重度晚发型卵巢过度刺激综合征的临床特点及其对IVF-ET活产结局的影响  

Clinical characteristics of severe late-onset ovarian hyperstimulation syndrome and its impact on the live birth outcome of IVF-ET

作　　者：马晓伟[1] 尹婧雯 杨蕊[1] 杨硕[1] 李嘉[1] 王洋[1] 李蓉[1] Ma Xiaowei;Yin Jingwen;Yang Rui;Yang Shuo;Li Jia;Wang Yang;Li Rong(Department of Obstetrics and Gynecology,Peking University Third Hospital,National Clinical Research Center for Obstetrics and Gynecology,Beijing 100191,China)

机构地区：[1]北京大学第三医院妇产科国家妇产疾病临床医学研究中心,北京100191

出　　处：《中华妇产科杂志》2022年第9期678-685,共8页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金(81801447);北京大学第三医院青年孵育基金(BYSYFY2021048)。

摘　　要：目的探讨体外受精-胚胎移植(IVF-ET)治疗后妊娠的重度晚发型卵巢过度刺激综合征(OHSS)患者的不同临床特点与活产结局的相关性。方法回顾性分析2016年1月至2020年12月在北京大学第三医院经IVF-ET治疗后妊娠,其后因重度晚发型OHSS就诊且需住院治疗的330例患者的临床资料。根据妊娠结局分为活产组(n=287)和非活产组(n=43),进一步根据分娩孕周将活产组分为足月产组(n=222)和早产组(n=65)两个亚组,通过单因素和多因素分析明确活产和早产结局的影响因素。结果同期重度OHSS的总发生率为0.67%(673/100758)。330例重度晚发型OHSS患者中,42.4%(140/330)表现为胸水,肝功能异常发生率为69.4%(229/330),活产率为87.0%(287/330)。287例活产组患者中无胸水者占55.4%(159/287)、少量胸水者占18.5%(53/287)、中大量胸水者占26.1%(75/287),非活产组中无胸水者多于活产组、而少量胸水者少于活产组,两组比较,差异有统计学意义(χ^(2)=6.213,P=0.045);活产组的减胎率为16.0%(46/287),明显高于非活产组的2.3%(1/43),两组比较,差异有统计学意义(χ^(2)=5.749,P=0.017)。多因素logistic回归显示,肝功能中度异常(OR=3.15,95%CI为1.60~6.19)是活产的独立危险因素,而减胎(OR=0.13,95%CI为0.02~0.96)是活产的独立保护因素,亚组分析提示双胎分娩(OR=8.54,95%CI为4.31~16.91)是早产的独立危险因素。结论中度肝功能异常可能预示着重度晚发型OHSS患者的不良妊娠结局,在给予积极保肝对症治疗的同时,对于合并多胎妊娠者,建议积极减胎,尽量做到单胎妊娠,以提高活产率和足月分娩率、改善母儿预后。Objective To investigate the correlation between different clinical features and live birth in patients with severe late-onset ovarian hyperstimulation syndrome(OHSS)after in vitro fertilization-embryo transfer(IVF-ET).Methods The clinical information of 330 patients who were pregnant after IVF-ET and referred to medical treatments diagnosed as late-onset severe OHSS in Peking University Third Hospital from January 2016 to December 2020 was retrospectively analyzed.The patients were divided into live birth achieved group(n=287)and non-live birth achieved group(n=43)according to pregnancy outcomes,and live birth achieved group was further divided into two subgroups,full-term birth group(n=222)and early-term birth group(n=65)according to gestational week at delivery for better analysis.Single factor and multi-factor analysis were utilized to clarify the influencing factors of both live birth and early-term birth.Results Among all the patients who received IVF-ET,the incidence of severe OHSS was 0.67%(673/100758).Among 330 severe late-onset OHSS patients,42.4%(140/330)had pleural effusion,the incidence of abnormal liver function was 69.4%(229/330),and the live birth rate was 87.0%(287/330).Among the 287 patients who achieved live birth,55.4%(159/287)had no pleural effusion,18.5%(53/287)had a small amount of pleural effusion,and 26.1%(75/287)had medium or massive pleural effusion;in the non-live birth achieved group,there were more patients without pleural effusion and less patients with a small amount of pleural effusion;the difference was statistically significant(χ^(2)=6.213,P=0.045).The rate of selective fetal reduction in live birth achieved group was 16.0%(46/287),which was significantly higher than that in the non-live birth achieved group,which was 2.3%(1/43;χ^(2)=5.749,P=0.017).Multivariate logistic regression analysis revealed that moderately abnormal liver function was an independent risk factor for live birth(OR=3.15,95%CI:1.60-6.19),while selective fetal reduction was an independent protective factor f

关 键 词：卵巢过度刺激综合征 体外受精 胚胎移植 活产 

分 类 号：R714.8[医药卫生—妇产科学]