阿司匹林联合泼尼松对抗磷脂抗体阳性者行IVF-ET妊娠结局的影响

摘要

Objective:To investigate the effect of aspinrin combined with prednisone on pregnancy outcome in patients with positive anti-phospholipid antibody (APA) undergoing in vitro fertility-embryo transfer (IVFET).Methods:Fifty-two patients underwent IVF-ET who had positive anticardiolipin(ACA) or/and anti-beta 2 glycoprotein 1 antibody(Aβ2GP 1) were randomly divided into two groups,one group treated with aspirin and prednisone at low doses,another untreated as control.Oocyte retrieval number,fertilization rate,cleavage rate,useful embryo rate,high quality embryo rate,implantation rate,clinical pregnancy rate,abortion rate were analyzed.Results:Between two groups,there were not significant differences in the oocyte retrieval rate and abortion rate (8.52+ 4.34 vs.9.67±4.02,P=0.312;9.09％ vs.50％,P=0.05).The treated group had higher fertilization rate (80.43％ vs.72.41％,P=0.032),cleavage rate(98.67％ vs.94.64％,P=0.045),useful embryo rate (89.24％ vs.76.73％,P=0.001),high quality embryo rate (72.65％ vs.42.77％,P＜0.001),and clinical pregnancy rate (66.67％ vs.33.33％,P=0.013) than control.Conclusions:Those patients with positive ACA and Aβ2GP1 but without recurrent abortion undergoing IVF-ET can be treated with aspirin and prednisone in low dose,which could be helpful to improve fertility rate,embryo quality,clinical pregnance rate,and IVF-ET outcomes.%目的:探讨阿司匹林联合泼尼松对抗磷脂抗体阳性者行体外受精-胚胎移植(IVF-ET)妊娠结局的影响.方法:选取抗心磷脂抗体(ACA)和(或)抗β2糖蛋白1抗体(Aβ2GP1)阳性的不孕症患者52例,其中30例患者于IVF-ET前给予阿司匹林及泼尼松治疗(研究组),余22例患者助孕前不予上述两种药物治疗(对照组),比较2组患者获卵数、受精率、卵裂率、可利用胚胎数、优质胚胎率、临床妊娠率、妊娠早期流产率的差异.结果:研究组和对照组获卵数差异无统计学意义(8.52±4.34 vs.9.67±4.02,P=0.312),研究组和对照组的受精率(80.43％ vs.72.41％,P=0.032)、卵裂率(98.67％ vs.94.64％,P=0.045)、可利用胚胎率(89.24％ vs.76.73％,P=0.001),优质胚胎率(72.65％ vs.42.77％,P＜0.001)、累积临床妊娠率(66.67％ vs.33.33％,P=0.013)差异有统计学意义,研究组均高于对照组,早期流产率虽低于对照组,但差异无统计学意义(9.09％ vs.50％,P=0.05).结论:对于抗磷脂抗体阳性不伴有复发性流产史且拟行IVF-ET助孕的患者,助孕前给予小剂量阿司匹林及泼尼松治疗,有助于提高受精率、改善胚胎质量、提高临床妊娠率并可能改善助孕结局.