温阳健脾中药干预体外受精-胚胎移植周期卵巢过度刺激综合征的临床研究

Effect of Wenyang Jianpi Chinese Medicine on Preventing Ovarian Hyper-stimulation Syndrome During in vitro Fertilization-embryo Transfer

[目的]探讨体外受精-胚胎移植周期（in vitro fertilization-embryo transfer,IVF-ET）早期应用温阳健脾中药干预对卵巢过度刺激综合征（ovarian hyperstimulation syndrome，OHSS）发生发展的影响。[方法]采用前瞻性随机对照研究，将107例接受体外受精（IVF）或单精子卵浆内注射（ICSI）治疗且具有OHSS高危风险的不孕妇女分为中药组、强的松组和联合组3组，分别在促排卵5～7d开始予五苓散合五皮饮加味、强的松、五苓散合五皮饮加味联合强的松不同措施进行干预，均用药至取卵后3d。动态监测启动日、人绒毛膜促性腺激素（human chorionic gonadotropin, HCG）注射日、取卵日、胚胎移植日血清血管内皮生长因子（vascular endothelial growth factor，VEGF）、雌二醇（E2）水平及卵泡液中VEGF。[结果]中药组HCG注射日E2、移植日E2水平低于强的松组；取卵日E2水平低于强的松组和联合组；中药组卵泡液VEGF水平低于强的松组，差异有统计学意义（P＜0.05）。3个组均未发生重度OHSS，总OHSS发生率及轻、中度发生率差异无统计学意义（P＞0.05），但中药组中度OHSS发生率仅9.30%，相对联合组及强的松组有降低趋势。各组实验室及临床结果之间差异均无统计学意义（P＞0.05）。[结论]运用温阳健脾中药温阳行气、健脾利水早期预防，可降低HCG注射日、取卵日、移植日E2水平及卵泡液VEGF水平，避免重度OHSS的发生，并有降低总OHSS及中度OHSS发生率的趋势。

[Objective]To study the effect of Wenyang Jianpi Chinese medicine on preventing ovarian hyper-stimulation syndrome（OHSS） during early stim-ulation stage of in vitro fertilization-embryo transfer（IVF-ET）.[Method] Prospectively randomized case-control study was conducted.107 infertile women with high risk of OHSS underwent IVF or intracytoplasmic sperm injection（ICSI） were divided into three groups after five to seven days of ovarian sit-mulation. Wenyang Jianpi Chinese medicine group（n=43）： anti-OHSS prescription, one dose ever day; prednisone group（n=32）： 5mg tid po; Combina-tion group（n=32）： Chinese medicine combined with prednisone. Al the medicine was used until three days after ovum pick-up. Dynamic monitoring serum vascular endothelial growth factor（VEGF） and estradiol（E2） levels on the days of stimulation starting, HCG injection, ovum pick-up（OPU）, embryo transfer（ET）, and VEGF level in fol icular fluid.[Result] Serum estradiol level in Chinese medicine group was lower than in prednisone group on HCG in-jection day ,and it was lower than prednisone and combination group on OPU day. Fol icular fluid VEGF level in Chinese medicine group was lower than in prednisone group, the difference had significant statistical meaning.There was no severe OHSS in three groups, total rate of OHSS and mild to moderate OHSS had no significant difference, but moderate OHSS occurrence in Chinese medicine group was only 9.30%, seemed a trend of decreasing compared with the other two groups. The clinical and Laboratory outcomes among three groups had no difference of statistical meaning. [Conclusion] Through testing VEGF and E2 of patients at high risk of 0HSS, forecasts the occurrence of OHSS. Administrating Wenyang Jianpi Chinese medicine warms yang for activating qi-flowing and invigorates spleen for diuresis on early stage of ovarian stimulation can decrease the serum E 2 level on days of HCG injection, OPU, ET and decrease fol icular fluid VEGF level, avoid severe OHSS and has a trend of reducing total occurrence of OHSS as wel as moderate OHSS.