Objective:This study aimed to explore the clinical effect of acupuncture therapy for menstruation regu-lation and pregnancy promotion on thin endometrium in the real world.Design:This study is a single-center pragmati...Objective:This study aimed to explore the clinical effect of acupuncture therapy for menstruation regu-lation and pregnancy promotion on thin endometrium in the real world.Design:This study is a single-center pragmatic randomized controlled trial blinded to the statisticians.Using the“blockrand”software package,based on the age(≥35,<35),37 patients were randomized into an intervention group(19 cases)and a control group(18 cases).After reassignment regarding patient preference,21 patients were included in the intervention group and 16 in the control group.Setting:The trial was executed in the Specialty Outpatient Clinic,Acupuncture-Moxibustion Hospital of China Academy of Chinese Medical Sciences,from March 1,2019,to September 30,2020.Participants:The study included 37 patients with thin endometrium and without previous acupuncture treatment.Intervention:The intervention group was administered acupuncture for menstruation regulation and pregnancy promotion and a small-dose of progynova(2 mg daily),while the control group was adminis-tered a large-dose of progynova(4 mg daily).Interventions started from Day 5 of menstruation until the end of ovulation under B-ultrasound monitoring.The intervention lasted for three menstrual cycles.Measurements:Primary outcomes were changes in endometrial thickness between baseline and after intervention completion and the difference between the two groups after intervention.The secondary outcomes were endometrial and subendometrial blood flow,serum estradiol levels,menstrual conditions,and adverse reactions.Results:(1)Comparison of each indicator before and after intervention completion in the two groups:in the intervention group,the differences were significant in endometrial thickness,menstrual score,estra-diol(E2)level in ovulatory period,the pulsatility index(PI)and resistance index(RI)of uterine artery,the ratio of peak systolic velocity to end-diastolic velocity(S/D),the endometrial vascular index(VI),flow index(FI),and vascular flow index(VFI)and volume(P<0.01).In the control group,significant changes were observed in endometrial thickness,menstrual score,and E2 before and after the interven-tion(P<0.05),and no differences were observed in uterine artery PI,RI,S/D and endometrial VI,FI,VFI,and volume(P>0.05).Compared with the control group,the intervention group showed significant differences in endometrial thickness,menstrual score,E2,uterine artery PI,RI,S/D,and endometrial VI,FI,VFI,and volume after intervention(P<0.01).No adverse reactions were reported in the intervention group.In contrast,the control group had two cases of nausea and gastrointestinal discomfort after med-ication,eight cases of breast distention during medication,and one case of breast nodules enlarged by 1 cm after trial completion.展开更多
Objective： To explore the effect of warming-needle moxibustion on the endometrial thickness and pregnancy outcome.Methods： Forty infertility women, selected from those who visited the TCM department of Maternity and...Objective： To explore the effect of warming-needle moxibustion on the endometrial thickness and pregnancy outcome.Methods： Forty infertility women, selected from those who visited the TCM department of Maternity and Child Care Centers in Fujian Province from October 2015 to October 2016, were enrolled in this study.These women had mature follicle and successful ovulation according to B ultrasound monitoring, but their endometrial thickness was thinner than 7 mm. The women were divided into warming-needle moxibustion group（group A. 20 cases） and medication group（group B, 20 cases）. In group A, acupuncture,warming-needle moxibustion and electroacupuncture were conducted at different clinical stage. In group B, progynova