| Part Ⅰ Effect of invigorating spleen,tonifying kidney,dredging liver and promoting blood circulation on pregnancy outcome of RIF patientsObjective : To explore the diagnosis and treatment by applying the method of invigorating kidney and liver to invigorate the circulation of planting repeatedly failed(Recurrent implantation failure,RIF)patients,to freezing and thawing embryo transfer to help pregnant again after treatment,patients with statistical RIF embryos grow rate,early abortion rate and clinical pregnancy rate to evaluate the curative effect,for clinical treatment of patients with RIF,provide new ideas to improve the pregnancy outcome.Methods:Collected from August 2019 to December 2020 at the First Affiliated Hospital of China University of Science and Technology(Anhui Provincial Hospital)Reproductive Center In vitro fertilization/egg plasma In-single microinjection-embryo transplantation(IVF / ICS)The patient data of 248 RIF patients in I-ET were divided into control groups(128 cases)and observation groups(120 cases)according to the number of machines,with subjects aged 22 to 40 years.Control group RIF patients to embryo implant endometrial preparation and other normal treatment;Observation group RIF patients on the basis of treatment of the group joint spleen to replenish kidneys and liver lesions oral medicine,from the 2nd to 3rd day of the menstrual cycle,until 10 days after the transplant,continuous use of 1 to 3 months of menstrual cycle.Analysis compared to two groups of RIF patients of the same data characteristics,analysis and comparison of the two groups of RIF patients base FSH level,promote ovulation,transplant number,transplant embryo number,analysis and comparison of two groups of RIF patients after treatment when the endometrial preparation program and the distribution of embryo quality transplant;Analysis and comparison of endometrial-related indicators in two groups of RIF patients,including endometrial thickness,endometrial morphology,uterine artery blood flow resistance(PI and RI),and changes before and after endometrial peristaltic wave rate(UPF)treatment.Results: 1.Comparison of general data between the two groups of RIF patients A total of 248 RIF patients were included in the study,including 128 RIF patients in the control group,with an average age of(32.16±3.51)years,an average infertility years of(4.60±1.98)years,an average BMI of(23.16±2.78)kg/m2 and an average basal FSH level of(7.86±2.63)U/L.In observation group,there were 120 RIF patients,with an average age of(32.29±3.62)years,an average infertility years of(4.98±2.64)years,and an average BMI of(22.57±3.00)kg/m2.The average basal FSH level was(7.74±2.41)U/L,and the general data of RIF patients in the two groups showed no statistical significance and were comparable(P > 0.05).2.Comparison of IVF-related information between the two groups of RIF patients Compared with RIF patients in the observation group,the control group R IF patients averaged ovulation(2.10±0.56 VS 2.04±0.68),average number of transplants(3.50±0.59 VS 3.46 ±0.56)and the average number of embryos transferred(5.02±0.48 VS 5.00±0.61)were slightly higher,but the differences were not generally significant and were comparable(P>0.05).There was no significant difference in the distribution of endometrial preparation and embryo quality in two groups of RIF patients after treatment(P>0.05).3.Comparison of endometrial indicators between the two groups of RIF patients 3.1 Comparison of endometrial thickness between the two groups of RIF patients There was no significant difference in the basic endometrial thickness before treatment between the two groups(P>0.05),and the endometrial thickness was lower than that of the observation group(9.01±1.10 mm VS 9.63±1.12 mm)after treatment,and the difference was statistically significant(P<0.05).3.2 Comparison of endometrial morphology between the two groups of RIF patients There was no significant difference between the proportion of type A endometrial form and the distribution of endometrial form before treatment in two groups of RIF patients,with comparability(P>0.05),and the proportion of endometrial type A in RIF patients in HCG day observation group after treatment was significantly higher than that of RIF patients in control group(80.00% VS 65.63%),and there was a significant difference between the two groups of endometrial patterns.Statistically significant(P<0.05).3.3 Comparison of uterine arterial blood flow resistance between two groups of RIF patients The differences in uterine arterial blood flow resistance(PI and RI)were not significant,statistically significant,and were comparable(P>0.05)between the two groups of RIF patients.After treatment,the resistance of blood flow to the uterine arteries was lower in both groups of RIF patients than before treatment,while the decrease in RIF patients in the observation group was more obvious,and there were significant differences compared with RIF patients in the control group,which was statistically significant(P<0.05).3.4 Comparison of endometrial peristaltic wave frequencies between two groups of RIF patients There was no significant difference between the frequency mean and frequency distribution of endometrial peristaltic wave before treatment in the two groups of RIF patients,and there was comparability(P>0.05).On the day of transplantation,the average endometrial peristaltic wave frequency decreased compared to pre-treatment in both groups of RIF patients,and the RIF patients in the observation group had lower UPF than the control group RIF patients,and the difference between the groups was statistically