年龄≤35岁行卵巢刺激患者迟发重度卵巢过度刺激综合征的最佳预测因子探析  

Identifying the best predictor of late-onset severe ovarian hyperstimulation syndrome in ≤35 years old women undergoing ovarian stimulation

作　　者：王慧慧[1] 陈夏珠 孙源[1] 王蕾[1] Wang Huihui;Chen Xiazhu;Sun Yuan;Wang Lei(Center for Reproductive Medicine,the Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China)

机构地区：[1]广州医科大学附属第三医院生殖医学中心,510150

出　　处：《中华生殖与避孕杂志》2020年第11期899-905,共7页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨迟发重度卵巢过度刺激综合征(OHSS)的最佳预测因子。方法采用回顾性队列研究分析了广州医科大学附属第三医院2017年12月至2018年12月期间年龄≤35岁患者1138个体外受精/卵胞质内单精子注射(IVF/ICSI)周期的临床数据。比较OHSS组和非OHSS组的妊娠周期。用单因素方差分析和χ2检验计算两组间的差异。采用多变量logistic回归分析确定预测迟发性OHSS的因素。受试者工作特征(ROC)曲线用于评价OHSS的预测因子。结果在≤35岁患者中,诊断为OHSS的妊娠周期中,基础窦卵泡数(AFC)(P=0.009)、人绒毛膜促性腺激素(hCG)注射日雌二醇水平(P<0.001)、获卵数(P=0.001)、可用胚胎数(P=0.016)、优质胚胎数(P=0.007)及孕囊数(P<0.001)均高于非OHSS妊娠周期。OHSS组的外源性卵泡刺激素(FSH)启动量(P=0.002)、总促性腺激素(Gn)使用量(P<0.001)和卵巢刺激时间(P=0.034)均低于非OHSS组。Logistic回归分析的结果显示:孕囊数(OR=2.408,95%CI=1.529~3.793,P<0.001)是迟发重度OHSS的独立预测因子。线性预测因子(lp)=孕囊数×0.879-3.946。孕囊数≥2个的病例相对于1个孕囊的病例发生OHSS的风险度RR值为2.25。结论在≤35岁患者中,孕囊数是迟发OHSS的独立预测因素。≥2个孕囊时,迟发性重度OHSS的发生率较高。Objective To identify the best predictor of late-onset severe ovarian hyperstimulation syndrome(OHSS)in≤35 years old women undergoing ovarian stimulation.Methods In this retrospective cohort study,the data from 1138 in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)cycles at the Third Affiliated Hospital of Guangzhou Medical University from December 2017 to December 2018 were analyzed.The pregnancy cycles were compared between OHSS group and non-OHSS group.The differences were calculated for two groups using one-way ANOVA and chi-squared test.Factors were identified to predict late onset OHSS using multivariable logistic regression.Receiver operating characteristic(ROC)curves were used to evaluate the predictors of OHSS.Results Antral follicle count(AFC)(P=0.009),estradiol levels on human chorionic gonadotropin(hCG)injection day(P<0.001),the number of oocytes retrieved(P=0.001),available embryos(P=0.016)and high-quality embryos(P=0.007)were higher,whereas,priming dosage of exogenous follicle-stimulating hormone(FSH)(P=0.002),total dosage of gonadotropin(Gn)used(P<0.001)and stimulation duration(P=0.034)were lower in OHSS group than in non-OHSS group.The number of gestational sacs was higher in OHSS group than in non-OHSS group(P<0.001).The number of gestational sacs(OR=2.408,95%CI=1.529-3.793,P<0.001)was found to be independent predictive factors of late onset OHSS in≤35 years old women.Linear predictor(lp)=number of gestational sacs×0.879-3.946.The risk ratio of OHSS was 2.25 for patients with the number of gestational sacs≥2 compared with those with 1 gestational sacs.Conclusion In≤35 years old women,the number of gestational sacs was the independent predictive factor of late-onset severe OHSS,which was higher when≥2 gestational sacs occurred.

关 键 词：卵巢过度刺激综合征 促性腺激素 获卵数 孕囊 妊娠 

分 类 号：R714.8[医药卫生—妇产科学]