中药和万汶在预防卵巢过度刺激综合征中的临床应用比较

Comparison of the effect of traditional Chinese medicine and Voluven on preventing ovarian hyper-stimulation syndrome during in vitro fertilization and embryo transfer

目的:探讨体外受精-胚胎移植周期(IVF-ET)取卵日应用中药或万汶干预对预防卵巢过度刺激综合征(OHSS)及临床结局的影响。方法:采用前瞻性队列研究,将74例在本中心行IVF-ET或单精子卵胞浆内注射(ICSI-ET)的患者,在促排卵注射人绒毛膜促性腺激素(HCG)日发现有OHSS高风险的妇女分为3组:中药组(24例)、万汶组(24例)和中药与万汶联合组(简称联合组,26例),取卵日开始中药组予温阳健脾中药(五苓散合五皮饮加味)共7 d,万汶组予万汶针每天500 m L,共3 d,联合组二者合用。比较这3组的实验室检查结果及临床结局,动态监测HCG注射日、取卵日、胚胎移植日的血清血管内皮生长因子(VEGF)、白介素-6(IL-6)及一氧化氮(NO)水平。结果:万汶组的临床妊娠率(为72.22%)高于中药组(为52.63%)和联合组(为58.82%),但差异无统计学意义(P>0.05)。3组均无重度OHSS发生,轻、中度的OHSS发生率差异无统计学意义(P>0.05),VEGF、IL-6和NO的变化趋势比较差异均无统计学意义(P>0.05)。结论:取卵日运用中药和万汶,均可避免重度OHSS的发生,测定VEGF、IL-6和NO的变化趋势相同,单独用万汶针则临床妊娠率有升高趋势,联合用药并没有改善临床和实验室结局。

To the effect and clinical of traditional Chinese medicine and Objective： compare outcome Voluven on preventing ovarian hyper-stimulation syndrome during in vitro fertilization or intracytoplasmic sperm injection and embryo transfer （IVF/ICSI-ET）. Methods： Prospective randomized case-control study was con- ducted. 74 women with high risk of OHSS on human chorionic gonadotropin （HCG） injection day were divided into 3 groups, 24 in traditional Chinese medicine group （Group A）, 24 in Voluven group （Group B） and 26 in the combined group （Group C）. In Group A, traditional Chinese medicine was used for 7 days since ovum pick up （OPU） day, in Group B, 500 mL Voluven vein injection were used for three days, and in Group C, traditional Chinese medicine and Voluven were both used. We compared their laboratory and clinical outcomes, vascular endothelial growth factor （VEGF）, interleukin-6 （IL-6） and Nitric oxide （NO） in both serum and follicular fluid on HCG injection day, OPU day, and ET day. Results： The pregnant rate of Group A （72.22%） was higher than that of Group B （52.63%） and Group （58.82%）, but without statistic differences. No patients developed severe OHSS. There were no statistically differences in the moderate and mild OHSS rate and the result of VEGF, IL- 6 and NO in all three groups. Conclusion： Both traditional Chinese medicine and Voluven have influence on the concentration ofVEGF, IL-6 and NO and can avoid severe OHSS. The use of Voluven seems to produce a higher pregnant rate. Combined method can not improve the clinical and laboratory result.