促性腺激素释放激素激动剂对早期宫颈癌行保留卵巢根治术后患者卵巢储备功能及临床妊娠情况的影响

Effect of GnRH agonist on ovarian reserve and clinical pregnancy in patients with early cervical cancer undergoing radical ovarian sparing

目的探讨早期宫颈癌行保留卵巢根治术后患者使用促性腺激素释放激素(GnRH)激动剂对卵巢储备功能及临床妊娠情况的影响。方法采用随机数字表法选取郑州市第二人民医院妇科2017年1月至2019年4月期间123例,早期宫颈癌行保留卵巢根治术患者作为研究对象,对照组61例给予保留卵巢根治术,术后接受4个疗程PT方案辅助化疗,观察组62例增加GnRH激动剂,比较两组患者化疗前后卵巢储备功能、临床妊娠情况和临床疗效。结果化疗后,患者基础促卵泡刺激素(bFSH)增加,基础雌二醇(bE2)、抗苗勒试管激素(AMH)及基础窦卵泡数(bAFC)水平均下降;但观察组bE2、AMH降低幅度高于对照组,bAFC降低幅度低于对照组,bFSH增加幅度低于对照组(P<0.05);观察组化疗后获卵数、成熟数、优胚数、可注射卵胞浆内单精子显微注射技术(ICSI)卵子成熟率以及临床妊娠率均较对照组高(P<0.05);治疗后,观察组、胚胎移植数和胚胎冷冻数均高于对照组(P<0.05);卵裂率和胚胎利用率也高于对照组(P<0.05)。结论GnRH激动剂早期宫颈癌行保留卵巢根治术后,能够通过增加原始卵泡数量,预防卵巢早衰,减少卵巢组织纤维化,提高临床妊娠率,值得推广。

【Objective】To explore the effect of gonadotropin releasing hormone(GnRH)agonist on ovarian reserve and clinical pregnancy in patients with early cervical cancer after radical ovarian sparing.【Methods】A random number table was used to select 123 patients with early cervical cancer who underwent radical ovarian sparing surgery in our department from January 2017 to April 2019 as the research subjects.Sixty-one cases in the control group were given radical ovarian sparing surgery and received 4 courses of PT regimen adjuvant chemotherapy after surgery,and GnRH agonists were added to 62 patients in the observation group.The ovarian reserve,clinical pregnancy and clinical efficacy were compared between the two groups before and after chemotherapy.【Results】After chemotherapy,basal follicle-stimulating hormone(BFSH)increased,basal estradiol(BE 2),anti-Müller tube hormone(AMH)and basal sinus follicle number(BAFC)decreased.However,the decrease rates of BE 2 and AMH in the observation group were higher than those in the control group,the decrease rate of BAFC in the observation group was lower than that in the control group,and the increase rate of BFSH in the observation group was lower than that in the control group(P<0.05).The number of eggs obtained,number of maturation,number of excellent embryos,the rate of egg maturation and clinical pregnancy in the observation group were higher than those in the control group after chemotherapy(P<0.05).After treatment,the number of embryos transferred and frozen in observation group were higher than those in control group(P<0.05).The cleavage rate and embryo utilization rate were also higher than those in the control group(P<0.05).【Conclusion】GnRH agonist can increase the number of primitive follicles,prevent premature ovarian failure,reduce ovarian tissue fibrosis,and improve t he clinical pregnancy rate after ovarian sparing radical surgery for early cervical cancer,which is worthy of promotion.