促性腺激素釋放激素拮抗劑預(yù)防中重度卵巢過度刺激綜合征的療效分析

曾誠+尚鶄+徐陽+賀占舉+單學(xué)敏+董朝彤+鄶艷榮+王晟+薛晴

【摘要】目的：探討促性腺激素釋放激素（GnRH）拮抗劑在預(yù)防IVF-ET過程中并發(fā)中重度OHSS的效果，旨在尋找預(yù)防中重度OHSS的有效措施。方法：回顧性分析我院生殖醫(yī)學(xué)中心2014年4月至2015年12月接受IVF-ET助孕，HCG日血清雌二醇（E2）>4000 pg/mL和/或獲卵數(shù)≥15個而取消新鮮胚胎移植行全胚冷凍的患者共102例。其中對照組在取卵后進行臨床觀察，共55例；思則凱組在取卵后第3d（D3）予GnRH拮抗劑思則凱0.25 mg，皮下注射，1次/d，共3d，共47例。計算輕、中、重度OHSS的發(fā)生率，對思則凱組和對照組住院患者的臨床資料進行分析。結(jié)果：思則凱組重度OHSS的發(fā)生率（6.4%）明顯低于對照組（21.8%， P=0.028）。思則凱組住院患者的住院率、住院天數(shù)、臨床指標(biāo)異常發(fā)生率（如血液濃縮、肝腎功能損害、卵巢大小及腹水量）、腹腔穿刺率均低于對照組住院患者。結(jié)論：在IVF-ET治療中，GnRH拮抗劑可以顯著降低中重度OHSS的發(fā)生，減少住院治療的幾率與時間，有效預(yù)防中重度OHSS。

【關(guān)鍵詞】 卵巢過度刺激綜合征； 體外受精-胚胎移植； 促性腺激素釋放激素拮抗劑

Research on the effect of GnRH antagonist in the prevention of ovarian hyperstimulation syndrome in IVFZENG Cheng1， SHANG Jing1， XU Yang1， HE Zhanju2， SHAN Xuemin1， DONG Zhaotong1， KUAI Yanrong1， WANG Sheng1， XUE Qing1△. 1.Department of Obstetrics and Gynecology， Peking University First Hospital， Beijing 100034， China； 2.Department of Urology， Peking University First Hospital， Beijing 100034， China

【Abstract】Objectives： To find effective measures in the prevention of OHSS， by investigating the therapeutic effects of gonadotropin-releasing hormone （GnRH） antagonist in the prevention of moderate to severe OHSS. Methods： A retrospective study was conducted. Fresh embryo transplantation was cancelled （the number of oocytes retrived ≥15， serum oestradiol level >4000 pg/ml on the day of HCG injected） in total 102 patients who subjected to IVF-ET. Control group （n=55） received clinical observation after oocyte retrieval， while GnRH antagonist group （n=47） were given cetrorelix of 0.25mg subcutaneously daily for 3 days. The incidence of mild， moderate and severe OHSS was surveyed and the clinical data of hospitalized patients in both groups were analyzed. Results： After administration of cetrorelix， the incidence of severe OHSS was much lower than the control group （P=0.028）. Meanwhile， the hospitalization rate， duration of hospitalization， clinical factors （such as blood concentration and blood coagulation， liver and kidney dysfuction， ovarian sizes and ascites） and abdominal paracentesis rate of the cetrorelix group were also lower than the control group. Conclusion： In IVE-ET treatment， GnRH antagonists can reduce the incidence of moderate and severe OHSS， reducing the hospitalization rate and duration of hospitalization. In conclusion， GnRH antagonist is an effective approach for the prevention of moderate and severe OHSS.

【Key words】Ovarian hyperstimulation syndrome （OHSS）； In vitro fertilization-embryo transfer （IVE-ET）； Gonadotropin - releasing hormone antagonist （GnRH antagonist）endprint

【中圖分類號】R711.75【文獻標(biāo)志碼】A

近年來，輔助生殖技術(shù)廣泛用于治療不孕患者，其安全性和有效性被逐步證實，但該技術(shù)的危險性及可能的并發(fā)癥需引起重視，特別是卵巢過度刺激綜合征（ovarian hyperstimulation syndrome，OHSS）。OHSS是控制性促排卵（controlled ovarian hyperstimulation，COH）患者常發(fā)生的醫(yī)源性疾病，其病理生理過程被認為是促排卵后血管完整性受損，卵巢釋放的血管活性因子導(dǎo)致體腔毛細血管的通透性增加，進而體液向第三體腔轉(zhuǎn)移，形成胸水和腹水；血管……