【作者】 陈颖；

【导师】 岳静；

【作者基本信息】 华中科技大学 ， 妇产科学（专业学位）， 2022， 硕士

【摘要】 目的:1.探究剖宫产术后子宫瘢痕缺陷(Cesarean scar defect,CSD)对体外受精/卵胞浆内单精子注射术(In vitro fertilization and Intracytoplasmic sperm injection,IVF/ICSI)临床结局的影响。2.探究CSD患者的子宫腔内微生物物种构成及丰度变化。方法:1.纳入2015年1月至2019年12月在华中科技大学同济医学院附属同济医院生殖中心行IVF/ICSI的既往有剖宫产史的不孕患者2441例。按照三维超声和宫腔镜是否观察到剖宫产瘢痕部位≥2mm的凹陷,将符合纳入标准的患者分为瘢痕缺陷组(Cesarean scar defect,CSD)(n=159)和非瘢痕缺陷组(n=2072),比较两组患者的临床活产率、临床妊娠率、h CG阳性率、流产率、分娩并发症及新生儿情况,应用广义估计方程(GEE)回顾性分析CSD对IVF/ICSI临床结局的影响。2.采用一次性子宫内膜取样器收集34名拟行IVF/ICSI的不孕患者的子宫内膜样本,其中CSD组9例,非CSD组9例,对照组16例,通过16S rRNA测序技术比较分析三组患者宫腔内微生物群的物种构成及丰度。结果:与非CSD组患者相比,CSD组患者的活产率(18.99%vs.31.51%,adjusted OR:0.52,95%置信区间:0.35-0.78),h CG阳性率(34.08%vs.46.40%,adjusted OR:0.61,95%置信区间:0.43-0.86)、临床妊娠率(29.05%vs.42.25%,adjusted OR:0.57,95%置信区间:0.40-0.81)和平均着床率(0.28±0.44 vs.0.39±0.47,adjusted OR:0.53,95%置信区间:0.38-0.76)均有显著性下降。两组患者的分娩孕周、围产期并发症、新生儿体重、出生缺陷均无显著性差异。CSD组、非CSD组患者子宫腔内微生物群物种的多样性及构成与对照组相比无显著性差异。结论:剖宫产术后子宫瘢痕缺陷对IVF/ICSI的临床结局会产生不利影响,但对分娩并发症和新生儿结局影响不大。这种不利影响可能与宫腔内微生物群变化无关。更多还原

【Abstract】 Objective: 1.The research aims to study the relationship between cesarean scar defect(CSD)and reproductive outcomes of In vitro fertilization and Intra-cytoplasmic sperm injection(IVF/ICSI).2.To explore the diversity and taxonomy of uterine microbiome collected from infertility women with cesarean scar defect.Method: The records of the patients(2441 women with 2874 stimulation cycles)with cesarean section history who were treated with IVF/ICSI at the IVF center,Tongji hospital,Tongji Medical College,Huazhong University of Science and Technology between 2015.1and 2019.12 were collected.The patients who were eligible for inclusion were allocated to the CSD group(n=159)if an indentation(depth ≥ 2 mm)at the site of the CS was detected by 3D TVS and hysteroscopy.Otherwise,the patients were divided into CSD negative group(n=2072).Then,live birth rate,clinical pregnancy rate,positive h CG test rate,miscarriage rate,delivery complications and neonatal conditions were compared between the two groups.Generalized estimating equation(GEE)analysis was applied to clarify the relationship between CSD and clinical outcomes.2.Endometrial samples were obtained from 34 subjects,including 9 patients with CSD,9 patients without CSD and 16 patients without scarred uterus.Endometrial samples were collected using a disposable endometrial sampler when subjects underwent the hysteroscopy,and the abundance and composition of the uterine flora were evaluated by 16 S rRNA sequencing technology.Outcome: Women with CSD had lower live birth rate(18.99% vs.31.51%,adjusted OR:0.52,95% CI: 0.35-0.78),positive h CG test rate(34.08% vs.46.40%,adjusted OR:0.61,95% CI:0.43-0.86),clinical pregnancy rate(29.05% vs.42.25%,adjusted OR:0.57,95%CI:0.40-0.81)and implantation rate(0.28 ± 0.44 vs.0.39 ± 0.47,adjusted OR:0.53,95%CI:0.38-0.76)than women without CSD.No significant differences were observed between the uterine microbiome of the CSD group,CS group,and control group.Conclusion: CSD may adversely affect clinical outcomes in infertile women undergoing IVF/ICSI,which may not be significantly associated with endometrial microbiota.更多还原