辅助生殖技术中卵巢过度刺激综合征发生发展预测指标的研究  

Study of predictive parameters of patients with ovarian hyperstimulation syndrome developed during assisted reproductive technique.

作　　者：李志凌[1] 林虹[1] 肖婉芬[1] 王玉莲[1] 

机构地区：[1]汕头大学医学院第一附属医院生殖中心,515041

出　　处：《中国实用妇科与产科杂志》2004年第3期161-163,共3页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：广东省科技计划项目资助课题 ( 2 0 0 3C3 40 0 5 );广东省医学科研基金资助课题 (A2 0 0 3 494)

摘　　要：目的　寻找辅助生殖技术 (ART)中卵巢过度刺激综合征 (OHSS)发生发展的预测指标。方法　比较1998～ 2 0 0 3年ART治疗后 4 5例OHSS和 4 0例非OHSS患者的妊娠结局 ;并根据OHSS发生时间分早发、晚发两组 ,比较组间特征和实验室资料 ,回归分析筛查OHSS发生发展预测指标。结果　HCG注射后发生OHSS的平均时间为 (9 3± 4 7)d。早发组 (尤合并妊娠者 )比晚发组年轻、促性腺激素用量少、多囊卵巢病例多、HCG注射日中小卵泡评分高 ,差异有显著性意义。回归分析发现 :仅中小卵泡评分与OHSS发生时间相关 ;用中小卵泡评分 >2 0分预测早发组OHSS发生的阳性、阴性预测值 ,敏感性、特异性分别为 90 0 %、92 0 %、81 8%、95 8%。OHSS持续时间与是否妊娠或多胎妊娠有关 ,用OHSS持续时间 >7d、≤ 7d、≥ 12d可分别预测早发组妊娠、晚发组未孕和多胎妊娠。结论　早发OHSS与卵巢对外源性HCG过度反应有关 ,HCG日中小卵泡评分可预测OHSS的发生 ;晚发OHSS更多与胚胎种植后产生的内源性HCG有关 。Objective To identify the predictive parameters of patients with ovarian hyperstimulation syndrome developed during assisted reproductive technique(ART).Methods The pregnancy outcomes were compared between 45 cases of OHSS and 40 non-OHSS.Then the OHSS group was divided into early and late OHSS according to the onset time of OHSS.We compared patient's characteristics and laboratory data,and selected the predictive parameters related to OHSS onset and development by logistic regression.Results OHSS occurred (9^3±4^7)days after the administration of HCG.Early OHSS(especially complicated pregnancy)occurred to younger patients with fewer gonadotropin requirements,higher polycystic ovaries and middle and small follicular score(MSFS)on the day of HCG than that of late OHSS.There were associations between MSFS and the onset time of OHSS.The sensitivity,specificity,positive and negative values of predictive value on onset of early OHSS by MSFS exceeding 20 were 90^0%,92^0%,81^8%,95^8%,respectively.The duration of OHSS >7 days,≤7 days,≥12 days could predict pregnancy in early OHSS,no pregnancy and multiple pregnancies in late OHSS respectively.Conclusion Early OHSS is related to ovarian excessive reaction,and MSFS can predict the onset of early OHSS,whereas late OHSS is more likely related to the endogenous HCG of an implanting embryos,and the duration of OHSS can predict pregnancy or multiple pregnancies.

关 键 词：辅助生殖技术 卵巢过度刺激综合征 预测指标 OHSS ART 妊娠 卵泡 

分 类 号：R711.75[医药卫生—妇产科学]