黄体期长方案与拮抗剂方案在首次拮抗剂失败后PCOS患者中的应用比较  

Comparison of luteal phase long protocol and GnRH antagonist protocol in PCOS patients after the first antagonist failure cycle

作　　者：王田娟[1,2,3] 王超 邢琼[1,2,3] 徐玉萍 张文香[1,2,3] 周平[1,2,3] 许孝凤 魏兆莲[1,2,3] 曹云霞 Wang Tianjuan;Wang Chao;Xin Qiong;Xu Yuping;Zhang Wenxiang;Zhou Ping;Xu Xiaofeng;Wei Zhaolian;Cao Yunxia(Dept of Obstetrics and Gynecology,The First Affiliated Hospital of Anhui Medical University,Hefei 230032;NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract,Hefei 230032;Key Laboratory of Population Health Across Life Cycle,Ministry of Education of the People′s Republic of China,Hefei 230032)

机构地区：[1]安徽医科大学第一附属医院妇产科,合肥230032 [2]国家卫生健康委配子及生殖道异常研究重点实验室,合肥230032 [3]出生人口健康教育部重点实验室,合肥230032

出　　处：《安徽医科大学学报》2024年第6期976-982,共7页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金(编号:82271675);安徽医科大学基础与临床合作研究基金(编号:2021xkjT031)。

摘　　要：目的探讨首次拮抗剂治疗失败的多囊卵巢综合征(PCOS)患者再次超促排卵时分别采用黄体期长方案和拮抗剂方案诱导排卵的临床效果及妊娠结局的优劣。方法检索首次采用拮抗剂方案行IVF/ICSI-ET助孕失败后再次超促排卵的PCOS患者163例,根据第二次超促排卵方案,分为黄体期长方案组(共95例)和拮抗剂方案组(共68例)。回顾性分析比较两组患者的基础临床资料、临床及实验室指标及妊娠结局。结果①两组患者的基础临床指标除了LH,其他指标差异均无统计学意义。②黄体期长方案组患者自身超排卵对比,促性腺激素(Gn)启动剂量、Gn总天数、Gn总使用量、hCG注射日雌二醇(E_(2))值、获卵数、卵子成熟率、2PN受精数、2PN卵裂数、囊胚形成率、优质囊胚形成率显著高于首次拮抗剂周期(P<0.05)。拮抗剂方案组患者自身超排卵对比也观察到类似改善。③两组第二次超促排卵周期比较,黄体期长方案组Gn总天数、总用量、总费用较高(P<0.05),而hCG注射日E_(2)及LH水平、卵子成熟率显著低于拮抗剂方案(P<0.05),但两组间获卵数、2PN受精数、2PN卵裂数、囊胚形成率、OHSS率差异无统计学意义。④两组第二次超促排卵新鲜移植周期比较,黄体期长方案新鲜移植率、种植率、临床妊娠率及活产率略高,但差异无统计学意义。首次解冻周期的妊娠结局比较,拮抗剂组的生化妊娠率、临床妊娠率高于黄体期长方案组(P<0.05),但着床率、活产率、新生儿胎龄及出生体质量差异无统计学意义。结论对于首次拮抗剂方案治疗失败的患者,适当增加Gn启动剂量及用量,两种方案均能获得满意的妊娠结局。相较于黄体期长方案,再次使用拮抗剂方案保持了其优势,包括治疗周期短、成本低、患者依从性好。Objective To investigate the clinical effects and pregnancy outcomes of using luteal phase long protocol and GnRH antagonist protocol in patients with polycystic ovary syndrome(PCOS)who have failed their first GnRH antagonist protocol therapy.Methods The clinical data of 163 PCOS patients who underwent IVF/ICSI-ET were retrieved.After the failure of their first GnRH antagonist protocol treatment,they were divided into two groups in the second controlled ovarian hyperstimulation(COH)cycle:Luteal phase long protocol group(n=95)and GnRH antagonist protocol group(n=68).A retrospective analysis and comparison of basic clinical data,clinical and laboratory indicators,and pregnancy outcomes between two groups were conducted.Results①There was no statistically significant difference in basic clinical indicators between two group except LH.②Compared the first and second cycle treatments of patients in the luteal phase long protocol group,the initiation dose of gonadotropin(Gn),total number of Gn days,total Gn usage,estradiol(E_(2))on the day of hCG injection,number of retrieved eggs,oocyte maturation rate,2PN fertilization rate,2PN cleavage rate,blastocyst formation rate,high-quality blastocyst formation rate,and moderate to severe OHSS rate were significantly higher than those in the first GnRH antagonist cycle(P<0.05).The GnRH antagonist protocol group also showed similar improvements.③The comparison of the second COH cycle between two groups showed that the total number of Gn days,total Gn usage,and total Gn cost in the luteal phase long protocol group were significantly higher(P<0.05),while the E_(2) and LH on the day of hCG injection,and the maturation rate of eggs were significantly lower than those in the GnRH antagonist protocol group(P<0.05).However,there was no statistically significant difference in the number of retrieved eggs,2PN fertilization,2PN cleavage,blastocyst formation rate,high-quality blastocyst formation rate,and OHSS rate between the two groups;④The comparison of fresh transplantation cycle

关 键 词：多囊卵巢综合征 体外受精 黄体期长方案 拮抗剂方案 控制性促排卵 

分 类 号：R711.6[医药卫生—妇产科学]