青春期前重度地中海贫血患者生育力保存病例1例并文献复习

A case of fertility preservation in a prepubertal patient with thalassemia major and review of relevant literature

目的探讨青春期前重度β-地中海贫血(thalassemia major,TM)患者进行生育力保存的方法,为青春期前血液疾病患者进行生育力保存提供进一步的数据支持。方法对1例青春期前拟行造血干细胞移植的TM患者通过卵巢组织冷冻(ovarian tissue cryopreservation,OTC)合并卵子体外成熟(in vitro maturation,IVM)行生育力保存进行病例报道,结合文献阐述青春期前地中海贫血患者进行生育力保存的时机、指征及策略。结果患者卵巢组织获取术后,体外穿刺抽吸共获取24枚卵丘-颗粒细胞复合体(cumulus-oocyte complexes,COCs)及11片卵巢组织皮片。COCs经48 h IVM后共有9枚MⅡ期卵子行玻璃化冷冻。结论对亟待造血干细胞移植的青春期前女童,OTC结合卵母细胞IVM技术能在短期内最大程度地保存TM患者的生育力,提高其生育力保存的治疗效果。

Objective To explore the methods of fertility preservation in prepubertal patients with thalassemia major(TM),and to provide further data support for the fertility preservation in prepubertal patients with hematologic diseases.Methods A case of a prepubertal patient with TM who required urgent hematopoietic stem cell transplantation(HSCT)receiving ovarian tissue cryopreservation(OTC)and in vitro maturation(IVM)to preserve fertility was reported,and the timing,the indications and strategies of fertility preservation in prepubertal girls with thalassemia were discussed in combination with related literature.Results After ovarian tissue extraction,a total of 24 cumulus-oocyte complexes(COCs)and 11 ovarian cortex pieces were obtained through puncture and aspiration.After IVM for 48 h,a total of 9 MⅡoocytes were frozen by vitrification.Conclusion For the prepubertal girls facing HSCT urgently,cryopreserving ovarian tissue in combination with retrieving immature oocytes followed by IVM can preserve the fertility of patients to the greatest extent in a short period of time,as well as improve the therapeutic effect of fertility preservation in patients.