胡琳莉，代玮，孙莹璞

(郑州大学第一附属医院生殖医学中心，郑州　450000)



长效/短效GnRH激动剂长方案分别用于卵泡期/黄体期的临床效果比较

胡琳莉，代玮，孙莹璞*

(郑州大学第一附属医院生殖医学中心，郑州450000)

目的比较卵泡期长效促性腺激素释放激素激动剂(GnRH-a)长方案和黄体期短效GnRH-a长方案在体外受精-胚胎移植中的治疗结局。方法回顾性分析2015年5月～2016年2月在本院行体外受精-胚胎移植的患者5 197例，其中A组：卵泡期长效GnRH-a长方案2 395例，B组：短效GnRH-a长方案2 802例，比较两种方案的临床特征及结局。结果两组间bFSH[(7.01±2.33 vs.7.20±2.34)U/L]、周期数(1.31±0.43 vs.1.12±0.41)、rFSH总量[(1 672.55±521.84)vs.(1 829.33±741.08)U]、HMG总量[(938.59±909.14) vs.(207.38±364.85)U]、促性腺激素(Gn)天数[(13.89±2.48) vs.(11.64±1.84)d]、HCG日E2[(13 033±7 909)vs. (18 267±10 277)pmol/L]、P[(3.14±1.87)vs. (2.82±1.49)nmol/L]、LH[(1.05±1.51) vs.(1.55±0.85)U/L]、内膜厚度[(12.11±2.49) vs.(11.75±2.38)mm]、≥16 mm卵泡数[(5.77±2.53) vs.(7.01±3.21)个]，14～16 mm卵泡数[(2.92±2.26vs.2.75±2.21)个]、12～13 mm卵泡数[(2.92±2.29) vs.(2.1±1.91)个]、MⅡ卵泡数[(10.36±6.24) vs.(10.88±6.54)个]、2PN受精率(64.21% vs.67.22%)、优质胚胎率(67.66%vs.74.05%)、着床率(45.34% vs.37.68%)、临床妊娠率(63.72% vs.52.67%)、流产率(8.41% vs.11.55%)、宫外孕率(1.52% vs.3.30%)差异具有统计学意义(P<0.05)，BMI、全胚冷冻率、取消率、获卵数、平均移植胚胎数、多胎率无显著性差异(P>0.05)；按年龄分层分析后，各年龄组中A组着床率(年龄<35岁组：49.98% vs.42.94%；年龄35～40岁组：38.57% vs.27.85%)；及妊娠率(年龄<35岁组：70.00% vs.59.38%;年龄35～40岁组：57.14% vs.42.24%)；均显著高于B组(P<0.05)。结论与黄体期短效长方案相比，卵泡期长效GnRH-a长方案能显著提高着床率及临床妊娠率。

促性腺激素释放激素激动剂；长方案；体外受精-胚胎移植

Methods：The data of 5 197 IVF/ICSI cycles from May 2015 to Feb. 2016 were retrospectively analyzed. The cycles were divided into two groups：the patients in group A were used long-acting GnRH-a long protocol in follicular phase (n=2 395)，and the patients in group B were used short-acting GnRH-a long protocol in mid-luteal phase (n=2 802). The clinical characters and outcomes were compared.

Results：There were significant differences in amount of bFSH [(7.01±2.33) vs. (7.2±2.34)U/L]，number of cycles (1.31±0.43 vs. 1.12±0.41)，total dose of rFSH [(1 672.55±521.84) vs. (1 829.33±741.08) U]，HMG [(938.59±909.14)vs. (207.38±364.85) U]，gondotropin days (13.89±2.48 vs. 11.64±1.84)；on HCG day，E2[(13 033±7 909) vs. (18 267±10 277) pmol/L]，LH [(1.05±1.51) vs. (1.55±0.85) U/L]，progesterone [(3.14±1.87) vs. (2.82±1.49) nmol/L]，endometrial thickness [(12.11±2.49) vs. (11.75±2.38) mm]，number of follicles≥16 mm (5.77±2.53 vs. 7.01±3.21)，number of follicles with 14-16 mm (2.92±2.26 vs. 2.75±2.21)，number of follicles with 12-13 mm (2.92±2.29 vs.2.10±1.91)，number of MⅡ follicles (10.36±6.24 vs. 10.88±6.54)；2PN fertility rate (64.21% vs. 67.22%)，high quality embryo rate (67.66% vs. 74.05%)，implantation rate (45.34% vs. 37.68%)，clinical pregnancy rate (63.72% vs. 52.67%)，miscarriage rate (8.41% vs. 11.55%)，ectopic pregnancy rate (1.52% vs. 3.30%) (allP<0.05). There were no significant differences in BMI，embryo frozen rate，cancel cycle rate，number of retrieved oocytes，number of embryo transferred，multiple pregnancy rate (P>0.05). After adjusted by age，the implantation rate (age<35 group：49.98% vs. 42.94%，35-40 group：38.57% vs. 27.85%)and clinical pregnancy rate (age<35 group：70% vs. 59.38%，35-40 group：57.14% vs.42.24%)in group A were still significantly higher than those group B (allP<0.05).

Conclusions：Administration of long-acting GnRH-a protocol in early follicular phase can improve implantation rate and clinical pregnancy rate compared with administration of short-acting GnRH-a protocol in the mid-luteal phase.

(JReprodMed2016，25(10)：919-925)

自1978年世界第一例试管婴儿诞生以来，体外受精-胚胎移植技术(IVF-ET)的发展已有近40年历史。1984年，Porter等[1]首次报道促性腺激素释放激素激动剂(gonadotropin releasing hormone agonist，GnRH-a)应用于IVF-ET的控制性促排卵(controlled ovarian hyperstimulation，COH)获得成功，自此之后GnRH-a降调节已成为促排卵的主流方向。经过不断探索，短效GnRH-a长方案能达到稳定的妊娠率已成为国内大部分中心的首选方案，而长效GnRH-a能改善盆腔微环境、子宫内膜容受性，主要应用于子宫内膜异位症人群。对于普通人群，卵泡期长效GnRH-a长方案与短效GnRH-a长方案的临床应用适应人群仍存在争议，本文通过回顾性分析卵泡期长效GnRH-a长方案与短效GnRH-a长方案在临床应用中的特征及治疗结局，探讨二者在临床的应用价值。……