强的松及万汶对中、重度卵巢过度刺激综合征预防作用的比较

Comparison of prednisone versus hydroxyethylstarch for prevention of moderate and severe ovarian hyperstimulation syndrome

目的:研究比较强的松及万汶(6%中分子羟乙基淀粉130/0.4)的应用对卵巢过度刺激综合征(OHSS)高危患者中、重度OHSS发病的预防作用。方法:2009年10月至2010年9月行体外受精-胚胎移植(IVF-ET)治疗的OHSS高危患者(注射日血雌二醇≥4000 pg/mL或获卵数≥15个)207例,共207个治疗周期,随机将其分成口服强的松组(A组,66个周期)、静脉滴注万汶组(B组,75个周期)及两者合用组(C组,66个周期)。A组患者从人绒毛膜促性腺激素(hCG)注射日起口服强的松片5 mg tid×2 d,后改为5 mg bid×5 d;B组患者于取卵日起予以万汶500 mL×3 d;C组患者则为同时应用上述两种药物治疗。根据Golan分类标准,对3组患者中、重度OHSS的发病率及其他相关指标进行统计学分析。结果:A组共移植60个周期,妊娠率为50.0%,中、重度OHSS的发病率为3.03%;B组共移植65个周期,妊娠率为44.6%,中、重度OHSS的发病率为13.33%;C组共移植59个周期,妊娠率为42.4%,中、重度OHSS的发病率为3.03%,3组间比较妊娠率无统计学差异(P>0.05),但B组的中、重度OHSS发病率明显高于A组及C组,差异有统计学意义(P<0.05)。结论:口服强的松预治疗不影响IVF-ET妊娠结局,与静脉滴注万汶相比能更经济、方便及有效地预防中、重度OHSS的发生。

AIM：To compare the efficiency of prednisone and 6% hydroxyethylstarch in the prevention of moderate and severe ovarian hyperstimulation syndrome（OHSS）. METHODS： A total of 207 OHSS high-risk patients and 207 cycles of in vitro fertilization and embryo transfer（IVF-ET） programme with estradiol serum concentration≥4000 pg/mL on the day of hCG injection and/or≥15 oocyte collection were prospective and randomized divided into A,B and C three groups.The patients in group A（66 cycles） orally took prednisone 5 mg tid on the day of hCG injection for 2 d,and then changed to 5 mg qd for 5 d;the patients in group B（75 cycles） were infused with 500 mL 6% hydroxyethylstarch on the day of oocyte collection for 3d;the patients in group C（66 cycles） were treated with prednisone and hydroxyethylstarch.The incidence of moderate and severe OHSS and the other corresponding indexes among the three groups were analyzed.RESULTS：There have 60 cycles were transferred in group A,clinical pregnancy rate was 50% and the incidence of moderate and severe OHSS was 3.03%;65 cycles were transferred in group B,clinical pregnancy rate was 44.6%,and the incidence of moderate and severe OHSS was 13.33%;59 cycles were transferred in group C,clinical pregnancy rate was 42.4% and the incidence of moderate and severe OHSS was 3.03%.There was no significant difference in pregnancy outcome among the three groups（P0.05）,but the incidence of moderate and severe OHSS in group B was higher than those in group A and group C（P0.05）.CONCLUSION： Oral administration of prednisone have no effect on pregnant rate of IVF and it is a cheaper,more convenient and effective alternative to 6% hydroxyethylstarch in moderate and severe OHSS prevention.