联合使用地屈孕酮改善阴道微粒化黄体酮时低孕酮水平的不良围产结局  

Additional Dydrogesterone Use Improves the Adverse Perinatal Outcomes during Low Progesterone Levels by Use of Micronized Vaginal Progesterone Alone

作　　者：谢言信[1] 林海燕[1] 黄佳[1] 陈晓莉[1] 张清学[1] 李予[1] XIE Yan-xin;LIN Hai-yan;HUANG Jia;CHEN Xiao-li;ZHANG Qing-xue;LI Yu(Reproductive Center,Department of Obstetrics and Gynecology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510220,China)

机构地区：[1]中山大学孙逸仙纪念医院妇产科生殖中心,广州广东510220

出　　处：《中山大学学报（医学科学版）》2022年第5期837-844,共8页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家重点研发计划(2016YFC1000205);白求恩中青年医生优才培养计划-女性健康科研项目(X-J-2019-024)。

摘　　要：【目的】探索激素替代疗法(HRT-FET)周期中,单独使用阴道微粒化黄体酮(MVP)作为黄体支持时,血清低孕酮(P 4)水平对活产、胎龄和新生儿出生体质量的不良影响是否可通过联合口服地屈孕酮(DYG)得到改善。【方法】本研究分析了单独使用MVP的549个HRT-FET周期,并匹配年龄、血清P 4水平的同期联合使用MVP和DYG的495个周期。主要结果指标为活产率(LBR),次要结果为临床妊娠率(CPR)、孕周(GW)和新生儿出生体质量(BW)。【结果】验孕日孕酮P 4上升是获得活产的保护因素,单独使用MVP情况下,P 4水平<7.46 ng/mL与高P 4水平(≥7.46 ng/mL)相比,LBR(25.6%vs.40.7%,P<0.001),CPR(34.6%vs.50.1%,P<0.001)、足月分娩率(18.6%vs.32.6%,P=0.003)和新生儿正常出生体质量(normal birth weight,NBW)发生率(17.9%vs.34.4%,P<0.001)显著下降。与仅使用MVP组相比,虽然联合使用MVP和DYG并没有显著改善活产率(38.3%vs.40.6%,P=0.366),但显著延长新生儿分娩平均孕周[(37.28±3.01)周vs.(38.36±1.48)周;P=0.043],并提高新生儿NBW率(18.2%vs.27.6%;P=0.039),降极低出生体质量和低出生体质量儿(LBW+VLBW)的比例(7.7%vs.2.2%;P=0.037)。【结论】在单独使用MVP的HRT-FET周期中,低血清P 4水平(<7.46 ng/mL)时,活产率、足月分娩率、新生儿NBW率显著下降。在血清P 4浓度较低的情况下,联合使用DYG可显著延长新生儿分娩孕周,增加新生儿NBW率、降低新生儿LBW+VLBW比例,改善围产结局。【Objective】To explore whether the impact of low serum progesterone(P 4)levels on the adverse pregnancy outcomes could be improved by the additional use of oral dydrogesterone(DYG)during the single use of micronized vagi⁃nal progesterone(MVP)for luteal phase support in hormone replacement therapy frozen embryo transfer(HRT-FET)cy⁃cles.【Methods】In this retrospective study,the clinical and perinatal outcomes of HRT-FET cycles using MVP alone(n=549)and MVP combined with DYG(n=495)were analyzed.The primary outcome was live birth rate(LBR),and the sec⁃ondary outcomes were clinical pregnancy rate(CPR),gestational weeks(GW)at delivery,and perinatal birth weight(BW).【Results】The elevated serum P 4 level on the day of pregnancy test was a protective factor for live birth.In the group using MVP alone,compared with the high serum P 4 concentration(≥7.46 ng/mL),the low serum P 4 concentration(<7.46 ng/mL)was closely associated with low LBR(25.6%vs.40.7%,P<0.001),CPR(34.6%vs.50.1%,P<0.001),rates of full-term birth(FTB)(18.6%vs.32.6%,P=0.003)and normal birth weight(NBW)(17.9%vs.34.4%,P<0.001).Compared with the group using MVP alone,combined use of MVP and DYG did not significantly improve LBR(38.3%vs.40.6%,P=0.366),but significantly increased the mean GW at delivery(37.28±3.01 vs.38.36±1.48 weeks;P=0.043),the neonatal NBW rate(18.2%vs.27.6%;P=0.039)and decreased the proportion of low BW and very low BW(LBW+VLBW)infants(7.7%vs.2.2%;P=0.037).【Conclusion】Additional use of DYG could significantly increase the GW at de⁃livery and NBW rate,decrease the LBW+VLBW rates and thereby improve the adverse perinatal outcomes induced by low serum P 4 levels(<7.46 ng/mL)in the HRT-FET cycles using MVP alone.

关 键 词：孕酮 活产率 解冻胚胎移植 激素替代周期 

分 类 号：R711.6[医药卫生—妇产科学]