醋酸亮丙瑞林微球治疗子宫腺肌病合并不孕的临床疗效观察

Study on leuprorelin acetate in treatment of uterine adenomyosis with infertility

目的探讨醋酸亮丙瑞林微球（其他名称：贝依）治疗子宫腺肌病合并不孕的临床疗效。方法对2011年1月1日至2012年3月31日在宁波市妇女儿童医院生殖医学中心因子宫腺肌病合并不孕接受醋酸亮丙瑞林微球超长方案超促排卵后，行体外受精一胚胎移植（IVF—ET）治疗的166例患者的166个周期（腺肌病组）的临床资料进行回顾性分析，另选取同期因输卵管因素及其他原因不孕行IVF—ET治疗的子宫正常者作为对照组，共200例患者的200个周期，观察腺肌病组经醋酸亮丙瑞林微球治疗后子宫体积的变化，并比较两组患者IVF—ET结局。结果（1）子宫体积：腺肌病组中，经过2—6次的醋酸亮丙瑞林微球（3．75mg／次，每28天1次）治疗后，子宫体积由治疗前的（180±73）cm。缩小至治疗后的（86±67）cm^3，差异有统计学意义（P〈0．05）。（2）IVF—ET结局：胚胎种植率腺肌病组为39．1％、对照组为35．8％，临床妊娠率腺肌病组为54．2％，对照组为53．7％；流产率腺肌病组为4．7％、对照组为4．2％；两组各指标分别比较，差异均无统计学意义（P〉0．05）。（3）在腺肌病组中，IVF-ET治疗后妊娠失败者的受精率（67．2％，319／475）、双原核率（60．8％，289／475）及优质胚胎率（52．9％，162／306）与IVF—ET治疗后妊娠成功者[分别为74．2％（423／570）、67．7％（386／570）、62．1％（256／412）]比较，差异均有统计学意义（P〈0．05）。结论醋酸亮丙瑞林微球能显著缩小子宫腺肌病患者的子宫体积，对合并不孕行IVF—ET治疗的患者，经醋酸亮丙瑞林微球治疗后能够获得理想的助孕结局。

Objective To study clinical efficacy of leuprorelin acetate in treatment of uterine adenomyosis with infertility. Methods From January 1,2011 to March 31,2012, 166 cycles in 166 infertile patients combined with uterine adenomyosis undergoing in vitro fertilization embryo transplant （IVF-ET） with long protocol ovum induction by leuprorelin acetate in centre of medical reproduction, ningbo women and children＇s hospital were studied retrospectively. In the mean time, 200 cycles in 200 infertile patients with tubal factors were enrolled as control group. The volume of uterus and outcome of IVF-ET were compared and studied between two groups. Results （ 1 ） Volume of uterus ： in adenomyosis group, after 2 - 6 cycles of injecting leuprorelin acetate （3.75 mg/28 days）, the mean uterine volume was shrinked from （180 ± 73） em3 to （ 86 ± 67 ） cm^3 （ P 〈 0. 05 ）. （2） Outcome of IVF-ET ： the rate of embryo implantation was 39. 1% in adenomyosis group and 35.8%o in control group. The rate of clinical pregnancy was 54. 2% in adenomyosis group and 53.7% in control group. The rate of abortion was 4. 7% in adenomyosis group and 4. 2% in control group. They all did not show statistical differences （P 〉 0. 05 ）. （3） In adenomyosis group, the rate of fertilization, two pronuclear （2PN） and superior embryo were 67.2% （319/475）, 60. 8% （289/475） and 52. 9% （162/306） in patients with failed pregnancy and 74. 2% （423/570）, 67.7% （386/570） and 62. 1% （256/412） in patients with successful pregnancy after [VF-ET, which reached significant difference （ P 〈 0. 05 ） . Conclusion Leuprorelin acetate could improve volume of uterine adenomyosis and outcome of pregnancy in patients undergoing IVF-ET.