不同剂量丙氨瑞林诱导排卵对黄体功能的影响  

Effects of different doses of alarelin for inducing ovulation on luteal function

作　　者：黎淑贞[1] 陈希曦[1] 李冬梅[1] 郭江华[1] 邓爱民[1] 陈晓燕[1] 

机构地区：[1]江门市中心医院生殖中心,529030

出　　处：《国际医药卫生导报》2012年第9期1222-1225,共4页International Medicine and Health Guidance News

摘　　要：目的探讨不同剂量的促性腺激素释放激素激动剂（gonadotropin releasing hormone—agonist．GnRHa）一丙氨瑞林诱发排卵后对黄体功能及妊娠率与流产率的影响，为临床使用最低有效剂量的丙氨瑞林提供理论依据。方法回顾分析本中心2011年3-11月进行促排卵治疗124例患者的临床资料；当患者优势卵泡直径≥18mm时，使用人绒毛膜促性腺激素（HCG）或不同剂量的丙氨瑞林促使卵泡排出（HCG日）。将患者随机分为三组：A组：43个治疗周期，使用HCG10000IU促进卵泡排卵；B组：38个治疗周期，使用丙氨瑞林450μg促使卵泡排卵；C组：43个治疗周期，使用丙氨瑞林150μg促使卵泡排卵。比较三组患者的HCG日及黄体中期的雌二醇（E2）、促黄体生成素（LH）、孕酮（P）以及排卵率、临床妊娠率、流产率、卵巢过度刺激综合征（ovarian hyperstimulation syndrome，OHSS）的发生率。结果B组黄体中期血清E2低于A组（P〈0．01），而排卵率高于A组（P〈0．05）和C组（P〈0．01），差异有统计学意义。A组排卯率也高于C组，差异有统计学意义（P〈0．05）。三组患者的年龄有统计学差异（P〈0．05）。三组间的子宫内膜厚度、HCG日的E2、LH、P，黄体中期的LH、P，临床妊娠率、流产率、中度OHSS发生率均无显著差异（P〉0．05）。结论使用丙氨瑞林150μg能有效诱导排卵，且对黄体中期甾体激素分泌无明显抑制作用。使用丙氨瑞林450μg诱导排卵，排卵率高，黄体期的E2显著下降，有利于降低OHSS的发生，黄体期补充外源性的雌孕激素，有利于提高妊娠率、降低流产率。Objective To explore the effects of different doses of gonadotropin releasing hormone agonist （ GnRH-a ） on luteal function and rates of pregnancy and abortion after ovulation induction and to provide theoretical support for clinical uses of the minimum effective dose of alarelin. Methods The clinical data on 124 women who received controlled ovarian stimulation （ COS ） during March 2011 to November 2011 were retrospectively analyzed. Human chorionic gonadotrophin（ HCG ） or different doses of GnRHa were used to induce ovulation as the diameter of dominate follicle was ≥18 mm. The women were randomly assigned to receive HCG of 10 000 IU for 43 cycles （ group A ）, alarelin of 450 μ g for 38 cycles （ group B ）, or alarelin of 150 μg for 43 cycles （ group C ）. Levels of estradiol, luteinizing hormone and progesterone on the day of induction and at mid-luteal phase, and rates of ovulation, clinical pregnancy, abortion, and OHSS were compared among the three groups. Results Serum E2 level at mid-luteal phase was significantly lower in group B than in group A （ P〈 0.01 ） while the ovulation rate was significantly higher in group B than in groups A and C （ P 〈 0.05 and P 〈 0.01 ） and it was higher in group A than in group C （ P 〈 0.05 ）. The age differed significantly among the three groups （ P 〈 0.05 ）. There were no significant differences among the three groups in endometrial thickness, serum levels of E2, LH, and P on the day of induction, levels of LH and P at mid-luteal phase, and rates of clinical pregnancy, abortion, and OHSS. Conclusions Alarelin of 150 μ g can effectively induces ovulation and has no obvious inhibitory effect on secretion of steroid hormone during mid-luteal phase. Alarelin of 450 μ g gains a higher ovulation rate but decreases E2 at mid-luteal phase, reducing the incidence of OHSS. Supplement of exogenous estrogen and progesterone at mid-luteal phase is beneficial for elevating pregnancy rate and lowering obortion rate.

关 键 词：促性腺激素释放激素类似物 诱导排卵 卵巢过度刺激综合症 人绒毛膜促性腺激素 

分 类 号：R96[医药卫生—药理学]