自发性卵巢过度刺激综合征68例临床分析  

Clinical analysis of 68 cases of spontaneous ovarian hyperstimulation syndrome

作　　者：葛蓓蕾 郑真真 朱一萍 隋孟松 吉梅 张彦丽 孙静 Ge Beilei;Zheng Zhenzhen;Zhu Yiping(First Maternal and Infant Hospital Affiliated to Tongji University,Shanghai 200126)

机构地区：[1]同济大学附属第一妇婴保健院,上海200126

出　　处：《现代妇产科进展》2022年第11期833-837,共5页Progress in Obstetrics and Gynecology

基　　金：上海科委(No:22Y11906100);上海市领军人才项目(2019年);申康SHDC(No:12019113)。

摘　　要：目的:分析自发性卵巢过度刺激征(sOHSS)患者的发病病因和妊娠结局,探讨其诊治流程。方法:Pubmed检索近30年文献,共收集sOHSS患者68例,分析患者的发病率、发病原因、发病孕周、妊娠结局等。结果:68例sOHSS病例中,孕产期发病55例(81%),非孕产期13例(19%)。合并甲减14例;受体突变8例,其中FSHR突变7例,HCG/LH受体突变1例;分泌促性腺激素肿瘤7例;滋养细胞疾病4例。55例孕产期合并sOHSS病例中,44例发生孕周<14周(80%),≥14孕周者仅占12.7%,产后sOHSS发生率约为7.3%。7例孕周≥14周的晚发病例中,2例葡萄胎,2例甲减,其余3例无明显诱发因素。产后发病者共4例,其中葡萄胎1例,滋养叶细胞肿瘤1例,1例早产后,1例流产后。孕期合并sOHSS的妊娠并发症发生率约20%(11/55),34例分娩约占61.8%(34/55)。疾病的家族聚集性约8.8%,复发率2.9%。结论:sOHSS病例中约半数无明确病因,病因中最常见的是甲减。妊娠合并sOHSS多发生于早孕阶段,胚胎丢失率较高,对母体的影响小于胎儿。疾病有一定的复发性和家族聚集性。Objective:To analyze the etiology and pregnancy outcome in the cases of spontaneous ovarian hyperstimulation(sOHSS),and to explore the diagnostic algorithm.Methods:A search of Pubmed collected a total of 68 cases with sOHSS in the past 30 years and analyzed the morbidity,pathogenesis,gestational age and pregnancy outcome of all cases.Results:Among the 68 cases of sOHSS,55 cases(81%)developed during pregnant and puer-peral period and 13 cases(19%)during non-pregnancy.14 cases were complicated with hypothyroidism.There were 8 receptor mutations among which 7 cases were FSHR mutations,only 1 case of HCG/LH receptor mutation.There were 7 cases of gonadotropin-secreting tumors and 4 cases of trophoblast disease.Among the 55 cases of sOHSS during pregnant and puer-peral period,44 cases occurred at gestational age less than 14 weeks(80%),and only 12.7%occurred at gestational age of 14 weeks or more.The incidence of postpartum sOHSS was about 7.3%.Among the 7 late onset cases with gestational age of 14 weeks or more:2 cases hydatidiform mole;2 cases hypothyroidism;no cause was identifified in the remaining 4 cases.There were 4 postnatal cases:1 case hydatidiform mole,1 case trophoblastic tumor,1 case preterm birth and 1 case abortion.The incidence of pregnancy complications in sOHSS was about 20%(11/55).34 cases(61.8%,33/55)can reach delivery.The familial clustering of the disease in this study was about 8.8%and the recurrence rate was 2.9%.Conclusion:Half of cases had no clear etiology.Among the cases with clear inducing factors,hypothyroidism was the most common.Most of cases combined with pregnancy occurred at early gestation age.sOHSS during pregnancy had a higher rate of embryo loss,which had less impact on the mother than the fetus.sOHSS had certain recurrence and familial clustering.

关 键 词：自发性卵巢过度刺激征 发病病因 妊娠结局 诊治流程 

分 类 号：R711.75[医药卫生—妇产科学]