长方案中长效与短效达菲林的垂体降调节效果比较

Comparative Study of Long- and Short-acting Triptorelin on Pituitary Down-regulation in Long Protocol

目的：探讨长方案中长效与短效达菲林的垂体降调节效果及体外受精-胚胎移植的妊娠结局．方法行体外受精助孕的患者317例，均于前1月经周期黄体中期开始注射达菲林．随机分为2组，A组（145例）皮下注射长效达菲林1.25 mg，单次给药；B组（172例）每天皮下注射短效达菲林0.1 mg，14-18 d降调节后减量至每天注射0.05 mg，直到HCG注射日．结果（1）促性腺激素使用天数及用量：A组[（11.8±2.1） d，（31.2±9.5）支]显著多于B组[（10.1±1.3） d，（25.4±9.3）支]，P〈0.05；（2）2组患者的获卵数、受精率、优质胚胎数、着床率比较差异无统计学意义（P〈0.05）；（3）临床妊娠率：2组比较差异无统计学意义（P〈0.05），但B组有增高趋势．结论长方案中短效达菲林的垂体降调节效果与长效达菲林相似，而促性腺激素用量更少，使用更灵活，值得推荐．

Objective To explore the efficacy of long- and short-acting triptorelin on pituitary down-regulation in long protocol and the pregnancy outcome in vitro fertilization and embryo transfer （IVF-ET） . Methods Three hundred and seventeen patients for IVF-ET were enrolled as study and randomized them into two groups. In group A （n=145）, patients received single dose subcutaneous injection of 1.25 mg long-acting diphereline in mid-luteal phase. In group B （n=172）, patients received 0.1 mg/d subcutaneous injection of short-acting diphereline in mid-luteal phase for 14-18 days until pituitary suppression were got,and then reduced to 0.05 mg/d until the injection of HCG. Results The dose and the days of gonadotropin administration in group A were bigger and longer than those in group B （ P〈0.05） . There were no significant differences in the number of retrieved oocytes, fertilization rate,high quality embryos,implantation rate and clinical pregnancy rate between the two groups （all P〈 0.05） . But clinical pregnancy rate of group B had increasing trend. Conclusion Administration of short-acting diphereline has the similar effect with that of long-acting diphereline on pituitary down-regulation in long protocol. Short-acting diphereline requires lower amount of gonadotropin and is more flexible,so it should be recommended.