was given to the patients from the 7 th day of menstruation to the 14 th day after ovulation（2 tablets, bid oral administration in the morning and evening）. The treatment lasted for 3 menstrual cycles, and the endometrial thickness changes and pregnancy rate of the patients in the two groups were compared after treatment.Results： The endometrial thickness of patients in the two groups increased after treatment when compared with the thickness before treatment. The average endometrial thickness in group A increased from（5.23 ±1.57） mm before treatment to（8.31 ±2.80） mm after treatment, while the average endometrial thickness in group B increased from（5.27 士 0.99） mm before treatment to（8.32 ±1.97） mm after treatment, and the differences were statistically significant（both P〈0.05）. The increase of endometrial thickness of the patients in group A after treatment was slightly larger than that in group B, and the difference was not statistically significant（P〉0.05）. After treatment for 3 menstrual cycles, the pregnancy rate of infertility women in group A was 25%（5/20） and 15%（3/20） in group B.Conclusion： Warming-needle moxibustion can increase the endometrial thickness to a certain extent,thus improving the endometrial receptivity, enhancing the embryo implantation rate, and improving the pregnancy outcome.展开更多
Thin endometrium has been proven to be a key contributing factor leading to infertility and poor pregnancy outcomes.Increasing the thickness and capacity of thin endometrium seems to be one of the challenging issues i...Thin endometrium has been proven to be a key contributing factor leading to infertility and poor pregnancy outcomes.Increasing the thickness and capacity of thin endometrium seems to be one of the challenging issues in reproductive medicine.The states of qi and blood are closely related to uterine blood circulation.Constitution is regarded as an important basis for determining the incidence as well as distinguishing,preventing,and treating diseases in traditional Chinese medicine.Based on the theory of qi and blood,this paper discusses the constitution factors of thin endometrium and puts forward the prospect of using big data tools to investigate the correlation between qi-blood imbalance constitution and the incidence of thin endometrium,so as to explore new approaches for the prevention and treatment of thin endometrium by regulating qi and blood as well as improving the constitution condition.展开更多
Intrauterine adhesions(IUA)and thin endometrium(TE)represent significant challenges in human reproduction.The condition arises frequently from damage to the endometrial basal layer,leading to fibrous tissue replacing ...Intrauterine adhesions(IUA)and thin endometrium(TE)represent significant challenges in human reproduction.The condition arises frequently from damage to the endometrial basal layer,leading to fibrous tissue replacing the functional endometrium and impairing the uterus's ability to accept embryo implantation.Conventional treatments,mainly including hysteroscopic adhesiolysis and estrogen therapies,have shown limited success,particularly in severe cases.Regenerative medicine,with its focus on stem cell-based therapies and biomaterials,offers a promising avenue for restoring endometrial function and structure.This review synthesizes the current landscape of endometrial regeneration,focusing on the therapeutic potential of stem cells,the supportive role of biomaterials,and the importance of understanding molecular mechanisms to develop effective strategies for reconstruction of endometrial functional and fertility restoration.展开更多
