取卵后使用GnRH-拮抗剂联合米非司酮和来曲唑预防早发型中重度OHSS:一项随机对照研究  

Clinical effect of GnRH antagonist combined with letrozole and mifepristone in preventing early onset of moderate-severe OHSS post oocyte retrieval:a randomized controlled study

作　　者：夏旖 谢青贞[1] 张祎明 XIA Yi;XIE Qing-zhen;ZHANG Yi-ming(Center for Reproductive Medicine/Hubei Clinic Research Center for Assisted Reproductive Technology & Embryonic Development, Renmin Hospital of Wuhan University,Wuhan 430060)

机构地区：[1]武汉大学人民医院生殖医学中心/湖北省辅助生殖与胚胎发育医学临床研究中心

出　　处：《生殖医学杂志》2019年第7期734-739,共6页Journal of Reproductive Medicine

基　　金：湖北省卫生厅科研基金(WJ2019M181

摘　　要：目的研究取卵后卵巢过度刺激综合征(OHSS)高危患者在黄体期使用促性腺激素释放激素拮抗剂(GnRH-ant)联合米非司酮和来曲唑预防重度早发型OHSS的临床效果。方法2016年10月至2017年11月在我院生殖中心接受IVF/ICSI-ET过程中因有OHSS高风险行全胚冷冻的150例不孕女性,随机分为以下3组:联合用药组(同时联合使用GnRH-ant、米非司酮和来曲唑)、米非司酮组和来曲唑组。比较各组OHSS发生率、取卵后黄体期天数及性激素水平等。结果联合用药组中重度OHSS发生率显著低于米非司酮组(P<0.05)。联合用药组中重度OHSS发生率低于来曲唑组,但无显著性差异(P>0.05)。米非司酮组和来曲唑组之间OHSS的发生率的差异均无统计学意义(P>0.05)。联合用药组、米非司酮组、来曲唑组取卵后的黄体期分别为(7.66±2.44)d、(9.90±1.74)d、(8.74±1.31)d,3组间及两两比较均有显著性差异(P<0.05)。联合用药组D3、D5、D7的E2水平显著低于米非司酮组(P<0.05),来曲唑组D3、D5的E2水平显著低于米非司酮组(P<0.05)。组内比较结果显示,联合用药组和米非司酮组D5的E2水平显著高于D3(P<0.05)。联合用药组D7的孕酮(P)水平显著低于D3、D5(P<0.05),联合用药组D5的P水平显著高于D3(P<0.05),来曲唑组D7的P水平高于D3和D5,但差异无统计学意义(P>0.05);3组间比较各组间P水平均无显著差异(P>0.05)。3组间白细胞计数升高(WBC>15×109/L)、血细胞比容升高(HCT>41%)、肝酶升高(ALT>80U/L)比例、卵巢最大直径、胸/腹腔穿刺率及住院天数均无显著性差异(P>0.05)。结论全胚冷冻的OHSS高危患者在取卵后早期采用GnRH-ant联合米非司酮和来曲唑可以有效降低早发型中重度OHSS的发生率,缩短黄体期。Objective : To study the clinical effect of GnRH antagonist (GnRH-ant) combined with mifepristone and letrozole (LE) during luteal phase on prevention of early onset of moderate-severe ovarian hyperstimulation syndrome (OHSS) in high-risk patients after oocytes retrieval. Methods : A total of 150 infertile women underwent IVF/ICSI-ET with whole embryos frozen due to high risk of OHSS in our reproductive center from October 2016 to November 2017. They were randomly allocated into the following three groups: the combined treatment group (GnRH-ant combined with mifepristone and LE),mifepristone group and LE group,with 50 patients in each group. The incidence of OHSS,the duration of corpus luteum after oocyte retrieval and sex hormones levels,etc. were compared among the three groups. Results : The incidence of moderate-severe OHSS in combined treatment group was significantly lower than that in mifepristone group (46.0% vs. 72.0%, P <0.05),and slightly lower than that in LE group (46.0% vs. 58.0%, P >0.05). There was no significant difference in the incidence of OHSS between the mifepristone group and the letrozole group ( P >0.05). The duration of luteal phase after oocyte retrieval was (7.66±2.44),(9.90±1.74) and (8.74±1.31) days in the combined treatment group,mifepristone group and LE group respectively. There were significant differences among the 3 groups ( P <0.05). The E 2 levels on Day 3,Day 5 and Day 7 in the combined treatment group were significantly lower than those in the mifepristone group ( P <0.05),and the E 2 levels on Day 3 and Day 5 in LE group were also significantly lower than those in the mifepristone group ( P <0.05). The intra-group comparison showed that the E 2 level on Day 5 was significantly higher than that in Day 3 in the combination group and mifepristone group ( P <0.05). The progesterone (P) level on Day 7 was significantly lower than that on Day 3 and Day 5 in the combined treatment group ( P <0.05),but there was no significant difference in the LE group ( P >0.05). There was no

关 键 词：卵巢过度刺激综合征 促性腺激素释放激素拮抗剂 米非司酮 来曲唑 黄体溶解 

分 类 号：R711.6[医药卫生—妇产科学]