卵巢早衰性不孕症预后及妊娠结局研究

Studyof prognosis and pregnancy outcome for infertility patients with premature ovarian

目的:探讨卵巢早衰(POF)性不孕症的发病相关因素、预后及其对妊娠结局的影响。方法:以42例卵巢早衰性不孕症为研究对象(POF组),收集同期输卵管性不孕症患者60例作为对照(对照组),分析POF发病相关因素、临床预后以及受孕和妊娠结局情况。结果:POF组全部都有停经史,平均孕产次低于对照组(P<0.001),但是初潮平均年龄两组相当(P>0.05)。POF组FSH、LH和E激素水平,子宫、双侧卵巢体积以及窦卵泡计数等与对照组明显不同(P<0.001)。POF组患者中腮腺炎病毒/细菌感染史、宫颈Leep刀手术史、放射性及有毒物质长期接触史以及自身免疫性疾病史的构成比显著高于对照组(P<0.001),但是附件手术史以及巨大精神创伤史两组间差异无统计学意义(P>0.05)。POF组治疗1年后月经周期恢复率及自觉症状改善率均在95%以上,激素FSH、E、LH,子宫体积、卵巢体积、窦卵泡等情况也在持续改善,但是,卵巢功能相关临床指标达标率较低。两组随访2年,POF组自然妊娠率7.4%(3/42),辅助生殖率4.8%,抱婴率4.8%(2/42),对照组自然妊娠率25.0%(15/60),辅助生殖率28.3%,抱婴率38.3%(23/60),两组自然妊娠率、辅助生殖率以及抱婴率差异有统计学意义(P<0.05)。结论:卵巢早衰性不孕症发病病因复杂,可能和多种因素有关,治疗效果不佳,卵巢功能指标恢复正常率较低,治疗后妊娠率、抱婴率也较低,要加强预防,早诊断、早治疗。

Objectives： To investigate the related etiology factors,prognosis and the effect on pregnancy for infertility patients with premature ovarian failure（ POF）. Methods： 42 infertility patients with POF were selected as study objects（ POF group）,and 60 patients with tubal infertility were collected as control（ control group）. The related pathogenesis factors,clinical prognosis and pregnancy outcome of two groups was analyzed. Results： In POF group,all patients had menopause history,with fewer gravidity number on average than the control group（ P〈0. 001）; however,the age of menarche between two groups was roughly same（ P〉0. 05）. In POF group,the hor-mone levels of FSH,LH and E,the volume of uterine and bilateral ovarian,and the count of antral follicle was significantly different from those in the control group（ P〈0. 001）. The constitute ratio of patients with mumps virus /bacteria infection history,cervical Leep knife operation history,radioactive and toxic substances long-term contact history and autoimmune disease history in POF group was significantly higher than that of control group（ P〈0. 001）,but the attachment operation history and tremendous mental trauma between two groups had no significant difference（ P〉0. 05）. After 1 years of treatment,both menstrual cycle recovery rate and self-conscious symptom improvement rate in POF group were over 95%,while FSH,E,LH,volume of uterus and ovarian,antral follicle also improved continually,however,the compliance rate of clinical indicators on ovarian function was still low. Two groups were followed up for 2 years. The natural pregnancy rate of POF group was 7. 4%（ 3 /42） with 4. 8% assisted reproductive rate and 4. 8% carried infant rate; while in control group,the natural pregnancy rate was 25%（ 15 /60）,assisted reproductive rate was 28. 3%,with 38. 3%（ 23 /60） carried infant rate; the difference in natural pregnancy rate,assisted reproductive rate and carried infant rate between the two groups was statistically significant（ P〈0. 05）. Conclusion： The etiology of infertility with premature ovarian failure is complex,relevant to various factors. The treatment effect is poor,with low recovery rate of ovarian function,and the pregnancy rate and carried infant rate after treatment is also low. Therefore,it is important to strengthen prevention,early diagnosis and early treatment for POF.