Background： Thin endometrium is associated with poor reproductive outcomes; estrogen treatment can increase endomctrial thickness （EMT）. The aim of this retrospective cohort study was to investigate the factors inf...Background： Thin endometrium is associated with poor reproductive outcomes; estrogen treatment can increase endomctrial thickness （EMT）. The aim of this retrospective cohort study was to investigate the factors influencing the effectiveness of estrogen treatment and reproductive outcomes after the treatment in patients with thin endometrium. Methods： Relevant clinical data of 101 patients with thin endometrium who had undergone estrogen treatment were collected. Possible factors influencing the effectiveness of treatment were analyzed retrospectively by logistic regression analysis. Eighty-seven infertile women without thin endometrium who had undergone assisted reproduction served as controls. The cases and controls were matched for age, assisted reproduction method, and number of embryos transferred. Reproductive outcomes of study and control groups were compared using Student＇s t-test and the Chi-square test. Results： At the end of estrogen treatment, EMT was ≥8 mm in 93/101 patients （92.1%）. Effectiveness of treatment was significantly associated with maximal pretreatment EMT （P = 0.017） and treatment duration （P = 0.004）. The outcomes of assisted reproduction were similar in patients whose treatment was successful in increasing EMT to ≥8 mm and the control group. The rate of clinical pregnancy in patients was associated with the number of good-quality embryos transferred in both fresh （P = 0.005） and frozen-thawed （P = 0.000） embryo transfer cycles. Conclusions： Thinner EMT before estrogen treatment requires longer treatment duration and predicts poorer treatment outcomes. The effectiveness of treatment depends on the duration of estrogen administration. Assisted reproductive outcomes of patients whose treatment is successful （i.e., achieves an EMT ≥8 mm） are similar to those of controls. The quality of embryos transferred is an important predictor of assisted reproductive outcomes in patients treated successfully with exogenous estrogen.展开更多
Objective:To evaluate the effect of recombinant human growth hormone(rhGH)supplementation during hormone-replacement therapy and frozen-thawed embryo transfer(FET)in patients with thin endometrium.Methods:A retrospect...Objective:To evaluate the effect of recombinant human growth hormone(rhGH)supplementation during hormone-replacement therapy and frozen-thawed embryo transfer(FET)in patients with thin endometrium.Methods:A retrospective research was conducted on 225 patients,who underwent artificial cycle FET in Shanghai,China,between January 2016 and November 2017.Data from 245 FET cycles were analyzed,of which 184 cycles received rhGH(GH group)and 61 did not(control group).Results:Clinical pregnancy and implantation rates were significantly higher in the GH group than those in the control group(64.7%vs.49.2%,P=0.032;44.8%vs.32.8%,P=0.019,respectively).After logistic regression analysis,rhGH was considered the only significant variable that influenced clinical pregnancy rate,increasing it by 1.89-fold.On the other hand,the presence of rhGH did not seem to affect the early pregnancy loss.Conclusions:Our results indicated that simultaneous addition of rhGH could improve clinical outcomes of FET in patients with thin endometrium,particularly in patients between 30 and 34 years of age.展开更多
背景:研究发现人脐血富血小板血浆与人脐血间充质干细胞对薄型子宫内膜有一定治疗效果,但目前针对人脐血单个核细胞对薄型子宫内膜的研究尚未报道,且目前尚缺乏三者比较的相关研究。目的:探讨人脐血富血小板血浆、单个核细胞及间充质干...背景:研究发现人脐血富血小板血浆与人脐血间充质干细胞对薄型子宫内膜有一定治疗效果,但目前针对人脐血单个核细胞对薄型子宫内膜的研究尚未报道,且目前尚缺乏三者比较的相关研究。目的:探讨人脐血富血小板血浆、单个核细胞及间充质干细胞修复大鼠薄型子宫内膜的效果与机制。方法:60只雌性SPF级SD大鼠随机分为假手术组、模型组、人脐血富血小板血浆组、人脐血单个核细胞组和人脐血间充质干细胞组,每组12只。假手术组宫角注射0.5 mL生理盐水,5 min后再灌注0.5 mL PBS;模型组、人脐血富血小板血浆组、人脐血单个核细胞组和人脐血间充质干细胞组宫角注射0.5 mL体积分数95%乙醇,5 min后吸出剩余乙醇,经生理盐水冲洗2次后再分别灌注0.5 mL PBS、人脐血富血小板血浆、人脐血单个核细胞悬液(1×10^(7)个)和人脐血间充质干细胞悬液(1×10^(7)个),于再灌注后第3个正常动情周期的动情间期收集脏器组织与血清,检测相关指标。结果与结论:①子宫组织大体观、苏木精-伊红染色和Masson染色结果:假手术组结构完整,内膜厚度适中,血管结构清晰。与假手术组相比,模型组子宫萎缩,结构不完整,内膜厚度、腺体数量明显减少,血管结构紊乱,纤维化增加;与模型组相比,经人脐血衍生物治疗后,子宫大小、结构、内膜厚度均有所恢复(均P<0.01),并且纤维化均减轻,其中以人脐血单个核细胞组恢复最为明显。在腺体数量增加方面,以人脐血富血小板血浆组效果最为显著(P<0.0001)。