促性腺激素释放激素拮抗剂在防治卵巢过度刺激综合征中的应用

Application of gonadotropic releasing hormone antagonist in the prevention and treatment of ovarian hyperstimulation syndrome

目的探讨促性腺激素释放激素(GnRH)拮抗剂在预防和治疗体外受精-胚胎移植(IVF-ET)过程中并发卵巢过度刺激综合征(OHSS)的作用。方法选择我院生殖医学中心2011年1月至2013年6月接受IVF-ET助孕,HCG日血清雌二醇(E2)>4000 pg/ml且获卵数≥20个而取消新鲜胚胎移植的患者44例,随机分为2组。对照组(n=23)予临床常规处理;拮抗剂组(n=21)在此基础上加用醋酸西曲瑞克0.25 mg,每日一次,共7 d。检测血清E2水平,计算OHSS、中重度OHSS的发生率。结果两组血清E2水平均逐步下降,而拮抗剂组治疗后第3、5、7天血清E2水平均低于对照组(P<0.05);拮抗剂组未出现OHSS的比例显著高于对照组(42.9%vs.13.0%,P=0.027),而中重度OHSS的发生率明显低于对照组(23.8%vs.69.6%,P=0.001)。结论 GnRH拮抗剂可以降低OHSS的发生比率、减少轻度向中重度OHSS发展。GnRH拮抗剂是预防和治疗IVF-ET中OHSS的有效措施之一。

Objective To investigate the effectiveness of the prevention and treatment with gonadotropic releasing hormone antagonist（GnRH ant） on OHSS patients who underwent in vitro fertilization and embryo transfer（IVF-ET）. Methods In this study, fresh transplantation was cancelled（the number of oocytes retrieved≥ 20, serum E2 level〉4000 pg/ml on the day of HCG injected） in total 44 patients who subjected to IVF-ET. GnRH antagonist group of 21 patients were given cetrorelix acetate 0.25 mg daily. Control group of 23 patients received the same treatment protocol except the GnRH antagonist. Serum E2 level was examined and the prevalence of OHSS, moderate and severe OHSS was calculated. Results Serum E2 level in two groups were all decreased gradually. However, E2 level of the antagonist group on third, fifth, seventh day after treatment was lower than that of the control group （P〈0.05）. The ratio of non-OHSS in antagonist group significantly higher than that in the control group（42.9% vs. 13.0%, P=0.027）, while morbidity of the severe OHSS in antagonist group was significantly lower than that in the control group （23.8% vs. 69.6%, P=0.001）. Conclusions Gonadotropic releasing hormone antagonists can decrease the incidence of OHSS and reduce the deterioration of OHSS. GnRH antagonist administration might represent a new approach for the effective prevention and treatment of OHSS.