Therapeutic efficacy of prednisone in unexplained recurrent implantation failure patients with elevated peripheral natural killer cells

doi:10.11958/20252196

Abstract

Abstract:

Objective To investigate the clinical significance of peripheral blood natural killer cells (pNKC) in women with unexplained recurrent implantation failure (URIF) and to evaluate the effect of oral prednisone on pregnancy outcomes in this population. Methods A retrospective analysis was conducted on 373 URIF patients who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment at two tertiary hospitals. Patients were divided into two groups based on the proportion of pNKC in peripheral blood lymphocytes: the normal pNKC group (<18%, 202 cases) and the high pNKC group (≥18%, 171 cases). Patients were categorized by prednisone use: the prednisone group of 211 cases (including 123 cases of high pNKC and 88 cases of normal pNKC) and the control group of 162 cases (including 48 cases of high pNKC and 114 cases of normal pNKC). Whether pNKC concentration was associated with embryo implantation was analyzed. Whether prednisone administration positively affected pregnancy outcomes in URIF patients was also analyzed. Results Compared with the normal pNKC group, there were no significant differences in live birth rate, clinical pregnancy rate or miscarriage rate in the high pNKC group (P > 0.05). In URIF patients with normal pNKC levels, no significant difference was observed in pregnancy outcomes between the control group and the prednisone group (P > 0.05). In URIF patients with high pNKC levels, the clinical pregnancy rate was higher in the prednisone group than that of the control group (P<0.05), but there were no significant differences in live birth rate or miscarriage rate between the two groups (P > 0.05). Conclusion Women with URIF show a relatively high proportion of pNKC counts. The pNKC levels have no significant impact on pregnancy outcome in URIF patients. Oral prednisone may offer potential benefits for URIF patients with high pNKC levels.

Key words: killer cells, natural, embryo transfer, prednisone, pregnancy outcomes, unexplained recurrent implantation failure

CLC Number:

R711.76

Figures/Tables 6

References 27

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组别		n		母体年龄/岁		BMI/（kg/m²）			口服泼尼松
正常pNKC组		202		34.85±3.58		22.39±3.09			88（43.6）
高pNKC组		171		34.31±3.84		21.88±2.83			123（71.9）
t或χ²				1.407		1.660			30.328^＊＊
组别			既往胚胎移植次数/次				移植周期
组别			既往胚胎移植次数/次				新鲜周期			冷冻周期
正常pNKC组			4.22±1.93				47（23.3）			155（76.7）
高pNKC组			3.76±1.19				46（26.9）			125（73.1）
t或χ²			2.828^＊				0.653
组别	胚胎分布							卵裂期胚胎/个			囊胚期胚胎/个
组别	卵裂期胚胎				囊胚期胚胎			卵裂期胚胎/个			囊胚期胚胎/个
正常pNKC组	93（46.0）				109（54.0）			1.76±0.43			1.41±0.49
高pNKC组	73（42.7）				98（57.3）			1.79±0.41			1.36±0.48
t或χ²	0.421							0.550			0.644

组别		n		母体年龄/岁		BMI/（kg/m²）			口服泼尼松
正常pNKC组		202		34.85±3.58		22.39±3.09			88（43.6）
高pNKC组		171		34.31±3.84		21.88±2.83			123（71.9）
t或χ²				1.407		1.660			30.328^＊＊
组别			既往胚胎移植次数/次				移植周期
组别			既往胚胎移植次数/次				新鲜周期			冷冻周期
正常pNKC组			4.22±1.93				47（23.3）			155（76.7）
高pNKC组			3.76±1.19				46（26.9）			125（73.1）
t或χ²			2.828^＊				0.653
组别	胚胎分布							卵裂期胚胎/个			囊胚期胚胎/个
组别	卵裂期胚胎				囊胚期胚胎			卵裂期胚胎/个			囊胚期胚胎/个
正常pNKC组	93（46.0）				109（54.0）			1.76±0.43			1.41±0.49
高pNKC组	73（42.7）				98（57.3）			1.79±0.41			1.36±0.48
t或χ²	0.421							0.550			0.644

组别	n	临床妊娠	活产	流产
正常pNKC组	202	84（41.6）	64（31.7）	19（22.6）
高pNKC组	171	72（42.1）	45（26.3）	26（36.1）
χ²		0.010	1.290	2.935

组别	n	临床妊娠	活产	流产
正常pNKC组	202	84（41.6）	64（31.7）	19（22.6）
高pNKC组	171	72（42.1）	45（26.3）	26（36.1）
χ²		0.010	1.290	2.935

组别	n	临床妊娠	活产	流产
正常pNKC组	114	46（40.4）	32（28.1）	13（28.3）
高pNKC组	48	14（29.2）	8（16.7）	6（42.9）
χ²		1.812	2.362	0.039