醋酸西曲瑞克在合并OHSS高危因素的IVF-ET助孕患者中的应用观察

Application of cetrorelix acetate in patients with IVF-ET assisted pregnancy and highrisk factors of OHSS

目的分析醋酸西曲瑞克在合并卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)高危因素的体外受精-胚胎移植(IVF-ET)助孕患者中的应用价值。方法2018年1月—2019年12月在郑州大学第二附属医院生殖中心接受IVF-ET助孕,因预防OHSS拟取消移植的107例高危OHSS患者中,73例采用常规治疗,并在取卵24 h后给予低分子肝素钙的患者纳入对照组,34例联合醋酸西曲瑞克治疗患者纳入治疗组;依据雌激素的下降幅度等综合因素考虑评估能否D3或D5移植胚胎,对可移植胚胎患者进行胚胎移植;比较两组一般资料、促排卵情况、OHSS相关临床及实验室指标及临床结局。结果两组一般资料、促排卵情况及两组取卵日后第2天卵巢最大直径及白细胞计数(WBC)升高、纤维蛋白原(Fib)升高、D-二聚体(D-D)升高、红细胞压积(HCT)、肝功能异常无统计学意义(P>0.05);治疗组取卵日后第2天、第5天的E_(2)水平[(1672.04±751.127)pg/mL、(1475.11±905.44)pg/mL]低于对照组[(2774.42±1278.568)pg/mL、(2576.28±922.69)pg/mL](P<0.05);两组OHSS发生率、住院率、穿刺放腹水比例、单胚胎移植及临床妊娠率无统计学意义(P>0.05),但治疗组中重度OHSS比例(22.22%)低于对照组(84.62%)(P<0.05)。结论取卵后应用醋酸西曲瑞克联合低分子肝素钙可以显著降低OHSS高危患者雌激素水平,降低中重度OHSS风险,是预防及治疗OHSS的有效方法,经评估后实施单胚胎移植也可获得良好的临床妊娠结局。

Objective To analyze the application value of cetrorelix acetate in patients with IVF-ET assisted pregnancy and high risk factors of OHSS.Methods A total of 107 patients who received IVF-ET and planed to cancel transfer due to OHSS in Reproductive Medicine Center of the hospital were selected between January 2018 and December 2019.Among them,73 patients received conventional treatment and were treated with low-molecular-weight heparin calcium at 24 h after retrieval ova were included in the control group,and 34 patients treated with cetrorelix acetate were included in the treatment group.The feasibility of embryo transferon D3 or D5 was evaluated according to the decrease in estrogen.Embryo transfer was performed on suitable patients.The general information,ovulation induction,OHSS-associated clinical and laboratory indicators,and clinical outcomes of the two groups were comparatively analyzed.Results There were no statistically significant differences between the two groups in terms ofgeneral information,ovulation induction,increased maximum diameter of ovary,increased white blood cell count(WBC),increased fibrinogen(Fib),increased D-dimer(DD),abnormal hematocrit(HCT),and abnormal liver function on the 2nd day after retrieval ova(P>0.05).E_(2)levels in the treatment group on the 2nd and 5th day after egg retrieval day[(1672.04±751.127)pg/mL,(1475.11±905.44)pg/mL]were lower than those in the control group[(2774.42±1278.568)pg/mL,(2576.28±922.69)pg/mL](P<0.05).There was no statistically significant differencein the incidence of OHSS,hospitalization rate,the proportion of ascites discharge,single embryo transfer,or clinical pregnancy ratebetween the two groups(P>0.05).The the incidence of moderate to severe OHSS in the treatment group(2.94%)was lower than that in the control group(19.18%)(P<0.05).Conclusion Using cetrorelix acetate combined with low-molecular-weight heparin calcium after retrieval ova can significantly reduce the level of estrogen in patients at high risk of OHSS,and reduce the risk of moderate to severe OHSS.It is an effective method to prevent and treat OHSS.After evaluation,single embryo transfer can achieve good clinical pregnancy outcomes.