非多囊卵巢综合征患者控制性促排卵过程中卵巢高反应的预测指标探讨  

The discussion of predictive factors of high ovarian response of the non-polycystic ovary syndrome patients in the course of the controlled ovarian stimulation

作　　者：以善佳 陈正勤[1] 滕若冰[1] 姚军[1] 何丽霞[1] 金昌博 胡妍[1] 李曼[1] YI Shan-jia;CHEN Zheng-qin;TENG Ruo-bing;YAO Jun;HE Li-xia;JIN Chang-bo;HU Yan;LI Man(Reproductive Medicine Center,The Affiliated Hospital of Guilin Medical University,Guilin 541001,China)

机构地区：[1]桂林医学院附属医院生殖医学中心,541001

出　　处：《妇产与遗传（电子版）》2018年第4期11-16,共6页Obstetrics-Gynecology and Genetics (Electronic Edition)

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(编号:Z20170859)

摘　　要：目的探讨非多囊卵巢综合征患者在体外受精控制性促排卵过程中预测卵巢高反应的临床指标。方法对96例非多囊卵巢综合征的不孕症患者进行回顾性分析,分为卵巢高反应组(43例)及卵巢正常反应组(53例)。两组患者均接受黄体期长方案体外受精治疗。比较两组患者的一般情况、促性腺激素用量、控制性促排卵中的临床指标,探讨其与卵巢高反应的关系。结果与正常反应组相比,高反应组体重指数、促性腺激素起始量及促性腺激素总量明显降低,而基础促黄体生成素/促卵泡生成素、控制性促排卵第4日雌二醇、控制性促排卵第6日E2、控制性促排卵第7日E2、控制性促排卵第7日直径≥8 mm卵泡个数、控制性促排卵第7日直径≥10 mm卵泡个数、人绒毛膜促性腺激素注射日E2、获卵数、受精数及正常受精数均明显升高;相关性分析发现,控制性促排卵第4日E2、控制性促排卵第6日E2、控制性促排卵第7日E2、控制性促排卵第7日直径≥8 mm卵泡个数、控制性促排卵第7日直径≥10 mm卵泡个数与人体绒膜促性腺激素日E2和获卵数呈正相关;受试者工作特征曲线示:控制性促排卵第4日E2、控制性促排卵第6日E2、控制性促排卵第7日E2、控制性促排卵第7日直径≥8 mm卵泡个数、控制性促排卵第7日直径≥10 mm卵泡个数与卵巢高反应均具有相关性,最佳临界点分别为:664. 10 pmol/L、3 732 pmol/L、7 348 pmol/L、14. 5个和10. 5个。结论控制性促排卵过程中第4日E2、第6日E2、第7日E2、第7日直径≥8 mm卵泡个数、第7日直径≥10 mm卵泡个数在一定程度上可预测卵巢高反应。Objective To discuss the predictive factors of high ovarian response of the non-polycystic ovary syndrome(non-PCOS)patients in the course of the controlled ovarian stimulation(COS)of in-vitro fertilization(IVF).Methods A retrospective analysis of 96 infertility and non-PCOS patients who received IVF treatment by the way of the conventional luteal phase long protocol.The patients were divided into high ovarian response group(n=43)and normal ovarian response group(n=53).The general conditions,the dosage of gonadotropin(Gn)and the clinical indexs of the two groups were compared,and discussd the relationships between clinical indexs and the high ovarian response.Results Compared to normal ovarian response group,high ovarian response group had lower body mass index(BMI),starting dosage and total amount of Gn,and had higher basis of luteinizing hormone/follicle stimulating hormone(bLH/FSH),COS day 4 estradiol(E2),COS day 6 E2,COS day 7 E2,COS day 7 follicals with diameter≥8 mm,COS day 7 follicals with diameter≥10 mm,E2 on the day injecting human chorionic gonadatropin(HCG),number of eggs,mature eggs and fertilized eggs.By Spearman correlation,COS day 4 estradiol(E2),COS day 6 E2,COS day 7 E2,COS day 7 follicals with diameter≥8 mm and COS day 7 follicals with diameter≥10 mm was positively correlated with E2 on the day injecting HCG and number of eggs;ROC curve analysis showed that COS day 4 E2,COS day 6 E2,COS day 7 E2,COS day 7 follicals with diameter≥8 mm and COS day 7 follicals with diameter≥10 mm were correlated with high ovarian response,the cut-off value were 664.10 pmol/L,3 732 pmol/L,7 348 pmol/L,14.5 and 10.5,respectively.Conclusions COS day 4 E2,COS day 6 E2,COS day 7 E2,COS day 7 follicals with diameter≥8 mm and COS day 7 follicals with diameter≥10 mm could be to predict high ovarian response in a certain extent.

关 键 词：卵巢高反应 控制性促排卵 预测指标 

分 类 号：R714.8[医药卫生—妇产科学]