曾诚+尚鶄+徐阳+贺占举+单学敏+董朝彤+郐艳荣+王晟+薛晴

【摘要】目的：探讨促性腺激素释放激素（GnRH）拮抗剂在预防IVF-ET过程中并发中重度OHSS的效果，旨在寻找预防中重度OHSS的有效措施。方法：回顾性分析我院生殖医学中心2014年4月至2015年12月接受IVF-ET助孕，HCG日血清雌二醇（E2）>4000 pg/mL和/或获卵数≥15个而取消新鲜胚胎移植行全胚冷冻的患者共102例。其中对照组在取卵后进行临床观察，共55例；思则凯组在取卵后第3d（D3）予GnRH拮抗剂思则凯0.25 mg，皮下注射，1次/d，共3d，共47例。计算轻、中、重度OHSS的发生率，对思则凯组和对照组住院患者的临床资料进行分析。结果：思则凯组重度OHSS的发生率（6.4%）明显低于对照组（21.8%， P=0.028）。思则凯组住院患者的住院率、住院天数、临床指标异常发生率（如血液浓缩、肝肾功能损害、卵巢大小及腹水量）、腹腔穿刺率均低于对照组住院患者。结论：在IVF-ET治疗中，GnRH拮抗剂可以显著降低中重度OHSS的发生，减少住院治疗的几率与时间，有效预防中重度OHSS。

【关键词】 卵巢过度刺激综合征； 体外受精-胚胎移植； 促性腺激素释放激素拮抗剂

Research on the effect of GnRH antagonist in the prevention of ovarian hyperstimulation syndrome in IVFZENG Cheng1， SHANG Jing1， XU Yang1， HE Zhanju2， SHAN Xuemin1， DONG Zhaotong1， KUAI Yanrong1， WANG Sheng1， XUE Qing1△. 1.Department of Obstetrics and Gynecology， Peking University First Hospital， Beijing 100034， China； 2.Department of Urology， Peking University First Hospital， Beijing 100034， China

【Abstract】Objectives： To find effective measures in the prevention of OHSS， by investigating the therapeutic effects of gonadotropin-releasing hormone （GnRH） antagonist in the prevention of moderate to severe OHSS. Methods： A retrospective study was conducted. Fresh embryo transplantation was cancelled （the number of oocytes retrived ≥15， serum oestradiol level >4000 pg/ml on the day of HCG injected） in total 102 patients who subjected to IVF-ET. Control group （n=55） received clinical observation after oocyte retrieval， while GnRH antagonist group （n=47） were given cetrorelix of 0.25mg subcutaneously daily for 3 days. The incidence of mild， moderate and severe OHSS was surveyed and the clinical data of hospitalized patients in both groups were analyzed. Results： After administration of cetrorelix， the incidence of severe OHSS was much lower than the control group （P=0.028）. Meanwhile， the hospitalization rate， duration of hospitalization， clinical factors （such as blood concentration and blood coagulation， liver and kidney dysfuction， ovarian sizes and ascites） and abdominal paracentesis rate of the cetrorelix group were also lower than the control group. Conclusion： In IVE-ET treatment， GnRH antagonists can reduce the incidence of moderate and severe OHSS， reducing the hospitalization rate and duration of hospitalization. In conclusion， GnRH antagonist is an effective approach for the prevention of moderate and severe OHSS.

【Key words】Ovarian hyperstimulation syndrome （OHSS）； In vitro fertilization-embryo transfer （IVE-ET）； Gonadotropin - releasing hormone antagonist （GnRH antagonist）endprint

【中图分类号】R711.75【文献标志码】A

近年来，辅助生殖技术广泛用于治疗不孕患者，其安全性和有效性被逐步证实，但该技术的危险性及可能的并发症需引起重视，特别是卵巢过度刺激综合征（ovarian hyperstimulation syndrome，OHSS）。OHSS是控制性促排卵（controlled ovarian hyperstimulation，COH）患者常发生的医源性疾病，其病理生理过程被认为是促排卵后血管完整性受损，卵巢释放的血管活性因子导致体腔毛细血管的通透性增加，进而体液向第三体腔转移，形成胸水和腹水；血管……