糖皮质激素预处理对PCOS患者辅助生殖助孕结局的影响  

The effect of glucocorticoid pretreatment on the outcome of ART in PCOS patients

作　　者：郭钰英 戴芳芳 刘乾文 郑波 刘彦民 刘红 陶林林 GUO Yu-ying;DAI Fang-fang;LIU Qian-wen;ZHENG Bo;LIU Yan-min;LIU Hong;TAO Lin-lin(Xingtai Infertility Specialist Hospital,Xingtai 054000)

机构地区：[1]邢台不孕不育专科医院,邢台054000

出　　处：《生殖医学杂志》2024年第11期1423-1429,共7页Journal of Reproductive Medicine

基　　金：河北省卫生健康委科研基金项目(20221864)。

摘　　要：目的探讨糖皮质激素预处理对多囊卵巢综合征(PCOS)患者ART助孕结局的影响。方法回顾性分析2019年11月至2023年1月在我院生殖医学中心因PCOS不孕行IVF/ICSI-ET助孕患者的临床资料,共纳入符合条件的191例患者(共191个周期)。按照月经周期第2~5天检测的硫酸脱氢表雄酮(DHEAS)水平及预处理方式不同进行分组:DHEAS检测值200~450μg/dl、行口服避孕药(OC)联合糖皮质激素预处理的PCOS患者纳入A组(47例),DHEAS检测值200~450μg/dl、单纯使用OC预处理的PCOS患者纳入B组(67例),DHEAS检测值35~200μg/dl、单纯使用OC预处理的PCOS患者纳入C组(77例)。比较3组患者的一般资料、促排卵情况及鲜胚移植妊娠结局、新生儿体重等。结果3组PCOS患者中除A、B组的睾酮(T)、DHEAS水平显著高于C组(P<0.05)外,其它一般资料比较均无显著性差异(P>0.05)。A组的MⅡ卵率显著高于B组(83.59%vs.79.47%,P<0.05);3组间Gn天数、Gn总量、获卵数、卵裂数、可用胚胎数、移植日内膜厚度、移植胚胎数、囊胚移植占比及中重度卵巢过度刺激综合征(OHSS)发生率等比较均无显著性差异(P>0.05)。A组的流产率显著高于B组(28.00%vs.8.89%,P<0.05),A、C组的活产率均显著低于B组(36.17%、41.56%vs.58.21%,P<0.05),A组的子代活单胎出生体重显著高于B组[(3510.00±274.04)g vs.(3075.93±794.13)g,P<0.05];3组患者的临床妊娠率、种植率、宫外孕率、自然分娩率、活双胎出生体重等比较均无显著性差异(P>0.05)。结论PCOS患者行ART治疗时体内适宜的雄激素水平对助孕结局非常重要,DHEAS水平偏高的PCOS患者经糖皮质激素预处理后可提高促排卵成熟卵母细胞的比例,但糖皮质激素预处理对ART活产率的影响仍需进一步探讨。Objective:To explore the effect of glucocorticoid pretreatment on the outcome of ART in patients with PCOS.Methods:A retrospective analysis was conducted on PCOS patients who underwent IVF/ICSI-ET at the Reproductive Medicine Center of Xingtai Infertility Specialist Hospital from November 2019 to January 2023.A total of 191 eligible women were included.According to the levels of dehydroepiandrosterone sulfate(DHEAS)detected on the 2 nd to 5 th day of the menstrual cycle and different pretreatment methods,PCOS patients with DHEAS detection values ranging from 200 to 450μg/dl and treated with oral contraceptive(OC)combined with glucocorticoid were included in group A(47 cases),those with DHEAS detection values ranging from 200 to 450μg/dl and treated with OC alone were included in group B(67 cases),and PCOS patients with DHEAS detection values ranging from 35 to 200μg/dl and treated with OC alone were included in group C(77 cases).The basic characteristics,ovulation induction,clinical outcomes of fresh embryo transfer and the newborn birth weight were compared among the three groups.Results:Among the three groups of PCOS patients,except for the significantly higher levels of testosterone(T)and DHEAS in groups A and B compared to group C(P<0.05),there were no significant differences in other basic characteristics(P>0.05).The MⅡoocyte rate in group A was significantly higher than that in group B(83.59%vs.79.47%,P<0.05).There were no significant differences in the duration of gonadotropin(Gn)use,total Gn,the number of retrieved oocyte,the number of cleavage oocyte,the number of available embryo,endometrial thickness on the day of transfer,the number of transferred embryos,the proportion of blastocyst transfer and the incidence of mild to moderate OHSS among the three groups(P>0.05).The miscarriage rate in group A was significantly higher than that in group B(28.00%vs.8.89%,P<0.05),and the live birth rates in groups A and C were significantly lower than that in group B(36.17%,41.56%vs.58.21%,P<0.05).The birth weig

关 键 词：糖皮质激素 多囊卵巢综合征 硫酸脱氢表雄酮 临床结局 

分 类 号：R711.6[医药卫生—妇产科学]