②子宫组织免疫组化与免疫荧光结果显示,与假手术组相比,模型组细胞增殖相关指标角蛋白9、波形蛋白,内膜容受性相关指标白血病抑制因子、整合素αγβ3,血小板内皮细胞黏附分子、碱性成纤维细胞生长因子、血管内皮生长因子表达均降低(均P<0.05)。与模型组相比,经人脐血衍生物治疗后以上指标均有显著性升高,人脐血衍生物各组比较:角蛋白9、血管内皮生长因子蛋白:人脐血单个核细胞组>人脐血间充质干细胞组>人脐血富血小板血浆组;波形蛋白、白血病抑制因子蛋白:人脐血间充质干细胞组>人脐血单个核细胞组>人脐血富血小板血浆组;整合素αγβ3蛋白:人脐血富血小板血浆组>人脐血间充质干细胞组>人脐血单个核细胞组;血小板内皮细胞黏附分子蛋白:人脐血富血小板血浆组>人脐血单个核细胞组>人脐血间充质干细胞组;碱性成纤维细胞生长因子蛋白:人脐血单个核细胞组>人脐血富血小板血浆组>人脐血间充质干细胞组。③Western blot检测显示,与假手术组相比,模型组白细胞介素6、白细胞介素1β和肿瘤坏死因子α蛋白表达水平显著升高(均P<0.001),经人脐血衍生物治疗后上述指标均降低(均P<0.05)。④ELISA检测显示,与假手术组相比,模型组抗缪勒氏管激素、雌二醇、孕酮水平降低,促卵泡生成素、促黄体生成素水平增加(除促黄体生成素外,均P<0.05)。经人脐血衍生物治疗后,性激素和抗缪勒氏管激素水平有一定程度恢复。⑤生育力实验显示,与假手术组相比,模型组受孕时间有所增加,产仔数明显降低(均P<0.05)。经人脐血衍生物治疗后,3组产仔数均有所增加(P<0.05),组间比较尚未发现明显差异。此研究初步表明人脐血单个核细胞对薄型子宫内膜有一定治疗效果,且人脐血富血小板血浆、人脐血单个核细胞和人脐血间充质干细胞分别在改善薄型子宫内膜再生功能、内膜容受性、血管生成、炎症调控及妊娠结局方面具有不同的优势与差异。展开更多
Objective:To explore the best endometrial preparation scheme of freeze-thawed embryo transfer(FET)for patients with thin endometrium with kidney deficiency and blood stasis by comparing the clinical outcomes of three ...Objective:To explore the best endometrial preparation scheme of freeze-thawed embryo transfer(FET)for patients with thin endometrium with kidney deficiency and blood stasis by comparing the clinical outcomes of three endometrial preparation schemes of estradiol valerate tablets Hormone Replacement(HRT),Tamoxifen(TAM)and Endometrial Prescription combined with TAM(EP-TAM group).Method:Retrospective analysis of 318 patients with thin endometrium with kidney deficiency and blood stasis who underwent FET in Changle People's Hospital of Shandong Province,Shandong Maternal and Child Health Hospital,and Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine from September 2018 to March 2023,including 101 patients in HRT group(estradiol valerate tablets);108 patients in TAM group;109 patients in EP-TAM group.The cycle cancellation rate,intimal thickness,clinical pregnancy rate,embryo implantation rate,early abortion rate and ectopic pregnancy rate were compared among the three groups.Result:Cycle cancellation rates of TAM group and EP-TAM group were significantly lower than HRT group(8.3%,9.2%vs 17.8%,P<0.05).The intimal thickness of TAM group[(8.11±0.36)mm]and EP-TAM group[(8.21±0.40)mm]was significantly thicker than HRT group[(7.11±0.43)mm](P<0.05).The clinical pregnancy rate and implantation rate of TAM group and EP-TAM group were higher than HRT group,the early abortion rate and ectopic pregnancy rate were lower than HRT group,and EP-TAM group was more significant(P<0.05).Conclusion:Patients with thin endometrium underwent FET can try Endometrium Prescription combined with TAM(EP-TAM)to prepare the endometrium.展开更多
基金Supported by Special Funds for Basic Scientific Research of Central Public Welfare Research Institutes:201814006。
文摘Objective:This study aimed to explore the clinical effect of acupuncture therapy for menstruation regu-lation and pregnancy promotion on thin endometrium in the real world.Design:This study is a single-center pragmatic randomized controlled trial blinded to the statisticians.Using the“blockrand”software package,based on the age(≥35,<35),37 patients were randomized into an intervention group(19 cases)and a control group(18 cases).After reassignment regarding patient preference,21 patients were included in the intervention group and 16 in the control group.Setting:The trial was executed in the Specialty Outpatient Clinic,Acupuncture-Moxibustion Hospital of China Academy of Chinese Medical Sciences,from March 1,2019,to September 30,2020.Participants:The study included 37 patients with thin endometrium and without previous acupuncture treatment.Intervention:The intervention group was administered acupuncture for menstruation regulation and pregnancy promotion and a small-dose of progynova(2 mg daily),while the control group was adminis-tered a large-dose of progynova(4 mg daily).Interventions started from Day 5 of menstruation until the end of ovulation under B-ultrasound monitoring.The intervention lasted for three