西地那非对反复着床失败患者子宫内膜血流的改善作用

doi:10.5246/jcps.2022.03.018

中国药学(英文版) ›› 2022, Vol. 31 ›› Issue (3): 202-211.DOI: 10.5246/jcps.2022.03.018

• 【药事管理与临床药学专栏】 • 上一篇下一篇

西地那非对反复着床失败患者子宫内膜血流的改善作用

张佳佳¹, 李华², 甄秀梅¹, 王丽娜¹^,^*(), 王丽颖¹

1. 北京大学第三医院妇产科生殖医学中心, 北京 100191
2. 首都医科大学附属北京妇产医院妇科, 北京 100026

收稿日期:2021-11-15 修回日期:2021-12-24 接受日期:2022-01-12 出版日期:2022-03-31 发布日期:2022-03-31
通讯作者: 王丽娜
作者简介:
+ Tel.: +86-13910778175, E-mail: linabysy@163.com
基金资助:
National Key Research and Development Program (Grant No. 2018YFC1002104).

Sildenafil improves endometrial blood flow in patients with recurrent implantation failure

Jiajia Zhang¹, Hua Li², Xiumei Zhen¹, Lina Wang¹^,^*(), Liying Wang¹

1 Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
2 Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China

Received:2021-11-15 Revised:2021-12-24 Accepted:2022-01-12 Online:2022-03-31 Published:2022-03-31
Contact: Lina Wang

摘要/Abstract

摘要：

成功的胚胎着床依赖于功能良好的子宫内膜以及高质量的胚胎。越来越多的证据表明, 西地那非在子宫内膜容受性和着床中起着重要作用。然而, 关于西地那非对反复植入失败(RIF)患者临床结局影响的研究甚少。本研究目的是了解西地那非对RIF患者子宫内膜血流改善和妊娠的影响。选择2013年6月至2017年12月在北京大学第三医院生殖医学中心接受IVF的305例RIF患者的346个解冻胚胎移植周期。口服西地那非, 研究其对子宫内膜血流、子宫内膜厚度和临床结局的相关影响。在346例胚胎移植周期中, 口服西地那非前后三组 (A: 内膜无血流; B: 子宫内膜下探及血流; C: 子宫内膜内和子宫内膜下均探及血流)的比例分别为: A组: 36.7% ( n = 127) 对 7.5% ( n = 26); B组: 42.8% ( n = 148) 对 24.0% ( n = 83); C组: 20.5% ( n = 71)对68.5% ( n = 237)。总之, 137个FET周期的子宫内膜血流量有所改善 (61.8%)。着床率为19.47% (132/678), 临床妊娠率为32.66% (113/346), 妊娠组子宫内膜血流优于非妊娠组。结果发现, 本研究探讨了西地那非对RIF患者子宫内膜容受性和临床结局的改善作用, 证实了良好的子宫内膜血流在成功妊娠中的关键作用。同时, 由于不良事件发生率低, 证实西地那非应用在RIF患者临床治疗中的安全性和可行性。

关键词: 西地那非, 反复着床失败, 子宫内膜血流

Abstract:

Successful embryo implantation depends on a well-functioning endometrium and high-grade quality embryos. An increasing body of evidence suggests that sildenafil citrate plays an important role in endometrial receptivity and implantation. However, few studies have investigated the effects of oral sildenafil citrate on the clinical outcomes of patients with recurrent implantation failure (RIF). In the present study, we aimed to determine the impact of sildenafil citrate on improving the endometrial blood flow and pregnancy rate in RIF patients. A total of 346 frozen-thawed transfer cycles from 305 RIF patients undergoing IVF at the Center for Reproductive Medicine of Peking University Third Hospital from June 2013 to December 2017 were enrolled. Oral sildenafil citrate was given to the patients, and the related effects on endometrial blood flow, endometrial thickness, and clinical outcomes were investigated. In the 346 transferred cases, the proportion of three groups (A: undetectable blood flow; B: sub-endometrial blood flow; C: endometrial and sub-endometrial blood flow) before and after oral administration of sildenafil citrate was as follows: group A: 36.7% ( n = 127) vs. 7.5% ( n = 26); group B: 42.8% ( n = 148) vs. 24.0% ( n = 83); group C: 20.5% ( n = 71) vs. 68.5% ( n = 237). Moreover, the endometrial blood flow in 137 FET cycles was improved (61.8%). Besides, the implantation rate was 19.47% (132/678), and the clinical pregnancy rate reached 32.66% (113/346), while the endometrial blood flow of the pregnancy group was better compared with the non-pregnancy group. This study explored the improving effects of sildenafil citrate on the endometrial receptivity and clinical outcomes of RIF patients, confirming the crucial role of good endometrial blood flow in a successful pregnancy. Meanwhile, the low incidence of adverse events also supported the security and feasibility of sildenafil citrate in the clinical therapy of RIF patients.

Key words: Sildenafil, Repeated implantation failure, Endometrial blood flow

Supporting:

张佳佳, 李华, 甄秀梅, 王丽娜, 王丽颖. 西地那非对反复着床失败患者子宫内膜血流的改善作用[J]. 中国药学(英文版), 2022, 31(3): 202-211.

Jiajia Zhang, Hua Li, Xiumei Zhen, Lina Wang, Liying Wang. Sildenafil improves endometrial blood flow in patients with recurrent implantation failure[J]. Journal of Chinese Pharmaceutical Sciences, 2022, 31(3): 202-211.

图/表 4

Table 1. Comparison of baseline characteristics and cycle-related factors among group A (no endometrial blood flow), group B (sub-endometrial blood flow), and group C (endometrial and sub-endometrial blood flow) before intervention.

Table 2. The sample number of three groups before and after oral administration of sildenafil citrate.

Table 3. Comparison of baseline characteristics and clinical outcome-related factors between pregnant and non-pregnant patients.

Table 4. Comparison of pregnancy outcomes in different blood flow groups after taking oral sildenafil citrate.

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西地那非对反复着床失败患者子宫内膜血流的改善作用

Sildenafil improves endometrial blood flow in patients with recurrent implantation failure

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