GnRH诱发的卵巢过度刺激对胚胎着床的影响  

Effects of GnRH-induced ovarian hyperstimulation on embryo implantation

作　　者：沈兰 陈春华[1] 叶冬云 南方[1] SHEN Lan;CHEN Chunhua;YE Dongyun;NAN Fang(Department of Obstetrics and Gynecology,Ezhou Central Hospital,Ezhou 436000,Hubei,China)

机构地区：[1]鄂州市中心医院妇产科,湖北鄂州436000

出　　处：《中国性科学》2020年第4期35-39,共5页Chinese Journal of Human Sexuality

摘　　要：目的探究促性腺激素释放激素(GnRH)诱发的卵巢过度刺激对胚胎着床的影响。方法选取2016年3月至2019年1月鄂州市中心医院诊治的98例进行体外受精-胚胎移植方案进行促成怀孕的患者作为研究对象。根据OHSS分级标准分组,轻度组(n=37),症状恶心,呕吐,腹泻;中度组(n=35),超声检查确定有腹水,胸水;重度组(n=26),血黏度增加,低血容量,尿少。通过超促排卵对女性进行促排卵药物辅助处理;体外受精并记录受精卵数量及质量,记录胚胎发育良好情况,比对各组临床妊娠率及流产率;记录各组患者在进行体外受精-胚胎移植方案身体各项相关激素指标;采用RT-qPCR测定人体中炎症因子IL-2、IL-6和TNF-α的mRNA表达量。结果重度组炎症因子IL-2(3.68±0.54)、IL-6(3.79±0.52)和TNF-α(3.48±0.27)mRNA较中度组(2.78±0.25,2.34±0.14,2.59±0.35)高,中度组较轻度组(1.25±0.16,1.05±0.02,1.44±0.23)mRNA表达升高,差异具有统计学意义(P<0.05);AMH和E2水平检测上自我行为评分发现,重度组(5.89±1.35,5867.88±1826.34)与中度组(4.43±1.57,3328.56±1237.44)比较升高,差异具有统计学意义(P<0.05),中度组较轻度组(2.76±1.68,436.25±114.62)表达升高,差异具有统计学意义(P<0.05)。P水平和基础LH水平含量上重度组较中度组降低,中度组较轻度组降低,差异具有统计学意义(P<0.05)。胚胎着床率、临床妊娠率和流产率比较上,重度组较轻度组、中度组升高,差异具有统计学意义(P<0.05)。结论 GnRH在超促排卵的同时会引起OHSS,造成患者卵巢增大恶心腹痛腹积水等不适,同时会降低胚胎着床率及临床妊娠率,增加患者的流产风险。Objective To study the effect of gonadotropin-releasing hormone(GnRH)-induced ovarian hyperstimulation on embryo implantation. Methods From March 2016 to January 2019, 98 patients who underwent in vitro fertilization-embryo transfer in our hospital were grouped according to the grading criteria for ovarian hyperstimulation syndrome(OHSS), which were mild group(symptoms of nausea, vomiting, diarrhea, n=37), moderate group(ultrasound examination confirmed ascites, pleural effusion, n=35) and severe group(increased blood viscosity, hypovolemia, oliguria, n=26). Ovarian stimulation was used to assist women in ovulation induction;in vitro fertilization was performed and the number and quality of fertilized eggs and the development of the embryo was recorded;the clinical pregnancy rate and abortion rate of each group was compared;the related hormone indicators of patients were recorded and the mRNA expression levels of inflammatory factors 1 L-2, L-6 and TNF-α were detected by RT-qPCR. Results The expression levels of inflammatory factors of 1 L-2, L-6 and TNF-α RNA in the severe group(3.68±0.54, 3.79±0.52, 3.48±0.27) were higher than those in the moderate group(2.78±0.25, 2.34±0.14, 2.59±0.35), which were higher than those in the mild group(1.25±0.16, 1.05±0.02, 1.44±0.23), all with statistically significant differences(P<0.05). The self-behavior scores of AMH and E2 levels were found to be higher in the severe group(5.89± 1.35, 5586.88±1826.34) than those in the moderate group(4.43±1.57, 3238.56±1237.44), which were higher than those in the mild group(2.76± 1.68, 436.25±114.62), all with statistically significant differences(P<0.05). The P level and the basic LH level were the highest in the mild group and lowest in the severe group, with statistically significant differences among the three groups(P<0.05). The embryo implantation rate, clinical pregnancy rate and abortion rate in the severe group was higher than that in the mild group and the moderate group, with statistically significant difference

关 键 词：促性腺激素释放激素 体外受精-胚胎移植 胚胎着床 卵巢过度刺激综合症 临床路径 

分 类 号：R714[医药卫生—妇产科学]