长效/短效GnRH激动剂长方案分别用于卵泡期/黄体期的临床效果比较  

Comparison of clinical outcomes between long-acting GnRH-a long protocol in follicular phase and short-acting GnRH-a long protocol in luteal phase

作　　者：胡琳莉[1] 代玮[1] 孙莹璞[1] 

机构地区：[1]郑州大学第一附属医院生殖医学中心,郑州450000

出　　处：《生殖医学杂志》2016年第10期919-925,共7页Journal of Reproductive Medicine

摘　　要：目的比较卵泡期长效促性腺激素释放激素激动剂（GnRH-a）长方案和黄体期短效GnRH-a长方案在体外受精-胚胎移植中的治疗结局。方法回顾性分析2015年5月~2016年2月在本院行体外受精-胚胎移植的患者5 197例,其中A组：卵泡期长效GnRH-a长方案2 395例,B组：短效GnRH-a长方案2 802例,比较两种方案的临床特征及结局。结果两组间bFSH[（7.01±2.33vs.7.20±2.34）U/L]、周期数（1.31±0.43vs.1.12±0.41）、rFSH总量[（1 672.55±521.84）vs.（1 829.33±741.08）U]、HMG总量[（938.59±909.14）vs.（207.38±364.85）U]、促性腺激素（Gn）天数[（13.89±2.48）vs.（11.64±1.84）d]、HCG日E2[（13 033±7 909）vs.（18 267±10 277）pmol/L]、P[（3.14±1.87）vs.（2.82±1.49）nmol/L]、LH[（1.05±1.51）vs.（1.55±0.85）U/L]、内膜厚度[（12.11±2.49）vs.（11.75±2.38）mm]、≥16mm卵泡数[（5.77±2.53）vs.（7.01±3.21）个],14-16mm卵泡数[（2.92±2.26vs.2.75±2.21）个]、12-13mm卵泡数[（2.92±2.29）vs.（2.1±1.91）个]、MⅡ卵泡数[（10.36±6.24）vs.（10.88±6.54）个]、2PN受精率（64.21%vs.67.22%）、优质胚胎率（67.66%vs.74.05%）、着床率（45.34%vs.37.68%）、临床妊娠率（63.72%vs.52.67%）、流产率（8.41%vs.11.55%）、宫外孕率（1.52%vs.3.30%）差异具有统计学意义（P〈0.05）,BMI、全胚冷冻率、取消率、获卵数、平均移植胚胎数、多胎率无显著性差异（P〉0.05）;按年龄分层分析后,各年龄组中A组着床率（年龄〈35岁组：49.98%vs.42.94%;年龄35-40岁组：38.57%vs.27.85%）;及妊娠率（年龄〈35岁组：70.00%vs.59.38%;年龄35~40岁组：57.14%vs.42.24%）;均显著高于B组（P〈0.05）。结论与黄体期短效长方案相比,卵泡期长效GnRH-a长方案能显著提高着床率及临床妊娠率。Objective：To compare clinical outcomes between long-acting GnRH agonist（GnRH-a）long protocol used in follicular phase and short-acting GnRH-a long protocol used in luteal phase for ovarian stimulation in IVF/ICSI cycles.Methods：The data of 5 197IVF/ICSI cycles from May 2015 to Feb.2016 were retrospectively analyzed.The cycles were divided into two groups：the patients in group A were used long-acting GnRH-a long protocol in follicular phase（n=2 395）,and the patients in group B were used short-acting GnRH-a long protocol in mid-luteal phase（n=2 802）.The clinical characters and outcomes were compared.Results：There were significant differences in amount of bFSH [（7.01±2.33）vs.（7.2±2.34）U/L],number of cycles（1.31±0.43 vs.1.12±0.41）,total dose of rFSH [（1 672.55±521.84）vs.（1 829.33±741.08）U],HMG [（938.59±909.14）vs.（207.38±364.85）U],gondotropin days（13.89±2.48 vs.11.64±1.84）;on HCG day,E2 [（13 033±7 909）vs.（18 267±10 277）pmol/L],LH [（1.05±1.51）vs.（1.55±0.85）U/L],progesterone [（3.14±1.87）vs.（2.82±1.49）nmol/L],endometrial thickness[（12.11±2.49）vs.（11.75±2.38）mm],number of follicles≥16 mm（5.77±2.53 vs.7.01±3.21）,number of follicles with 14-16mm（2.92±2.26 vs.2.75±2.21）,number of follicles with 12-13mm（2.92±2.29 vs.2.10±1.91）,number of MⅡfollicles（10.36±6.24 vs.10.88±6.54）;2PN fertility rate（64.21% vs.67.22%）,high quality embryo rate（67.66% vs.74.05%）,implantation rate（45.34% vs.37.68%）,clinical pregnancy rate（63.72% vs.52.67%）,miscarriage rate（8.41% vs.11.55%）,ectopic pregnancy rate（1.52%vs.3.30%）（all P〈0.05）.There were no significant differences in BMI,embryo frozen rate,cancel cycle rate,number of retrieved oocytes,number of embryo transferred,multiple pregnancy rate（P〈0.05）.After adjusted by age,the implantation rate（age〈35group：49.98% vs.42.94%,35-40group：38.57% vs.27.85%）and clinical pregnancy rate（age〈35group：70% vs.59.38%,35-40group：57.

关 键 词：促性腺激素释放激素激动剂 长方案 体外受精-胚胎移植 

分 类 号：R[医药卫生]