醋酸加尼瑞克拮抗剂方案在多囊卵巢综合征患者体外受精-胚胎移植中的应用  

Efficacy of ganirelix in in vitro fertilization-embryo transfer of infertile patients with polycystic ovary syndrome

作　　者：王玮[1] 张信贤 郭影 罗卓野 郑嘉华[1] 许月明[1] 郝桂敏[1] Wang Wei;Zhang Xinxian;Guo Hng;Luo Zhuoye;Zheng Jiahua;Xu Yueming;Hao Guimin(Department of Reproductive Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Chin;Department of Reproductive Medicine, Shijiazhuang Maternity Hospital, Shijiazhuang 050000, Chin;Xingtai Infertility Specialist Hospital, Xingtai 054000, Chin)

机构地区：[1]河北医科大学第二医院生殖医学科,石家庄050000 [2]石家庄市妇产医院生殖中心,050000 [3]邢台不孕不育专科医院,054000

出　　处：《中华生殖与避孕杂志》2018年第3期206-209,共4页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨体外受精-胚胎移植(IVF-ET)助孕中更适合多囊卵巢综合征(PCOS)患者的治疗方案。方法回顾2012—2017年期间行IVF-ET助孕新鲜周期移植的PCOS患者,比较应用长方案(n=130)和拮抗剂方案(n=133)PCOS患者的临床资料和妊娠相关指标。结果患者年龄、不孕年限、体质量指数(BMI)值、取卵周期数和移植胚胎数差异均无统计学意义(P>0.05),垂体促性腺激素(Gn)总用量及Gn使用总时间,组间比较差异均有统计学意义(P<0.05),长方案组Gn总用量[(2 208.65±575.56)IU]较拮抗剂方案组多[(2 089.10±312.42)IU],Gn使用总时间长[(11.1±1.6)d,(10.6±1.5)d];长方案组患者的获卵数[14(2)]、扳机日血雌激素[(3 831.73±501.22)ng/L]大于拮抗剂组[13(1),(3 133.83±410.01)ng/L],并且较拮抗剂方案组有较高的卵巢过度刺激综合征(OHSS)发生率(3.8%,0.0%),且差异均有统计学意义(P<0.05);扳机日子宫内膜厚度、扳机日血孕激素、可移植胚胎比率、生化妊娠率、胚胎种植率、临床妊娠率差异均无统计学意义(P>0.05)。结论拮抗剂方案因无前期降调节过程,使药物注射时间缩短,患者经济负担减轻,依从性增加,且有较低OHSS发生率,更适合PCOS患者。Objective To provide insights into a suitable protocol in patients with polycystic ovary syndrome （PCOS） in in vitro fertilization-embryo transfer （IVF-ET）. Methods This study reviewed patients with PCOS who underwent IVF-ET from 2012 to 2017 in our hospital. The pregnancy and clinical data after matching were analyzed between the long GnRH agonist protocol （n=130） and antagonist protocol （n=133）. Results There were no significant differences in age, infertility, body mass index （BMI）, cycle number and number of transplanted embryos between the two groups （P〉0.05）. On the basis of this match, there was a significant difference in gonadotropin （Gn） usage and Gn used days between the two groups （P〈0.05）, that is, the total usage of Gn [（2 208.65± 575.56） IU] and Gn used days [（11.1±1.6） d] in the long GnRH agonist protocol was more and longer than those in the antagonist protocol [（2 089.10±312.42） IU, （10.6±1.5） d]. The number of ovaries [ 14 （2）] and blood estrogen [（831.73±501.22） ng/L] on trigger day in the long GnRH agonist protocol were higher than those in the antagonist protocol [13 （1）, （3 133.83±410.01） ng/L], and the long GnRH agonist protocol （3.8%） had a higher incidence of ovarian hyperstimulation syndrome （OHSS） than the antagonist protocol （0.0%）, and these diffenences were statistically significant （P〈0.05）. There was no significant difference in endometrial thickness and blood progesterone on trigger day, transplantable embryo ratio, biochemical pregnancy rate, embryo implantation rate and clinical pregnancy rate （P〉0.05）. Conclusion As the antagonist protocol without pre-adjustment process, it shortens the number of days of drug injection, increases patients＇ compliance and reduces the finacial burden of the patients. So the antagonist protocol has a lower incidence of OHSS and more suitable for PCOS patients.

关 键 词：多囊卵巢综合征(PCOS) 不孕症 体外受精-胚胎移植(TVF-ET) 拮抗剂 醋酸加尼瑞克 

分 类 号：R714.8[医药卫生—妇产科学] R711.75[医药卫生—临床医学]