Intrauterine perfusion of dexamethasone improves pregnancy outcomes in recurrent reproductive failure patients with elevated uterine natural killer cells. A retrospective cohort study

医学 地塞米松 怀孕 回顾性队列研究 灌注 流产 队列 活产 产科 内科学 生物 遗传学
作者
Feng Zhang,Zhuran Wang,Ruochun Lian,Lianghui Diao,Yuye Li,Yinghua Wu,Tailang Yin,Christopher Huang
出处
期刊:American Journal of Reproductive Immunology [Wiley]
卷期号:90 (6) 被引量:1
标识
DOI:10.1111/aji.13796
摘要

Abstract Objective To determine the effect of intrauterine perfusion of dexamethasone (DXM) on pregnancy outcomes in recurrent reproductive failure (RRF) patients with elevated uNK cells. Methods This retrospective cohort study included 132 RRF patients with elevated uNK cells: 56 patients received DXM treatment and 76 patients refused it in the frozen‐thawed embryo transfer cycles. To determine the efficacy of intrauterine perfusion of DXM, multivariate logistic regression models and diagnosis‐based subgroup analysis were performed. We also compared the pregnancy outcomes of patients with different responsiveness to DXM treatment. Results Intrauterine perfusion of DXM significantly improved clinical pregnancy rate (aOR: 3.188, 95% CI: 1.395–7.282, P = .006) and live birth rate (aOR: 3.176, 95% CI: 1.318–7.656, P = .010) in RRF patients with elevated uNK cells, but there was no significant association with miscarriage rate. Subgroup analysis revealed that intrauterine perfusion of DXM in patients with recurrent implantation failure (RIF) showed significant improvement in clinical pregnancy rate (aOR: 6.110, 95% CI: 1.511–24.713, P = .011) and live birth rate (aOR: 9.904, 95% CI: 1.963–49.968, P = .005), but there was insufficient evidence of benefit in recurrent pregnancy loss (RPL) patients. Additionally, uNK cell levels dropped to normal range was achieved in only 35.90% of RRF patients after DXM treatment, no significant difference was found in pregnancy outcomes among patients with different responsiveness to DXM treatment (all P > .05). Conclusion Intrauterine perfusion of DXM was a promising and effective treatment to enhance clinical pregnancy rate and live birth rate in RRF women with abnormally elevated uNK cells, and RIF patients are more likely to benefit than RPL patients.
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