significant(P<0.05).After treatment,there were significant differences in the frequency of endometrial peristaltic wave between the two groups of RIF patients,and there were significantly more UPFs between 1 and 2 times/min in the observation group than in the control group(54.17% VS 39.84%),and the difference was statistically significant(P<0.05).4.Comparison of pregnancy outcomes between the two groups of RIF patients The rate of pregnancy in the observation group was 56.67% VS 35.94%,and the rate of tissue and embryo implantation in the observation group was 35.23% VS 23.47%,which were higher than those in the control group.The early miscarriage rate of was significantly lower than that of the control group(13.24% VS 28.26%),and the difference between the two groups was significant(P < 0.05).Conclusion:The method of renal spleen and liver dredging can significantly improve the embryo implantation rate and clinical pregnancy rate of RIF patients and reduce their early abortion rate,and its mechanism may be related to increasing the thickness of the endometrial,reducing the resistance of the uterine artery blood flow,improving the endometrial morphology and reducing the frequency of endometrial peristaltic waves.PART Ⅱ Study on immunological mechanism of invigorating spleen,tonifying kidney,dredging liver and promoting blood circulation in patients with RIFObjective:To explore the immunological mechanism of RIF occurrence and the effect of spleen and kidney dredging on NK cell activity and Th1/Th2/Th17 cell factors in RIF patients,it is proposed to explore the internal mechanism of RIF occurrence and the ways of Chinese medicine to improve pregnancy outcomes in RIF patients from the molecular level.Methods:Collected 40 patients with IVF-ET or ICSI-ET assisted pregnancy at the First Annex Hospital(Anhui Provincial Hospital)Reproductive Center of China University of Science and Technology from August 2019 to December 2020 as a study subject,according to whether they received the treatment of spleen and kidney rehydration live blood as a In the group,those who did not receive Chinese medicine treatment were divided into Group B(20 cases),those who received Chinese medicine treatment were in Group C(20 cases),and the treatment method was the same,while 20 patients who received the first frozen and thawed embryo transfer were considered as normal pregnancy group A,with the study subjects aged 22 to 40 years.All three groups of patients were selected from the early morning empty-abdominal elbow static blood 4 ml to 5 ml on the day of the scheduled transplantation,using fluid cytomemic techniques for NK cell activity(NK cell ratio,NK cell activity,granzyme B,IFN-γ and CD-107a)and Th1/Detection of Th2/Th17 cells(tumor necross factor α,interferon γ,white mesotin-2,white melein-4,white melein-6,white melein-10 and white melein-17A).Using SPSS 2 1.0 software for statistical analysis,the differences between the three groups of N K cells and Th1/Th2/Th17 cells were compared and analyzed.Results: 1.Comparison of results in three groups of patients with NK cell ratio,activity,granzyme B,IFN-γ,and CD-107 a results Compared with patients in normal pregnancy group A,the proportion of NK cells,CD-107 a and the differences were statistically significant in group B and RIF patients in group C of Western medicine(P<0.05),while there were no significant differences between group B and group C,and there was no general significance(P>0.05).Compared with B group RIF patients,the proportion of N K cell activity and granzyme B in patients with normal pregnancy group A and C group RIF patients was significantly lower,and the differences were all of general significance(P< 0.05),while there was no significant difference between group A and group C patients.The comparison of IFN-γ between the three groups was not significantly different and did not have a general meaning(P>0.05).2.Comparison of Cytokine results in three groups of patients with Th1/Th2/Th17 In terms of IL-4 cytokine level,the differences were significantly lower in group B RIF patients than in normal pregnancy group A patients(P<0.01),while in group C RIF patients,although higher than group A patients and lower than group B patients,there were no significant differences between group C and group B,group C and group A,and none of them had statistical significance(P>0.05).In terms of IFN-γ cytokine levels,patients in group B and RIF in group C were significantly higher than those in group A,and the differences were statistically significant(P<0.05),but the differences between groups B and C were not statistically significant(P>0.05).In terms of IL-17 A cytokine levels,group B RIF patients were significantly higher than those in group A and C,and the differences were statistically significant(P<0.01),while the differences were not statistically significant in group C patients,although IL-17 A cytokines were higher than in group A patients(P>0.05).There was no significant difference between the remaining three groups of cytokine levels and were not statistically significant(P>0.05).Conclusion:The emergence of RIF may be due to the destruction of the balance of exocytokine Th1/Th2/Th17 cytokines,decreased IL-4,elevation of IFN-γ and IL-17 A,and abnormal increase in NK cell activity Therefore,thus interfering with the embryo bed,reduce the pregnancy rate,spleen supplement kidney dredging liver live blood Chinese medicine may be by reducing NK cell activity,granzyme B and IL-17 A cytokine levels,and thus achieve the goal of regulating immunity,improve pregnancy outcomes. |
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