晚卵泡期孕酮水平提前上升相关因素分析及其发生机制的新探讨  

Exploration of Factors and Mechanism of Serum Progesterone Level Rise on Late Follicular Phase

作　　者：郭悦[1] 杨菁[1] 蔡晶[1] 潘颖[1] 闫文杰[1] 

机构地区：[1]武汉大学人民医院生殖中心,武汉430060

出　　处：《生殖与避孕》2013年第7期456-462,共7页Reproduction and Contraception

摘　　要：目的:探讨晚卵泡期孕酮(P)水平上升对妊娠结局的影响,分析与P水平上升的相关因素并探讨其潜在机制。方法:回顾性分析1 083例IVF/ICSI患者的临床资料。根据hCG注射日血清P水平结合早发性LH峰将患者分为3组:低孕酮LH正常组(A组)、高孕酮LH正常组(B组)、高孕酮LH峰组(C组);根据hCG注射日卵泡数及E2水平将患者分为:卵巢正常反应组、卵巢高反应组。比较各组患者的临床特征、用药情况和妊娠结局。结果:P水平上升的最佳判断点为1.205 ng/ml。A、B和C组的临床妊娠率分别为51.0%、38.9%和28.6%(P=0.000),胚胎种植率分别为32.2%、24.9%和15.6%(P=0.001)。与A组相比,B和C组的Gn使用总量更高(P=0.000)、获卵数更多(P=0.000)。与B组相比,C组直径≥18 mm的卵泡数更少、E2水平更低、P水平上升更高,差异有统计学意义(P<0.05)。与卵巢正常反应组相比,卵巢高反应组同量用药情况下P水平上升更高。孕酮提前上升的相关因素为体质量指数(BMI)、基础FSH、hCG注射日最大卵泡直径、E2水平、Gn使用总量和Gn启动剂量。结论:晚卵泡期P水平提前上升不利于妊娠结局,但不影响卵母细胞及胚胎质量。卵巢自身反应性与FSH剂量是导致P水平提前上升的关键因素。Objective：To investigate the relationship between serumprogesterone（P） level on late follicular phase and pregnancy outcomes and to explore relevant factors and underlying mechanism of P level rise.Methods：Clinical data belonging to 1 083 women underwent IVF/ICSI were retrospectively analyzed.Patients were assigned to 3 groups according to serum P concentration on the day of human chorionic gonadotropin（hCG） administration and occurrence of premature LH surge：low P and LH surge negative group（group A）,high P and LH surge negative group（group B）,high P and LH surge group（group C）.The ovarian response was classified as intermediate or high according to the number of oocytes and estradiol（E 2） levels on hCG injection day.Clinical characteristics,treatment regimen and pregnancy outcomes were compared between each two groups.Results：Serum P concentration 1.205 ng/ml was the threshold which was set for an elevated P concentration.Clinical pregnancy rates were 28.6%（group C）,38.9%（group B） and 51.0%（group A）（P=0.000）.Implantation rates were 15.6%（group C）,24.9%（group B） and 32.2%（group A）（P=0.001）.Compared with group A,group B and group C had higher total dosage of Gn used（P=0.000）,more numbers of oocytes retrieved（P=0.000）.Group C had less number of follicles with diameter ≥ 18 mm,lower E 2 level and higher P level rise with statistical significances compared with group B.Increased P level rise was associated with high ovarian response under the same medication.Relevant factors of elevated P level were BMI,basal FSH,total follicle numbers and the largest follicle diameter on hCG injection day,E 2 level on hCG injection day,total dosage of Gn used and Gn starting dosage.Conclusion：Elevated P level on hCG injection day negatively influences pregnancy outcomes,but the detrimental effect seems to be unrelated to oocyte and embryo qualities.It is the ovarian response and FSH dosage that make serum P level rise.

关 键 词：孕酮 卵巢反应 体外受精-胚胎移植(IVF-ET) 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]