menstrual cycles.Measurements:Primary outcomes were changes in endometrial thickness between baseline and after intervention completion and the difference between the two groups after intervention.The secondary outcomes were endometrial and subendometrial blood flow,serum estradiol levels,menstrual conditions,and adverse reactions.Results:(1)Comparison of each indicator before and after intervention completion in the two groups:in the intervention group,the differences were significant in endometrial thickness,menstrual score,estra-diol(E2)level in ovulatory period,the pulsatility index(PI)and resistance index(RI)of uterine artery,the ratio of peak systolic velocity to end-diastolic velocity(S/D),the endometrial vascular index(VI),flow index(FI),and vascular flow index(VFI)and volume(P<0.01).In the control group,significant changes were observed in endometrial thickness,menstrual score,and E2 before and after the interven-tion(P<0.05),and no differences were observed in uterine artery PI,RI,S/D and endometrial VI,FI,VFI,and volume(P>0.05).Compared with the control group,the intervention group showed significant differences in endometrial thickness,menstrual score,E2,uterine artery PI,RI,S/D,and endometrial VI,FI,VFI,and volume after intervention(P<0.01).No adverse reactions were reported in the intervention group.In contrast,the control group had two cases of nausea and gastrointestinal discomfort after med-ication,eight cases of breast distention during medication,and one case of breast nodules enlarged by 1 cm after trial completion.
基金Supported by National Natural Science Foundation of China:81302998Science and Technology Planning project of Fujian Provincial Department of Science and Technology:20145Y0002+1 种基金TCM Scientific Research project of Fujian Provincial Health Department:wzfg201304Youth Scientific Research project of Fujian Provincial Health Department:2014-1-20~~
文摘Objective： To explore the effect of warming-needle moxibustion on the endometrial thickness and pregnancy outcome.Methods： Forty infertility women, selected from those who visited the TCM department of Maternity and Child Care Centers in Fujian Province from October 2015 to October 2016, were enrolled in this study.These women had mature follicle and successful ovulation according to B ultrasound monitoring, but their endometrial thickness was thinner than 7 mm. The women were divided into warming-needle moxibustion group（group A. 20 cases） and medication group（group B, 20 cases）. In group A, acupuncture,warming-needle moxibustion and electroacupuncture were conducted at different clinical stage. In group B, progynova was given to the patients from the 7 th day of menstruation to the 14 th day after ovulation（2 tablets, bid oral administration in the morning and evening）. The treatment lasted for 3 menstrual cycles, and the endometrial thickness changes and pregnancy rate of the patients in the two groups were compared after treatment.Results： The endometrial thickness of patients in the two groups increased after treatment when compared with the thickness before treatment. The average endometrial thickness in group A increased from（5.23 ±1.57） mm before treatment to（8.31 ±2.80） mm after treatment, while the average endometrial thickness in group B increased from（5.27 士 0.99） mm before treatment to（8.32 ±1.97） mm after treatment, and the differences were statistically significant（both P〈0.05）. The increase of endometrial thickness of the patients in group A after treatment was slightly larger than that in group B, and the difference was not statistically significant（P〉0.05）. After treatment for 3 menstrual cycles, the pregnancy rate of infertility women in group A was 25%（5/20） and 15%（3/20） in group B.Conclusion： Warming-needle moxibustion can increase the endometrial thickness to a certain extent,thus improving the endometrial receptivity, enhancing the embryo implantation rate, and improving the pregnancy outcome.
