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P-577 A Therapeutic Protocol in Previous Failed ART Patients With High Total NK Cells: An RCT
Human Reproduction ( IF 6.1 ) Pub Date : 2022-06-30 , DOI: 10.1093/humrep/deac107.533
A.S Saad, K Abdelaziz

Study question To evaluate a combined therapeutic protocol of lipid emulsion, prednisolone & LMWH in cases of failed ART cycles with high NK cells Summary answer The combined therapy of lipid emulsion, prednisolone & LMWH had a higher pregnancy rate but not significant than the standard therapy alone. What is known already Many researchers have proved that a high numbers and/or cytotoxicity of peripheral blood NK cells is associated with infertility, recurrent spontaneous miscarriage (RSM) and failed ART cycles. Many investigations have shown that intralipid has the ability to suppress NK cell activity. It is well known that parenteral fat emulsions accumulate in macrophages modifying many immune responses. So, modifying the T helper1/ T helper 2 balance in favor of T helper 2 with implantation chances increase. Prednisolone has an immunosuppressive and anti-inflammatory actions and has widely used in autoimmune diseases. Prednisolone also reduces the high numbers of uNK in RSM. Study design, size, duration This was a prospective randomized controlled trial in 100 cases with failed ART cycles & high NK cells. From Jan 2019- Dec 2021 Participants/materials, setting, methods One hundred failed ART cases with high NK cells were divided into 2 groups: (Control group)(50 cases) with previous failed ART cycles will undergo standard treatment (progesterone, low dose aspirin & folic a.). While the other (Interventional group)(50 cases) will have in addition to the previous protocol: lipid emulsion begin in the cycle before embryo transfer & prednisolone begin with the start of lipid emulsion & LMWH begin with the day of ET Main results and the role of chance Chemical pregnancy was higher in the interventional group (54.0%) than the control group (40.0%) but without statistical significance (P = 0.161). Also, ongoing pregnancy was higher in the interventional group (85.0%) than the control group (60.0%) but without statistical significance (P = 0.094). No significant difference was reported regarding clinical pregnancy (P = 0.943). Limitations, reasons for caution Wider implications of the findings Our results suggest a hopeful therapeutic protocol that may be used in such failed ART cases especially when no other reason can be found. But selecting which cases will benefit the most will need much further investigations. Trial registration number NCT03792997

中文翻译:

P-577 既往 NK 细胞总数高的失败 ART 患者的治疗方案:一项 RCT

研究问题 评估脂质乳剂、泼尼松龙和 LMWH 的联合治疗方案在高 NK 细胞的 ART 周期失败的情况下 总结答案 脂质乳剂、泼尼松龙和 LMWH 的联合治疗比单独的标准治疗具有更高的妊娠率,但不显着. 已知情况 许多研究人员已经证明,外周血 NK 细胞的高数量和/或细胞毒性与不孕症、复发性自然流产 (RSM) 和 ART 周期失败有关。许多研究表明,intralipid 具有抑制 NK 细胞活性的能力。众所周知,肠外脂肪乳剂在巨噬细胞中积累,从而改变许多免疫反应。因此,修改 T 助手 1/T 助手 2 的平衡以支持 T 助手 2 会增加植入机会。泼尼松龙具有免疫抑制和抗炎作用,已广泛用于自身免疫性疾病。泼尼松龙还能降低 RSM 中大量的 uNK。研究设计、规模、持续时间 这是一项前瞻性随机对照试验,涉及 100 例 ART 周期失败和高 NK 细胞的病例。2019 年 1 月至 2021 年 12 月 参与者/材料、设置、方法 100 例高 NK 细胞的 ART 失败病例分为 2 组:(对照组)(50 例)先前失败的 ART 周期将接受标准治疗(黄体酮、低剂量阿司匹林和叶酸 a.)。而另一组(干预组)(50 例)除了之前的方案之外还有:脂肪乳在胚胎移植前的周期开始,泼尼松龙从脂肪乳开始,LMWH 从 ET 主要结果当天开始,介入组(54.0%)化学妊娠的作用高于对照组(40.0%),但无统计学意义(P = 0.161)。此外,干预组的持续妊娠率(85.0%)高于对照组(60.0%),但无统计学意义(P = 0.094)。临床妊娠无显着差异(P = 0.943)。局限性,谨慎的理由 研究结果的更广泛意义 我们的结果表明了一种有希望的治疗方案,可用于此类失败的 ART 病例,尤其是在找不到其他原因的情况下。但选择哪些案件将受益最大将需要进一步调查。试用注册号NCT03792997 0%) 高于对照组 (40.0%) 但无统计学意义 (P = 0.161)。此外,干预组的持续妊娠率(85.0%)高于对照组(60.0%),但无统计学意义(P = 0.094)。临床妊娠无显着差异(P = 0.943)。局限性,谨慎的理由 研究结果的更广泛意义 我们的结果表明了一种有希望的治疗方案,可用于此类失败的 ART 病例,尤其是在找不到其他原因的情况下。但选择哪些案件将受益最大将需要进一步调查。试用注册号NCT03792997 0%) 高于对照组 (40.0%) 但无统计学意义 (P = 0.161)。此外,干预组的持续妊娠率(85.0%)高于对照组(60.0%),但无统计学意义(P = 0.094)。临床妊娠无显着差异(P = 0.943)。局限性,谨慎的理由 研究结果的更广泛意义 我们的结果表明了一种有希望的治疗方案,可用于此类失败的 ART 病例,尤其是在找不到其他原因的情况下。但选择哪些案件将受益最大将需要进一步调查。试用注册号NCT03792997 0%)但没有统计学意义(P = 0.094)。临床妊娠无显着差异(P = 0.943)。局限性,谨慎的理由 研究结果的更广泛意义 我们的结果表明了一种有希望的治疗方案,可用于此类失败的 ART 病例,尤其是在找不到其他原因的情况下。但选择哪些案件将受益最大将需要进一步调查。试用注册号NCT03792997 0%)但没有统计学意义(P = 0.094)。临床妊娠无显着差异(P = 0.943)。局限性,谨慎的理由 研究结果的更广泛意义 我们的结果表明了一种有希望的治疗方案,可用于此类失败的 ART 病例,尤其是在找不到其他原因的情况下。但选择哪些案件将受益最大将需要进一步调查。试用注册号NCT03792997
更新日期:2022-06-30
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