摘要
目的分析卵巢过度刺激综合征(OHSS)高风险全胚冷冻患者在取卵后接受来曲唑联合促性腺激素释放激素拮抗剂(GnRH-ant)治疗后的临床效果。方法回顾性分析2023年1—7月于郑州大学第一附属医院生殖与遗传专科医院接受体外受精/卵胞质内单精子注射(IVF/ICSI)助孕治疗、因OHSS高风险取消新鲜移植行全胚胎冷冻的348例女性患者的临床资料。根据患者意愿,将取卵术后添加GnRH-ant和来曲唑分为干预组(164例),取卵术后未添加以上两种药物分为对照组(184例)。评估两组患者取卵术后首个黄体期、OHSS的分级、卵巢体积和雌二醇(E_(2))水平,采用多因素logistic回归模型分析OHSS高风险全胚冷冻患者发生中重度OHSS的相关因素。结果干预组和对照组患者的年龄分别为(29.3±3.8)和(29.4±4.1)岁(P=0.821),取卵术后干预组首个黄体期[(7.16±1.39)d]短于对照组[(13.88±2.11)d](P<0.001)。干预组轻度、中度和重度OHSS发生比例分别为75.0%(123例)、23.8%(39例)和1.2%(2例),对照组分别12.5%(23例)、60.9%(112例)和26.6%(49例)(P<0.001)。干预组取卵术后第2、6天E_(2)水平[M(Q_(1),Q_(3))]分别为1520.0(1213.8,1884.8)和108.5(45.6,218.0)ng/L,低于对照组的1666.0(508.8,1702.0)和1761.0(826.0,2546.5)ng/L(均P<0.001);腹腔积液[M(Q_(1),Q_(3))]分别为19.5(0,30.0)和0 mm,小于对照组的46.0(0,61.0)和54.5(0,69.5)mm(均P<0.001)。在取卵术后第6天,双侧卵巢体积均小于对照组(P<0.001)。不进行来曲唑和GnRH-ant联合处理是发生中重度OHSS的相关因素,其中对照组发生中重度OHSS风险是干预组的35.312倍(OR=35.312,95%CI:17.488~71.300)。结论OHSS高风险患者在取卵术后应用来曲唑联合GnRH-ant,减少中、重度OHSS发生,缩短取卵后首个黄体期,加快血清E_(2)的下降速度,促进卵巢体积恢复及腹腔积液的吸收。
Objective To investigate the clinical efficacy of letrozole combined with gonadotropin-releasing hormone antagonists(GnRH-ant)in patients at high risk of ovarian hyperstimulation syndrome(OHSS)who underwent total embryo freezing after oocyte retrieval.Methods A retrospective analysis was conducted on 348 female patients who underwent in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)at the Reproductive and Genetic Hospital of the First Affiliated Hospital of Zhengzhou University between January and July 2023.Due to their high risk of OHSS,these patients canceled fresh embryo transfer and opted for total embryo freezing.Based on patients′preferences,those who received GnRH-ant and letrozole after oocyte retrieval were categorized as the intervention group(164 cases),while those who did not receive these medications were categorized as the control group(184 cases).The first luteal phase after oocyte retrieval,OHSS grading,ovarian volume,and estradiol(E_(2))levels were evaluated in both groups.A multivariate logistic regression model was used to analyze factors related to moderate-to-severe OHSS among patients at high risk of OHSS who underwent total embryo freezing after oocyte retrieval.Results The age of the intervention and control groups was(29.3±3.8)and(29.4±4.1)years,respectively(P=0.821).The duration of the first luteal phase post-oocyte retrieval was shorter in the intervention group[(7.16±1.39)days]compared to that in the control group[(13.88±2.11)days](P<0.001).The incidences of mild,moderate,and severe OHSS in the intervention group were 75.0%(123 cases),23.8%(39 cases),and 1.2%(2 cases),respectively,whereas in the control group they were 12.5%(23 cases),60.9%(112 cases),and 26.6%(49 cases)(P<0.001).E_(2)levels on the 2nd and 6th days after oocyte retrieval[M(Q_(1),Q_(3))]in the intervention group were 1520.0(1213.8,1884.8)and 108.5(45.6,218.0)ng/L,respectively,which were statistically significantly lower than those in the control group[1666.0(508.8,1702.0)ng/L]and[1761.0(826.0,2546.
作者
张莹莹
张轶乐
卜志勤
陈彩虹
杨丽
孟艳蕾
郭艺红
Zhang Yingying;Zhang Yile;Bu Zhiqin;Chen Caihong;Yang Li;Meng Yanlei;Guo Yihong(Reproductive Medical Center,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2024年第30期2823-2829,共7页
National Medical Journal of China
基金
国家自然科学基金(32271169)
关键词
卵巢过度刺激综合征
黄体期
促性腺激素释放激素拮抗剂
来曲唑
卵泡期长效长方案
Ovarian hyperstimulation syndrome
Luteal phase
Gonadotropin releasing hormone antagonist
Letrozole
Long-acting follicular phase protocol
