早发黄体酮升高

Premature progesterone rise

早发黄体酮升高是人绒毛膜促性腺激素(hCG)注射日血浆孕酮(P)水平有一定程度的升高。文献报道hCG注射日提前升高的孕酮值从2.54～6.34 nmol/L不等,也有用雌二醇/孕酮比例(E_2/P)定义早发黄体酮升高的报道。卵泡发育过程中黄体酮分泌的改变涉及一系列相关酶表达及活性的调节。超排卵周期提前升高的黄体酮有多种可能来源,它对于卵母细胞质量、胚胎发育、子宫内膜改变等的影响尚无定论。本文就早发黄体酮升高的定义、相关酶学变化以及早发黄体酮升高的来源和对妊娠结局的影响作一综述。

Premature progesterone （P） rise refers to a rise in plasma P on the day of hCG administration. Since the application of gonadotropin-releasing hormone agonist （GnRH-a） in treatment of in vitro fertilization （IVF）, premature elevation of luteinizing hormone （LH） has been prevented in 95 %- 98% of patients. It is reported that GnRH-a can eliminate both the immunoreaetive LH and bioactive LH in serum, however, premature P rise on the day of hCG injection still occurs frequently in IVF cycles with GnRH-a application. The exact pathogenesis of premature P rise has been poorly understood in controlled ovarian hyperstimulation （COH） cycles with pituitary down-regulation. It involves a series of regulation in steroidogenic enzymes in preovulatory follicles. Based on various definitions of premature P rise, different COH protocols used and the constitutional discrepancy in study subjects, previous reports of the incidence of premature P rise varied from 13% to 71%, with only P levels as defining standard. The incidence of premature luteinization （PL） with the definition of P/E2 ratio 〉1 was 41% in the report of Younis et al. The effect of premature P rise on pregnancy outcome has been one of the most controversial topics in IVF, with both embryo and endometrium involved.