基金National Natural Science Foundation of China(Grant Number:81603656)Infertility Innovation Team(Grant Number:132041929)+2 种基金National Pilot Project of Clinical Collaboration of Traditional ChineseWestern Medicine on InfertilityScientific Research Program of Shaanxi University of Traditional Chinese Medicine in 2017(Project Number:2017PY10)。
文摘Thin endometrium has been proven to be a key contributing factor leading to infertility and poor pregnancy outcomes.Increasing the thickness and capacity of thin endometrium seems to be one of the challenging issues in reproductive medicine.The states of qi and blood are closely related to uterine blood circulation.Constitution is regarded as an important basis for determining the incidence as well as distinguishing,preventing,and treating diseases in traditional Chinese medicine.Based on the theory of qi and blood,this paper discusses the constitution factors of thin endometrium and puts forward the prospect of using big data tools to investigate the correlation between qi-blood imbalance constitution and the incidence of thin endometrium,so as to explore new approaches for the prevention and treatment of thin endometrium by regulating qi and blood as well as improving the constitution condition.
基金supported by The Strategic Priority Research Program of the Chinese Academy of Sciences(XDA16040300)National Natural Science Foundation of China(82071600,82171618,82271653,82371641)Jiangsu Provincial Obstetrics and Gynecology Innovation Center(CXZX202229)。
文摘Intrauterine adhesions(IUA)and thin endometrium(TE)represent significant challenges in human reproduction.The condition arises frequently from damage to the endometrial basal layer,leading to fibrous tissue replacing the functional endometrium and impairing the uterus's ability to accept embryo implantation.Conventional treatments,mainly including hysteroscopic adhesiolysis and estrogen therapies,have shown limited success,particularly in severe cases.Regenerative medicine,with its focus on stem cell-based therapies and biomaterials,offers a promising avenue for restoring endometrial function and structure.This review synthesizes the current landscape of endometrial regeneration,focusing on the therapeutic potential of stem cells,the supportive role of biomaterials,and the importance of understanding molecular mechanisms to develop effective strategies for reconstruction of endometrial functional and fertility restoration.
文摘Background： Thin endometrium is associated with poor reproductive outcomes; estrogen treatment can increase endomctrial thickness （EMT）. The aim of this retrospective cohort study was to investigate the factors influencing the effectiveness of estrogen treatment and reproductive outcomes after the treatment in patients with thin endometrium. Methods： Relevant clinical data of 101 patients with thin endometrium who had undergone estrogen treatment were collected. Possible factors influencing the effectiveness of treatment were analyzed retrospectively by logistic regression analysis. Eighty-seven infertile women without thin endometrium who had undergone assisted reproduction served as controls. The cases and controls were matched for age, assisted reproduction method, and number of embryos transferred. Reproductive outcomes of study and control groups were compared using Student＇s t-test and the Chi-square test. Results： At the end of estrogen treatment, EMT was ≥8 mm in 93/101 patients （92.1%）. Effectiveness of treatment was significantly associated with maximal pretreatment EMT （P = 0.017） and treatment duration （P = 0.004）. The outcomes of assisted reproduction were similar in patients whose treatment was successful in increasing EMT to ≥8 mm and the control group. The rate of clinical pregnancy in patients was associated with the number of good-quality embryos transferred in both fresh （P = 0.005） and frozen-thawed （P = 0.000） embryo transfer cycles. Conclusions： Thinner EMT before estrogen treatment requires longer treatment duration and predicts poorer treatment outcomes. The effectiveness of treatment depends on the duration of estrogen administration. Assisted reproductive outcomes of patients whose treatment is successful （i.e., achieves an EMT ≥8 mm） are similar to those of controls. The quality of embryos transferred is an important predictor of assisted reproductive outcomes in patients treated successfully with exogenous estrogen.
