促排卵方案对不同分期子宫内膜异位症患者累积活产率的影响  

The effects of ovarian stimulation protocols on the cumulative live birth rates of endometriosis patients of different stages

作　　者：郑娟 刘琴 孙晶雪 蔡嘉力 任建枝 Zheng Juan;Liu Qin;Sun Jingxue;Cai Jiali;Ren Jianzhi(Center of Reproductive Medicine,73rd Group Army Hospital of PLA,Xiamen Fujian 361000,P.R.China)

机构地区：[1]中国人民解放军陆军第七十三集团军医院生殖中心,福建厦门361000

出　　处：《中国计划生育和妇产科》2024年第12期50-54,60,共6页Chinese Journal of Family Planning & Gynecotokology

基　　金：国家自然科学基金资助项目(项目编号:22176159);厦门市医学优势亚专科建设项目(项目编号:厦卫科教[2018]296号文);厦门市医疗卫生指导性项目(项目编号:3502Z20214ZD1189)。

摘　　要：目的探讨改良长方案和拮抗剂方案对不同分期子宫内膜异位症患者累积活产率的影响。方法回顾性分析中国人民解放军陆军第七十三集团军医院生殖中心2013年1月至2022年12月行体外受精/卵胞浆内单精子注射胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)治疗的子宫内膜异位症患者的临床资料,共2006个周期。根据子宫内膜异位症患者病情分为Ⅰ~Ⅱ期组和Ⅲ~Ⅳ期组,每组根据促排卵方案分为两个亚组。使用1∶1倾向性评分匹配(propensity score matching,PSM)两亚组患者基本情况并比较临床结局。采用多因素Logistic回归分析探讨子宫内膜异位症患者鲜胚移植累积活产率的影响因素。结果不同分期子宫内膜异位症患者匹配前后,改良长方案组累积活产率均较拮抗剂方案组显著升高,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,促排卵方案、年龄、不孕年限、窦卵泡数(antral follicle count,AFC)是子宫内膜异位症患者累积活产率的独立影响因素(P<0.05),而与其子宫内膜异位症分期无显著相关(P>0.05)。结论不同分期子宫内膜异位症患者使用改良长方案的累积活产率均较拮抗剂方案显著提高。Objective To investigate the impact of modified long protocol and antagonist protocol on cumulative live birth rates in patients with endometriosis of different stages.Methods Retrospective analysis the clinical data of patients with endometriosis who underwent in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)in the reproductive center of 73rd Group Army Hospital of PLA from January 2013 to December 2022,totally 2006 cycles were included.Patients were divided into two groups according to their endometriosis stage:stageⅠ~Ⅱgroup and stageⅢ~Ⅳgroup.Each group was subdivided into two subgroups based on the ovarian stimulation protocols.We utilized the propensity score matching(PSM)method to match the clinical characteristics of the two subgroups and analyzed the clinical outcome.Multivariate Logistic regression analysis was used to explore the factors affecting the cumulative live birth rate of fresh embryo transfer in endometriosis patients.Results The cumulative live birth rate in the modified long protocol group was significantly higher than that in the antagonist protocol group both before and after matching patients with endometriosis of different stages,and the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that ovarian stimulation protocols,female age,infertility duration,and antral follicle count(AFC)were the independent factors affecting the cumulative live birth rate of patients with endometriosis(P<0.05),while endometriosis stage was not significantly associated with it(P>0.05).Conclusion The cumulative live birth rates for patients with endometriosis at different stages,who used the modified long protocol,are significantly higher than those of patients who used the antagonist protocol.

关 键 词：子宫内膜异位症 促排卵方案 累积活产率 倾向性评分匹配 

分 类 号：R711.74[医药卫生—妇产科学]