Analysis of the Influence of Maternal Systemic Factors on Endometrial Implantation Window in Women with Repeated Implantation Failure
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摘要:
目的 分析接受辅助生殖治疗中反复移植失败人群影响子宫内膜种植窗的母体全身因素。 方法 回顾性分析2020年12月至2022年1月在云南省第一人民医院生殖医学科诊断为反复种植失败并行子宫内膜容受性检测（endometrial receptivity test，ERT ）病例的资料。根据ERT结果分为容受期组和非容受期组，比较2组间胰岛素抵抗、维生素D缺乏、血栓前状态、甲状腺自身免疫发生率以及抗核抗体、抗磷脂抗体阳性率。并将上述单因素分析结果进行Logistic回归分析，得出影响内膜种植窗的独立危险因素。 结果 2组患者一般资料的差异无统计学意义（P > 0.05），而2组患者的胰岛素抵抗发生率、抗磷脂抗体阳性率的差异均具有统计学意义（P < 0.05）。多因素Logistic回归分析显示胰岛素抵抗、血栓前状态、甲状腺自身免疫是子宫内膜种植窗发生的独立危险因素（P均 < 0.05）。 结论 母体全身因素中胰岛素抵抗、血栓前状态、甲状腺自身免疫是造成反复种植失败人群内膜种植窗移位的危险因素。 Abstract:Objective To analyze the maternal and systemic factors that affect the endometrial implantation window in women with repeated implantation failure in assisted reproductive therapy. Methods Retrospective analysis was made on the data of cases diagnosed as repeated implantation failure and endometrial receptivity test （ERT） in the Department of Reproductive Medicine, First People's Hospital of Yunnan Province from December 2020 to January 2022. According to ERT results, they were divided into tolerance group and non-tolerance group. Insulin resistance, vitamin D deficiency, prethrombotic state, incidence of thyroid autoimmunity and positive rates of antinuclear antibody and antiphospholipid antibody were compared between the two groups. Logistic regression analysis was carried out on the results of the above single factor analysis, and the independent risk factors affecting the endometrial implant window were obtained. Results There was no significant difference in general information between the two groups （P > 0.05）, but there were significant differences in the incidence of insulin resistance and the positive rate of antiphospholipid antibody between the two groups （P < 0.05）. Multivariate logistic regression analysis showed that insulin resistance, prethrombotic state and thyroid autoimmunity were independent risk factors for endometrial implantation window （P < 0.05）. Conclusion Among the maternal factors, insulin resistance, prethrombotic state, and thyroid autoimmunity are the risk factors for the displacement of endometrial implant window in the population with repeated implant failure. -
表 1 2组病例一般资料的比较[
$\bar x \pm s $ /n（%） ]Table 1. Comparison of general data of cases between the two groups [
$\bar x \pm s $ /n（%） ]项目 非容受期组（n = 19） 容受期组（n = 38） χ2/t P 年龄（岁） 33.87 ± 3.09 33.00 ± 2.79 0.324 0.306 BMI（kg/m2） 22.49 ± 2.09 22.26 ± 2.09 1.356 0.693 不孕类型（原发不孕占比） 11（57.89） 16（42.11） 1.267 0.260 不孕年限 4.16 ± 1.95 3.39 ± 1.29 2.407 0.078 内膜准备方案（替代占比） 13（68.42） 19（50.00） 1.746 0.186 
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表 2 2组病例种植窗移位相关因素比较[n（%）]
Table 2. Comparison of related factors of implant window displacement between two groups [n（%）]
项目 非容受期组（n = 19） 容受期组（n = 38） χ2/t P IR占比 7（36.84） 3（7.89） 7.337 0.007* ANA阳性占比 4（21.05） 6（15.79） 0.243 0.622 aPLs阳性占 7（36.84） 4（10.53） 5.632 0.018* PTS占比 4（21.05） 2（5.26） 3.353 0.067 维生素D缺乏占比 6（31.58） 7（18.42） 1.246 0.264 TAI占比 8（42.11） 7（18.42） 3.664 0.056 *P < 0.05。
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表 3 影响种植窗移位的Logistic回归分析
Table 3. Logistic regression analysis of influencing the displacement of planting window
项目 β P OR EXP（B）95%CI IR 2.481 0.004* 12.023 2.227～64.910 PTS 2.501 0.014* 12.190 1.651～90.028 TAI 1.613 0.032* 5.016 1.152～21.848 *P < 0.05。
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