添加GnRH—a黄体支持的辅助生殖技术治疗后妊娠结局及子代随访结局分析  

Analysis of the follow-up results concerning pregnancy, delivery and infants after assisted reproductive technique with GnRH-a for luteal support

作　　者：周卫琴[1] 潘艳平[1] 庄燕燕[1] 夏飞[1] 茅彩萍[1] 

机构地区：[1]苏州大学附属第一医院生殖中心,215006

出　　处：《中华妇产科杂志》2016年第1期31-35,共5页Chinese Journal of Obstetrics and Gynecology

基　　金：江苏省重点妇幼保健项目（苏卫社妇[2012]37号）;江苏省妇幼健康科研项目（F201547）

摘　　要：目的统计在体外受精．胚胎移植中，添加促性腺激素释放激素激动剂（GnRH-a）黄体支持后获临床妊娠者的妊娠、分娩经过及出生子代的随访结局，分析添加GnRH—a的黄体支持对母儿安全性的影响。方法回顾性分析苏州大学附属第一医院2012年1月至2014年1月215个黄体期长方案新鲜周期移植后获临床妊娠的临床资料，根据黄体支持方法不同，分为黄体酮＋地屈孕酮组124例，添加GnRH—a组91例（在黄体酮＋地屈孕酮组的基础上于取卵后第6天加用1次曲普瑞林0．1mg）。随访患者的妊娠、分娩经过以及新生儿出生情况、子代出生后1—2年间生长发育情况。结果（1）黄体酮＋地屈孕酮组与添加GnRH—a组问在孕早期的流产率（8．1％、12．1％）、流产绒毛异常率（50．0％、9．1％）、异位妊娠率（10．5％、5．5％）、双胎率（19．4％、28．6％）分别比较，差异均无统计学意义（P〉0．05）。（2）在孕中晚期，染色体异常率、胎儿畸形率、死胎率、晚期流产率无论是以单胎妊娠还是双胎妊娠比较，两组间均未见明显差异（P〉0．05）。（3）在分娩期，双胎妊娠中，添加GnRH—a组较黄体酮＋地屈孕酮组有较高的早产率（60．0％、39．1％；P=0．041）和低出生体质量儿率（56．0％、34．8％；P=0．037）。（4）在出生后1～2年间随访，常见病罹患率、语言障碍率、智力低下率、身高异常率、体质量异常率无论是以单胎妊娠还是双胎妊娠比较，两组间均无显著差异（P〉0．05）。结论在控制移植胚胎数、减少双胎发生的基础上添加GnRH-a黄体支持可能是相对安全和有效的。Objective To investigate the results of follow-up visits of pregnancy course, delivery and infants of women who got clinically pregnant by assisted reproductive technique after gonadotropin-releasing hormone agonist （GnRH-a） added for luteal support, and to analyse the influence of adding GnRH-a in luteal support on lhe safety of mother and infant. Methods A retrospective analysis was carried out on the medical record from 215 patients who got clinically pregnant after luteal phase long regimen fresh-cycle transfer was operated. According to the differences in luteal support methods, the patients were assigned to Group A （124 patients, progesterone＋dydrogesterone group）, Group B （91 patients, GnRH-a added group）. The patients＇ pregnancy course, delivery time, and the growth and development of infants within 1-2 years were followed up. Results （ 1 ） There was no obvious difference between Group A and Group B in terms of the abortion ratio during the early pregnancy （8.1%, 12.1%）, the rate of abortion villous deformity （50.0%, 9.1%）, the rate of heterotopic pregnancy （10.5%, 5.5%） and rate of twin pregnancy （19.4%, 28.6%; all P〉0.05）. （2） Compared to group A, during the middle and late pregnancy of single or twin pregnancy in Group B , there was no obvious difference in the rate of fetal chromosomal abnormality, organ malformation incidence, late abortion rate and stillbirth rate （all P〉0.05）. （3） As to childbirth, in the case of twin pregnancy, there was a higher rate of premature delivery （60.0%, 39.1%; P=0.041）, as well as rate of lower birth weight of newborn （56.0%, 34.8%; P=0.037） in group B. （4） The statistics on general growth and development as well as infantile common diseases within 2 years after birth indicated that there was no obvious difference between the two groups in single birth and twin birth subgroup （all P〉0.05）. Conclusion On the basis of controlling of implanted embrycos and reducing the occurrence of twins, GnRH-a luteal

关 键 词：促性腺素释放激素 生殖技术 辅助 随访研究 早产 婴儿 出生时低体重 黄体支持 

分 类 号：R714.8[医药卫生—妇产科学]