退病因比例均高于RPL患者,RIF患者不明原因病因比例低于RPL患者(P均<0.05).多因素Logistic回归分析显示,RIF患者中病因为慢性子宫内膜炎(OR=3.044,95%CI 1.849~5.011,P<0.001)、子宫内膜息肉(OR=3.769,95%CI 1.670~8.510,P<0.001)、子宫内膜异位症(OR=3.812,95%CI 2.131~6.819,P<0.001)、卵巢储备功能减退(OR=2.175,95%CI 1.285~3.683,P=0.004)比RPL患者更为多见,RIF患者中抗米勒管激素水平低(OR=0.917,95%CI 0.864~0.973,P=0.004)的情况也较RPL患者多见.结论 慢性子宫内膜炎、子宫内膜息肉、子宫内膜异位症、抗米勒管激素水平下降及卵巢储备功能减退等现象,在RIF患者中更为普遍,后续人工辅助生殖的工作实践中临床医师应强化对上述病变的筛查和监测.

Objective To explore the differences of etiology of recurrent implantation failure(RIF)and recurrent pregnancy loss(RPL).Methods Patients with RIF(n=315)and patients with RPL(n=376)admitted to the Reproductive Center of the First Affiliated Hospital of Sun Yat-sen University from June 2018 to June 2021 were included.General and etiological data were collected to compare the differences in baseline data and etiological composition.Relative risk factors of the etiology of these two conditions were identified by multivariate regression analysis.Results Univariate analysis showed a significantly higher proportion of chronic endometritis,endometrial polyps,endometriosis,endometriosis complicated with polyps,diminished ovarian reserve and a significantly lower proportion of unexplained cause in the RIF group than in the RPL group(all P<0.05).Multivariate logistic regression analysis showed that the incidence of chronic endometritis(OR=3.044,95%CI 1.849-5.011,P<0.001),endometrial polyps(OR=3.769,95%CI 1.670-8.510,P<0.001),endometriosis(OR=3.812,95%CI 2.131-6.819,P<0.001)and diminished ovarian reserve(OR=2.175,95%CI 1.285-3.683,P=0.004)in the RIF group was significantly higher than that in the RPL group.The proportion of patients with lower anti-Mullerian hormone levels(OR=0.917,95%CI 0.864-0.973,P=0.004)in the RIF group was higher compared with that in the RPL group.Conclusion Chronic endometritis,endometrial polyps,endometriosis,decreased anti-Mullerian hormone level and diminished ovarian reserve are more common in RIF patients,and the screening and monitoring of the above lesions should be strengthened in the subsequent practice of assisted reproduction.

胡奕芳;杨宇欣;王灿;钟雪;梁玉莲;龙姝辰;陈雪儿;叶玉津;王琼

中山大学附属第一医院,广东 广州 510080||江西省抚州市妇幼保健院(江西省抚州市第二人民医院),江西 抚州 344000中山大学附属第一医院,广东 广州 510080||广东省生殖医学实验室及广东省妇产疾病临床研究中心,广东 广州 510080

反复种植失败复发性流产病因慢性子宫内膜炎子宫内膜息肉子宫内膜异位症抗米勒管激素

Recurrent implantation failureRecurrent pregnancy lossEtiologyChronic endometritisEndometrial polypsEndometriosisAnti-Müllerian hormone

《新医学》 2024 (009)

693-700 / 8

广东省自然科学基金(2021A1515010290);广州市科技计划重点研发计划(202206010003)

10.3969/j.issn.0253-9802.2024.09.003

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