超生理剂量雌激素是新鲜胚胎移植单胎子代小于胎龄儿及低出生体质量的危险因素  

Superphysiological estradiol level is a risk factor of small for gestational age and low birth weight of fresh embryo transfer

作　　者：张俊韦 孙丽君[1] 杜明泽 李哲[1] 王璐璐 胡继君[1] 赵贝[1] 冯营营[1] Zhang Junwei;Sun Lijun;Du Mingze;Li Zhe;Wang Lulu;Hu Jijun;Zhao Bei;Feng Yingying(Reproductive Center of the Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)

机构地区：[1]郑州大学第三附属医院生殖医学中心,450052

出　　处：《中华生殖与避孕杂志》2019年第5期349-356,共8页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨人绒毛膜促性腺激素(hCG)注射日超生理剂量的血清雌二醇水平与小于胎龄儿(small for gestational age,SGA)及低出生体质量(low birth weight,LBW)的关系。方法回顾性队列分析2008年7月—2017年7月期间在郑州大学第三附属医院生殖医学中心行新鲜胚胎移植的卵巢反应正常并分娩单胎的年轻患者作为研究对象。根据hCG注射日血清雌二醇水平分组,A组:雌二醇≤2000 ng/L;B组:雌二醇2001~3000 ng/L;C组:雌二醇3001~4000 ng/L;D组:雌二醇4001~5000 ng/L;E组:雌二醇5001~6000 ng/L;F组:雌二醇>6000 ng/L,分析6组患者基础资料、临床及实验室数据,并以A组为参照组,分别计算其余各组SGA、LBW、极低出生体质量(very low birth weight,VLBW)、足月LBW、早产(preterm birth,PT)的比值比(odds ratio,OR)及95%置信区间(confidence interval,CI),并采用多因素逻辑回归,校正混杂因素[年龄、产次、体质量指数(body mass index,BMI)、不孕时间、不孕类型、不孕原因、hCG注射日子宫内膜厚度、助孕方式、移植胚胎阶段、移植胚胎个数、新生儿性别],比较不同组间上述观察指标校正后的OR值(adjusted odds ratio,aOR)。结果与A组相比,D组、E组、F组的SGA、LBW、足月LBW的发生率明显增加,差异均有统计学意义(P<0.001)。然而VLBW、PT的发生率随雌二醇水平的增长无明显变化(P=0.70;P=0.85)。经多因素逻辑回归分析校正混杂因素后,雌二醇≥ 4001 ng/L是SGA(D组aOR=1.69,95% CI=1.03~2.75,P=0.04;E组aOR=1.94,95% CI=1.12~3.36,P=0.02;F组aOR=2.31,95% CI=1.38~3.87,P<0.001)、LBW(D组aOR=1.95,95% CI=1.11~3.44,P=0.02;E组aOR=2.57,95% CI=1.38~4.78,P<0.001;F组aOR=3.36,95% CI=1.89~5.98,P<0.010)、足月LBW(D组aOR=5.36,95% CI=2.00~14.37,P<0.001;E组aOR=7.35,95% CI=2.64~20.49,P<0.001;F组aOR=12.02,95% CI=4.55~31.78,P<0.001)的独立危险因素。同时,BMI与SGA的发生率相关,即BMI较低的患者分娩SGA子代风险更大(aOR=0.88,95% CI=0.83~0.90,P<0.001)。结论超生理剂量Objective To investigate the relationship between supraphysiologic estradiol levels on the human chorionic gonadotropin (hCG) injection day and small for gestational age (SGA) and low birth weight (LBW). Methods It was a retrospective cohort study. Patients with singleton pregnancies with delivered after transfer of fresh embryos during the period of July 2008 to July 2017 at the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University were included. According to the serum estradiol level on the day of hCG trigger, we divided all patients into 6 groups. Group A: estradiol≤2000 ng/L (referent group), group B: estradiol 2001-3000 ng/L, group C: estradiol 3001-4000 ng/L, group D: estradiol 4001-5000 ng/L, group E: estradiol 5001-6000 ng/L, group F: estradiol>6000 ng/L. The outcome measures were SGA, LBW, very low birth weight (VLBW), preterm birth (PT) and full-term LBW. We compared the odds ratio (OR) of SGA, LBW, VLBW, PT and full-term LBW among the groups. Then multivariable logistic regression [age, parity, body mass index (BMI), infertility time, type of infertility, cause of infertility, endometrial thickness of hCG injection day, mode of assisted pregnancy, stage of embryo transfer, the number of transplanted embryos, the sex of the newborn] was used to analyze whether these outcome measures could be explained by the estradiol level on the hCG trigger day. Results Compared with group A, the incidence of SGA, LBW and term LBW in group D, group E and group F increased significantly. However, the incidence of VLBW and PT did not change significantly with the increase of estradiol levels (P=0.70, P=0.85). After adjusting for confounding factors by logistic regression analysis, estradiol ≥ 4001 ng/L was an independent risk factor for SGA (group D: aOR=1.69, 95% CI=1.03-2.75, P=0.04;group E: aOR=1.94, 95% CI=1.12-3.36, P=0.02;group F: aOR=2.31, 95% CI=1.38-3.87, P<0.001), LBW (group D: aOR=1.95, 95% CI=1.11-3.44, P=0.02;group E: aOR=2.57, 95% CI=1.38-4.78, P<0.001;group F: aOR=3.36, 95% CI=1

关 键 词：雌激素 小于胎龄儿 新鲜胚胎移植 低出生体质量 

分 类 号：R714.8[医药卫生—妇产科学]