拮抗剂方案中应用GnRHa扳机与hCG扳机对妊娠结局的影响  

Effect of gonadotropin-releasing hormone agonist and human chorionic gonadotropin in gonadotropin-releasing hormone antagonist protocol on pregnancy outcome

作　　者：邢泽 焦娇[1] 孙弘昊 王秀霞[1] XING Ze;JIAO Jiao;SUN Honghao;WANG Xiuxia(Department of Obstetrics and Gynecology,Shengjing Hospital of China Medical University,Shenyang 110022,China)

机构地区：[1]中国医科大学附属盛京医院妇产科,沈阳110022

出　　处：《中国医科大学学报》2021年第1期34-39,共6页Journal of China Medical University

基　　金：辽宁省重点研发计划指导计划项目(2018225090)。

摘　　要：目的研究拮抗剂方案中应用促性腺激素释放激素激动剂(GnRHa)扳机与人绒毛膜促性腺激素(hCG)扳机对患者胚胎质量和妊娠结局的影响。方法本研究为前瞻性研究,选择于我院接受体外受精/卵胞浆内单精子注射(IVF/ICSI)助孕且采用拮抗剂方案促排卵的224例患者,根据扳机日采用的扳机方案分为2组:A组为GnRHa扳机组,使用达菲林0.2 mg进行扳机;B组为重组hCG扳机组,使用艾泽250μg进行扳机。2组患者取卵后新鲜周期行全部胚胎冻存。比较2组患者的双原核(2PN)数、2PN率、2PN卵裂数、2PN卵裂率、可移植胚胎数、优质胚胎数、培养囊胚数、囊胚形成数、囊胚形成率、首次复苏周期生化妊娠率、临床妊娠率、流产率和活产率。结果A组患者2PN数和2PN卵裂数显著高于B组,差异有统计学意义(P<0.05),但2组2PN率、2PN卵裂率、可移植胚胎数和优质胚胎数的差异无统计学意义(P>0.05)。A组患者培养囊胚数、囊胚形成数和囊胚形成率显著高于B组,差异有统计学意义(P<0.05)。A组患者生化妊娠率、临床妊娠率、活产率高于B组,流产率低于B组,但差异无统计学意义(P>0.05)。结论本研究中GnRHa扳机提高了患者的囊胚形成率,未降低患者生化妊娠率、临床妊娠率和活产率,且GnRHa扳机相较于重组hCG扳机更能保证患者的安全性,推断GnRHa可以作为临床一线扳机用药。Objective To explore the effect of gonadotropin-releasing hormone agonist(GnRHa)and human chorionic gonadotropin(hCG)as triggers in GnRH antagonist protocol on embryo quality and pregnancy outcomes.Methods In this prospective study,224 women who underwent GnRH antagonist protocol and in vitro fertilization/intracytoplasmic sperm injection were included.The patients were divided into two groups:group A,wherein patients were administered 0.2 mg Diphereline(GnRHa),and group B,wherein patients were administered 250μg Ovidrel(recombinant hCG).Both groups underwent fresh cycles and freeze-all cycles.The laboratory and clinical parameters from the two groups were evaluated and compared.Results The number of embryos that underwent 2 pronuclear(2PN)and 2PN cleavage in group A was significantly higher than that in group B(P<0.05);there were no significant difference in 2PN rate,2PN cleavage rate,and the numbers of transplantable embryos and high-quality embryos(P>0.05).The number of embryos that underwent cleavage for blastocyst formation,the number of blastocysts,and the rate of blastocyst formation were significantly higher in group A than those in group B(P<0.05).The biochemical pregnancy,clinical pregnancy,and live birth rates were higher and the miscarriage rate was lower in group A than in group B,but the differences were not statistically significant(P>0.05).Conclusion GnRHa can increase the rate of blastocyst formation without reducing the biochemical pregnancy,clinical pregnancy,and live birth rates.Compared with recombinant hCG,GnRHa can better ensure the safety of patients.GnRHa may be used as a clinical first-line trigger drug.

关 键 词：促性腺激素释放激素激动剂 体外受精 生化妊娠率 临床妊娠率 卵巢过度刺激综合征 

分 类 号：R711.6[医药卫生—妇产科学]