脱氢表雄酮与坤泰胶囊预处理对卵巢功能低下患者助孕结局的影响

Effects of dehydroepiandrosterone and Kuntai capsules pretreatment on assisted-fertility outcomes in patients with diminished ovarian reserve

目的观察脱氢表雄酮(DHEA)和坤泰胶囊预处理对卵巢功能低下(DOR)患者助孕结局的影响,为临床DOR的治疗提供参考依据。方法选取2017年4月~2019年1月期间的150例DOR患者为研究对象进行前瞻性研究,根据预处理使用药物分为DHEA组(n=89)和坤泰胶囊组(n=61),预处理9个月。在预处理结束后即停药后月经第2-5天进行各指标检测,比较分析两组患者卵巢储备功能[血清基础卵泡刺激素(FSH)水平、卵泡期抗苗勒激素(AMH)水平、双侧基础窦卵泡数(AFC)],性激素水平[睾酮(T)、孕酮(P)、促黄体生成素(LH)、基础雌二醇(E2)],卵巢微环境相关参数[卵巢体积、卵巢动脉收缩期峰值流速(PSV)]的相关参数,随访时间自促排卵周期结束到妊娠结束,记录助孕结局相关参数(临床妊娠率、诱发排卵率以及流产率)。结果DHEA与坤泰胶囊预处理后卵巢储备功能,性激素水平均优于预处理前,且差异显著(P<0.05);两组间卵巢储备功能、性激素水平、卵巢体积、临床妊娠率、诱发排卵率比较并无明显差异(P>0.05),坤泰胶囊组的PSV明显高于DHEA组,DHEA组的流产率明显高于坤泰胶囊组(P<0.05);坤泰胶囊组不良反发生率8.20%明显低于DHEA组的53.93%(χ2=33.134,P<0.001)。结论两种药物预处理在促进早期卵泡发育,改善卵巢储备功能,调节患者性激素水平方面效果相当,但坤泰胶囊改善卵巢微环境效果更佳,流产率更低且安全性高。

Objective:To observe the effects of dehydroepiandrosterone(DHEA)and Kuntai capsules pretreatment on in vitro fertilization-embryo transfer(IVF-ET)assisted-fertility outcomes in patients with diminished ovarian reserve(DOR).Methods:A total of 150 DOR patients during the period from June 2018 to December 2019 were enrolled as the research objects.According to different medication in pretreatment,they were divided into DHEA group(n=89)and Kuntai capsule group(n=61).All were given pretreatment for 3 menstrual cycles.At end of pretreatment,induced ovulation treatment was started,and follow-up observation were conducted within 4 weeks.The ovarian reserve function[serum basal follicle stimulating hormone(FSH),anti-Müllerian hormone(AMH)in follicular phase,bilateral basic antral follicle count(AFC)],levels of sex hormones[testosterone(T),progesterone(P),luteinizing hormone(LH),basic estradiol(E2)],ovarian micro-environment related parameters[ovarian volume,peak systolic velocity of ovarian artery(PSV)]and assisted-fertility outcomes related parameters(pregnancy rate,induced ovulation rate,miscarriage rate)in both groups were compared and analyzed.Results:After DHEA and Kuntai capsules pretreatment,ovarian reserve function and levels of sex hormones were better than those before pretreatment(P<0.05).There were no significant differences in ovarian reserve function,levels of sex hormones,ovarian volume,pregnancy rate and induced ovulation rate between the two groups(P>0.05).PSV in Kuntai capsule group was significantly higher than that in DHEA group,miscarriage rate in DHEA group was significantly higher than that in Kuntai capsule group(P<0.05).The incidence of adverse reactions in Kuntai capsule group was significantly lower than that in DHEA group(8.20%vs 53.93%)(χ2=33.134,P<0.001).Conclusion:The effects of the two pretreatment drugs are comparable in terms of promoting early follicle development,improving ovarian reserve function,and regulating levels of sex hormones.However,the effects of Kuntai capsules are better on improving ovarian micro-environment,with lower miscarriage rate and higher safety.