以每取卵周期累积活产率评价拮抗剂方案与PPOS方案在波塞冬标准低预后患者的临床效果:一项回顾性队列研究  

Evaluation of the clinical effects of antagonist protocol and progestin-primed ovarian stimulation protocol in patients with low prognosis according to POSEIDON criteria by cumulative live birth rate per oocyte extraction cycle:a retrospective cohort study

作　　者：张少娣[1] 尹轶莎 李秋圆 张翠莲[1] Zhang Shaodi;Yin Yisha;Li Qiuyuan;Zhang Cuilian(The Reproductive Medicine Center,Henan Provincial People's Hospital(People's Hospital of Henan University),Zhengzhou 450003,China)

机构地区：[1]河南省人民医院(河南大学人民医院)生殖医学中心,郑州450003

出　　处：《中华生殖与避孕杂志》2022年第1期9-16,共8页Chinese Journal of Reproduction and Contraception

基　　金：国家重点研发计划(2018YFC1002106)。

摘　　要：目的以评价拮抗剂方案和高孕激素状态下促排卵(progestin-primed ovarian stimulation,PPOS)方案在低预后患者中的临床效果。方法回顾性队列研究分析2016年1月至2018年12月期间在河南省人民医院生殖医学中心接受体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)助孕,符合波塞冬低预后诊断标准并采用拮抗剂方案或PPOS方案治疗的不孕症患者1419名,共1560个取卵周期。比较拮抗剂方案组和PPOS方案组患者基线特征、临床指标、实验室指标及临床结局。通过多因素logistic回归分析调整混杂因素后分析两种促排卵方案的每取卵周期累积活产率。结果一般情况比较显示,拮抗剂方案组中患者抗苗勒管激素(anti-Müllerian hormone,AMH)和窦卵泡计数(antral follicle count,AFC)显著高于PPOS方案组[1.45(0.68,3.28)μg/L比1.10(0.55,2.71)μg/L,P=0.002;7.00(4.00,11.00)μg/L比6.00(3.00,9.00)μg/L,P=0.010],基础卵泡刺激素(follicle-stimulating hormone,FSH)显著低于PPOS方案组患者[7.65(6.26,9.99)U/L比7.88(6.29,10.58)U/L,P=0.007]。实验室结局及临床结局指标显示,拮抗剂方案组人绒毛膜促性腺激素(human chorionic hormone,hCG)注射日雌二醇水平[726.20(415.30,1095.00)ng/L]显著低于PPOS方案组[738.00(412.55,1187.75)ng/L,P=0.028],hCG注射日子宫内膜厚度[(9.31±2.67)mm]、每取卵周期累积妊娠率[49.35%(379/768)]及每取卵周期累积活产率[38.04%(291/765)]显著高于PPOS方案组[(6.81±2.26)mm,P<0.001;37.62%(298/792),P<0.001;26.08%(206/790),P<0.001],差异均有统计学意义。调整混杂因素后,在波塞冬标准低预后患者中拮抗剂方案组的每取卵周期累积妊娠率(OR=1.58,95%CI=1.24~2.01,P<0.001)及每取卵周期累积活产率(OR=1.68,95%CI=1.30~2.17,P<0.001)均显著高于PPOS方案组;分层分析结果显示,在不同变量分层中,拮抗剂方案的每取卵周期累积妊娠率及每取卵周期�Objective To evaluate the clinical effects of antagonist protocol and progestin-primed ovarian stimulation(PPOS)protocol in patients with low prognosis.Methods A total of 1560 controlled ovarian stimulation cycles of 1419 patients consistent with POSEIDON low prognosis with antagonist protocol or PPOS protocol in the treatment of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)from January 2016 to December 2018 in the Reproductive Medicine Center of Henan Provincial People's Hospital were collected in a retrospective cohort study.The essential characteristic,clinical characteristics,laboratory index and clinical outcomes of patients in the antagonist protocol group and the PPOS protocol group were compared.Multivariate logistic regression analysis was used to compare cumulative live rate per ovulation cycle after adjusting for confounders of the two controlled ovarian stimulation protocols.Results The comparison of the general conditions of the patients with the two controlled ovarian stimulation protocols showed that anti-Müllerian hormone(AMH)[1.45(0.68,3.28)μg/L]and antral follicle count(AFC)[7.00(4.00,11.00)μg/L]in the antagonist protocol group were significantly higher than those in the PPOS protocol group[1.10(0.55,2.71)μg/L,P=0.002;6.00(3.00,9.00)μg/L,P=0.010],and basal follicle-stimulating hormone(FSH)[7.65(6.26,9.99)U/L]was significantly lower than that in the PPOS protocol group[7.88(6.29,10.58)U/L,P=0.007].The results of laboratory and clinical outcomes showed that the estrogen level[726.20(415.30,1095.00)ng/L]on human chorionic hormone(hCG)injection day in the antagonist protocol group was significantly lower than that in the PPOS protocol group[738.00(412.55,1187.75)ng/L,P=0.028],and the endometrial thickness[(9.31±2.67)mm]on hCG injection day,the cumulative pregnancy rate[49.35%(379/768)]and the cumulative live birth rate per ovulation cycle[38.04%(291/765)]were significantly higher than those in the PPOS protocol group[(6.81±2.26)mm,P<0.001;37.62%(298/792)

关 键 词：受精 体外 胚胎移植 累积活产率 波塞冬标准 

分 类 号：R714.8[医药卫生—妇产科学]