文摘Objective:To evaluate the effect of recombinant human growth hormone(rhGH)supplementation during hormone-replacement therapy and frozen-thawed embryo transfer(FET)in patients with thin endometrium.Methods:A retrospective research was conducted on 225 patients,who underwent artificial cycle FET in Shanghai,China,between January 2016 and November 2017.Data from 245 FET cycles were analyzed,of which 184 cycles received rhGH(GH group)and 61 did not(control group).Results:Clinical pregnancy and implantation rates were significantly higher in the GH group than those in the control group(64.7%vs.49.2%,P=0.032;44.8%vs.32.8%,P=0.019,respectively).After logistic regression analysis,rhGH was considered the only significant variable that influenced clinical pregnancy rate,increasing it by 1.89-fold.On the other hand,the presence of rhGH did not seem to affect the early pregnancy loss.Conclusions:Our results indicated that simultaneous addition of rhGH could improve clinical outcomes of FET in patients with thin endometrium,particularly in patients between 30 and 34 years of age.
文摘背景:研究发现人脐血富血小板血浆与人脐血间充质干细胞对薄型子宫内膜有一定治疗效果,但目前针对人脐血单个核细胞对薄型子宫内膜的研究尚未报道,且目前尚缺乏三者比较的相关研究。目的:探讨人脐血富血小板血浆、单个核细胞及间充质干细胞修复大鼠薄型子宫内膜的效果与机制。方法:60只雌性SPF级SD大鼠随机分为假手术组、模型组、人脐血富血小板血浆组、人脐血单个核细胞组和人脐血间充质干细胞组,每组12只。假手术组宫角注射0.5 mL生理盐水,5 min后再灌注0.5 mL PBS;模型组、人脐血富血小板血浆组、人脐血单个核细胞组和人脐血间充质干细胞组宫角注射0.5 mL体积分数95%乙醇,5 min后吸出剩余乙醇,经生理盐水冲洗2次后再分别灌注0.5 mL PBS、人脐血富血小板血浆、人脐血单个核细胞悬液(1×10^(7)个)和人脐血间充质干细胞悬液(1×10^(7)个),于再灌注后第3个正常动情周期的动情间期收集脏器组织与血清,检测相关指标。结果与结论:①子宫组织大体观、苏木精-伊红染色和Masson染色结果:假手术组结构完整,内膜厚度适中,血管结构清晰。与假手术组相比,模型组子宫萎缩,结构不完整,内膜厚度、腺体数量明显减少,血管结构紊乱,纤维化增加;与模型组相比,经人脐血衍生物治疗后,子宫大小、结构、内膜厚度均有所恢复(均P<0.01),并且纤维化均减轻,其中以人脐血单个核细胞组恢复最为明显。在腺体数量增加方面,以人脐血富血小板血浆组效果最为显著(P<0.0001)。②子宫组织免疫组化与免疫荧光结果显示,与假手术组相比,模型组细胞增殖相关指标角蛋白9、波形蛋白,内膜容受性相关指标白血病抑制因子、整合素αγβ3,血小板内皮细胞黏附分子、碱性成纤维细胞生长因子、血管内皮生长因子表达均降低(均P<0.05)。与模型组相比,经人脐血衍生物治疗后以上指标均有显著性升高,人脐血衍生物各组比较:角蛋白9、血管内皮生长因子蛋白:人脐血单个核细胞组>人脐血间充质干细胞组>人脐血富血小板血浆组;波形蛋白、白血病抑制因子蛋白:人脐血间充质干细胞组>人脐血单个核细胞组>人脐血富血小板血浆组;整合素αγβ3蛋白:人脐血富血小板血浆组>人脐血间充质干细胞组>人脐血单个核细胞组;血小板内皮细胞黏附分子蛋白:人脐血富血小板血浆组>人脐血单个核细胞组>人脐血间充质干细胞组;碱性成纤维细胞生长因子蛋白:人脐血单个核细胞组>人脐血富血小板血浆组>人脐血间充质干细胞组。③Western blot检测显示,与假手术组相比,模型组白细胞介素6、白细胞介素1β和肿瘤坏死因子α蛋白表达水平显著升高(均P<0.001),经人脐血衍生物治疗后上述指标均降低(均P<0.05)。④ELISA检测显示,与假手术组相比,模型组抗缪勒氏管激素、雌二醇、孕酮水平降低,促卵泡生成素、促黄体生成素水平增加(除促黄体生成素外,均P<0.05)。经人脐血衍生物治疗后,性激素和抗缪勒氏管激素水平有一定程度恢复。⑤生育力实验显示,与假手术组相比,模型组受孕时间有所增加,产仔数明显降低(均P<0.05)。经人脐血衍生物治疗后,3组产仔数均有所增加(P<0.05),组间比较尚未发现明显差异。此研究初步表明人脐血单个核细胞对薄型子宫内膜有一定治疗效果,且人脐血富血小板血浆、人脐血单个核细胞和人脐血间充质干细胞分别在改善薄型子宫内膜再生功能、内膜容受性、血管生成、炎症调控及妊娠结局方面具有不同的优势与差异。
