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目的:探讨针灸对体外受精-胚胎移植(IVF-ET)反复种植失败(RIF)患者子宫内膜容受性的影响及其作用机制。方法:将IVF-ET胚胎质量好但RIF的40例患者随机分为试验组及对照组,每组20例。试验组于月经第7日开始运用艾条灸神阙穴,针刺穴位关元、气海、子宫、血海等至排卵后第7日止,此为1个疗程,共行3个疗程。对照组于相同时间运用安慰针灸针治疗。观察治疗前、后排卵第7日的子宫内膜厚度、类型、子宫内膜血流指数[搏动指数(PI)及阻力指数(RI)],并用扫描电子显微镜观察患者子宫内膜表面胞饮突情况。结果:治疗前所有IVF-ET反复失败患者发育的胞饮突少,不同步,发育完全的胞饮突少见,试验组治疗后的患者子宫内膜胞饮突表达丰富,发育完全,与治疗前比差异有统计学意义,对照组治疗前、后变化差异无统计学意义。试验组治疗3个疗程后,排卵后第7日A型内膜比例高于对照组,差异有统计学意义(P<0.05),子宫内膜血流参数PI、RI低于对照组,差异均有统计学意义(P<0.01或P<0.05),试验组与对照组治疗后的排卵第7日子宫内膜厚度差异无统计学意义(P>0.05)。结论:针灸可以改善IVF-ET胚胎质量好,但RIF患者的子宫内膜形态,降低子宫内膜的血流阻力,改善血供,提高患者子宫内膜胞饮突的表达,从而提高子宫内膜容受性,有利于胚胎种植。
Objective: To investigate the effect of acupuncture and moxibustion on endometrial receptivity in patients with repeated implantation failure (IVF-ET) of IVF-ET and its mechanism. Methods: 40 patients with good IVF-ET embryo quality but with RIF were randomly divided into experimental group and control group, with 20 cases in each group. The experimental group began to use moxibustion Shenque acupoint on acupuncture on the seventh day of menstruation, acupuncture points Guanyuan, gas sea, uterus, blood and so on until the 7th day after ovulation, this is a course of treatment, a total of 3 courses. The control group received comfort acupuncture treatment at the same time. The endometrial thickness, type, endometrial blood flow index [pulsatility index (PI) and resistance index (RI)] on the 7th day after ovulation were observed before and after ovulation. The endodermal phenotypes were observed by scanning electron microscopy Happening. Results: All patients with IVF-ET failure failed to develop PCDs with few, no synchronized and fully developed PCDs. Before treatment, patients with endometriosis had abundant expression and developed completely. Compared with those before treatment The difference was statistically significant, the control group before and after treatment, the difference was not statistically significant. After 3 courses of treatment, the ratio of type A endometrium on the 7th day after ovulation was higher in the experimental group than in the control group (P <0.05), the endometrial blood flow parameters PI and RI were lower than those in the control group (P <0.01 or P <0.05). There was no significant difference in endometrial thickness between the experimental group and the control group on the 7th day after ovulation (P> 0.05). Conclusion: Acupuncture can improve the quality of IVF-ET embryos, but the morphology of endometrium in RIF patients decreases the blood flow resistance of the endometrium, improves the blood supply and improves the expression of endometriosis in patients with endometrial Tolerance, is conducive to embryo cultivation.