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目的:探讨人粒细胞集落刺激因子(G-CSF)宫腔灌注对于子宫内膜状况欠佳患者的子宫内膜容受性的影响。方法:将进行体外受精-胚胎移植(IVF-ET)的子宫内膜厚度不足或基底低回声、反复种植失败的患者按2∶1随机分为G-CSF组和对照组,进行前瞻性研究,G-CSF组(n=60)行IVF-ET前进行1~6次G-CSF宫腔灌注,对照组(n=30)则不给予G-CSF,观察子宫内膜厚度、回声、基底回声、血流动力学等指标。结果:与对照组相比,G-CSF组在早卵泡期、晚卵泡期的子宫内膜厚度增加明显,基底回声优于对照组,差异有统计学意义(P<0.05);围排卵期内膜厚度与对照组相比无统计学差异(P>0.05),基底回声优于对照组,差异有统计学意义(P<0.05)。早卵泡期、晚卵泡期及围排卵期G-CSF组子宫内膜基底区(EMI)动脉搏动指数(PI)均高于对照组,G-CSF组早卵泡期及围排卵期阻力指数(RI)高于对照组,差异均有统计学意义(P<0.05);晚卵泡期RI与对照组无统计学差异(P>0.05)。在已行ET的患者中,G-CSF组的妊娠率为62.5%(35/56),显著高于对照组的33.3%(9/27),差异有统计学意义(P<0.05)。结论:G-CSF宫腔灌注可改善子宫内膜的厚度及基底回声,对于内膜较薄、基底低回声及胚胎反复种植失败的患者具有较好的临床治疗效果,妊娠率较高。
Objective: To investigate the effect of intrauterine perfusion of human granulocyte-colony stimulating factor (G-CSF) on endometrial receptivity in patients with poor endometrium. Methods: In-vitro fertilization-embryo transfer (IVF-ET) patients with endometrial thickness insufficiency or basal hypoechoic failure and repeated implant failure were randomly divided into G-CSF group and control group at 2: 1. G-CSF was intrauterine perfusion 1 to 6 times before IVF-ET in G-CSF group (n = 30), G-CSF was not given in control group (n = 30), endometrial thickness, echo, basal echo , Hemodynamics and other indicators. Results: Compared with the control group, the thickness of endometrium in G-CSF group increased significantly in early follicular phase and late follicular phase, and the basal echo was superior to that in control group (P <0.05) There was no significant difference in the thickness of the membrane between the control group and the control group (P> 0.05). The basal echo was superior to the control group (P <0.05). Early follicular phase, late follicular phase and ovulation period of G-CSF group were significantly higher than control group in G-CSF group (P <0.01), G-CSF group of early follicular phase and ovulation resistance index (RI ) Was higher than that of the control group (P <0.05). There was no significant difference between the control group and the RI of the late follicles (P> 0.05). The pregnancy rate of G-CSF group was 62.5% (35/56), which was significantly higher than that of the control group (33.3%, 9/27) (P <0.05). Conclusion: Intrauterine perfusion of G-CSF can improve the thickness of the endometrium and the basal echogenicity. It has a good clinical effect on patients with thinner endometrial, hypoechoic basal cells and repeated implantation of embryos, with a higher pregnancy rate.