体外受精-胚胎移植周期中阴道真菌感染及其影响因素:多中心开放性临床研究

Vaginal Fungal Infection and Its Influencing Factors during In Vitro Fertilization-embryo Transfer Cycles:A Multicenter Open-label Study

目的了解卵巢刺激后体外受精-胚胎移植(in vitrofertilization and embryo transfer,IVF-ET)女性阴道真菌感染的发生率及其影响因素,探讨预防其发生的措施。方法 采用多中心开放性临床研究方法 ,于2006年1月至12月共纳入301例因卵管因素行IVF-ET治疗的患者。分别于开始卵巢刺激前、人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)注射日和胚胎移植(embryo transfer,ET)日行阴道真菌培养,观察年龄、体重指数(body mass index,BMI)、不育类型及年限、卵巢刺激药物用量、卵泡数目、取卵个数、雌激素水平及应用抗生素等因素对阴道真菌感染的影响。将可能对阴道真菌感染的影响因素作为自变量,以是否有阴道真菌感染为应变量,采用Logistic回归分析法进行多因素统计分析。结果 所有患者开始卵巢刺激前阴道真菌培养均为阴性;HCG注射日阴拭子阳性32例,占10.6%;ET日阴拭子阳性22例,占7.3%。患者平均年龄(32.23±3.86)岁,BMI(21.54±2.73)kg/m2,不育年限(5.32±3.23)年,卵巢刺激中使用促性腺激素总量为(35.45±14.08)支,平均卵泡数目为(13.26±7.01)个,取卵个数(12.77±7.47)个,雌二醇(estradiol,E2)水平(2520.69±1686.04)pg/ml,66.78%患者取卵后使用抗生素。年龄、BMI、不育类型及年限、卵巢刺激药物总量及取卵后是否使用抗生素与阴道真菌感染无明显相关性(P>0.05),而E2水平、卵泡数目和取卵个数与阴道真菌感染的发生具有相关性(P<0.05)。结论 IVF-ET治疗中阴道真菌感染的总体发生率较低。患者年龄、不育类型及年限、促性腺激素用量、取卵后是否应用抗生素等因素对阴道真菌感染的发生影响不大。较多的卵泡数目、取卵个数及较高的雌激素水平可能增加阴道真菌感染的机会。

Objective To explore the incidence of vaginal fungal infection and its influencing factors during in vitro fertilization and embryo transfer（IVF-ET）cycles.Methods In this multicenter open-label clinical trial,301 patients who underwent IVF-ET due to tubal factors from January 2006 to December 2006 were enrolled.Vaginal fungal cultures were performed before the commencement of ovarian stimulation,on the day of human chorionic gonadotropin（HCG）injection and on the day of embryo transfer.The possible influencing factors of vaginal fungal infections including age,body mass index（BMI）,type and duration of infertility,dosage of ovarian-stimulating drug,follicle numbers,oocyte numbers,estrogen levels,and use of antibiotics were analyzed using Logistic regression analysis.Results Vaginal fungal cultures showed negative results before the commencement of ovarian stimulation in all patients.However,32 cases（10.6 %）had positive vaginal swab on HCG injection day and 22 cases（7.3%）on ET day.The average age of patients were（32.23±3.86）years.BMI（21.54±2.73）kg/m2.Sterile period（5.32±3.23）years,usage of total gonadotropin（35.45±14.08）ampous,average numbers of follicles（13.26±7.01）,retrieved oocytes（12.77±7.47）,and estradiol levels（2520.69±1686.04）pg /ml.Antibiotics were used in 66.78% of the patients after ovulation.Multiple factor Logistic regression analysis that factors such as age,BMI,type and duration of infertility,ovarian stimulation,and the use of antibiotics after oocyte retrieval were not significantly correlated with vaginal fungal infection（P 0.05）,which estradiol levels,follicle numbers,and oocyte numbers significantly influenced the incidence of vaginal fungal infection（P0.05）.Conclusions The incidence of vaginal fungal infections is low during IVF-ET treatment.Age,type and duration of infertility,drug dosage,use or not of antibiotics after oocyte retrieval has little effect on vaginal fungal infection,while larger number of follicles/oocyte numbers and the higher levels of estrogen may increase the incidence of vagina fungal infection.