基金Shenzhen“Medical and Health Three Projects”Project Grant(SZZYSM 202106003)Shenzhen Bao’an District of Medical and Health Research Project(2023JD212)+1 种基金Shenzhen Bao’an District of Traditional Chinese Medicine Clinical Research Project(2023ZYYLCZX-12)Weifang Health Committee Scientific Research Project(wfwsjk-2023-140).
文摘Objective:To explore the best endometrial preparation scheme of freeze-thawed embryo transfer(FET)for patients with thin endometrium with kidney deficiency and blood stasis by comparing the clinical outcomes of three endometrial preparation schemes of estradiol valerate tablets Hormone Replacement(HRT),Tamoxifen(TAM)and Endometrial Prescription combined with TAM(EP-TAM group).Method:Retrospective analysis of 318 patients with thin endometrium with kidney deficiency and blood stasis who underwent FET in Changle People's Hospital of Shandong Province,Shandong Maternal and Child Health Hospital,and Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine from September 2018 to March 2023,including 101 patients in HRT group(estradiol valerate tablets);108 patients in TAM group;109 patients in EP-TAM group.The cycle cancellation rate,intimal thickness,clinical pregnancy rate,embryo implantation rate,early abortion rate and ectopic pregnancy rate were compared among the three groups.Result:Cycle cancellation rates of TAM group and EP-TAM group were significantly lower than HRT group(8.3%,9.2%vs 17.8%,P<0.05).The intimal thickness of TAM group[(8.11±0.36)mm]and EP-TAM group[(8.21±0.40)mm]was significantly thicker than HRT group[(7.11±0.43)mm](P<0.05).The clinical pregnancy rate and implantation rate of TAM group and EP-TAM group were higher than HRT group,the early abortion rate and ectopic pregnancy rate were lower than HRT group,and EP-TAM group was more significant(P<0.05).Conclusion:Patients with thin endometrium underwent FET can try Endometrium Prescription combined with TAM(EP-TAM)to prepare the endometrium.
