取卵后使用GnRH拮抗剂防治卵巢过度刺激综合征的临床研究

Clinical study on prevention and treatment of ovarian hyperstimulation syndrome with GnRH antagonist after oocyte retrieval

目的评价取卵后使用促性腺激素释放激素拮抗剂(GnRH-ant)防治中/重度卵巢过度刺激综合征(OHSS)的应用价值。方法收集2019年10月至2022年10月在郑州大学第二附属医院生殖中心接受拮抗剂方案助孕因OHSS高风险行全胚冷冻的160例患者作为研究对象,根据取卵术后使用的药物不同分为GnRH-ant组(n=80)与对照组(n=80);对照组采用常规治疗及取卵术后第2天开始给予低分子肝素钙治疗5 d,而GnRH-ant组在对照组治疗的基础上于取卵术后当日开始给予GnRH-ant治疗3~7 d。比较两组患者的一般资料、促排卵情况、OHSS相关临床和实验室指标及临床结局,并采用Spearman相关性分析探讨GnRH-ant组患者各临床指标与中/重度OHSS的关系。结果GnRH-ant组的获卵数、2PN胚胎数及冷冻胚胎数均显著高于对照组(P<0.05);GnRH-ant组取卵后提前来月经的患者比例显著高于对照组(P<0.05);GnRH-ant组穿刺放腹水比例、中/重度OHSS发生率及取卵后2~5 d雌二醇(E 2)、白细胞计数(WBC)、血红蛋白(Hb)、红细胞比容(HCT)、血管内皮生长因子(VEGF)、血浆纤维蛋白原(FIB)均显著低于对照组(P<0.05)。Spearman相关性分析结果显示,GnRH-ant组患者的中/重度OHSS发生与取卵后GnRH-ant总剂量呈负相关(r=-0.224,P<0.05),与获卵数呈正相关(r=0.252,P<0.05)。结论取卵后使用GnRH-ant可以加速黄体溶解并显著降低OHSS高危患者E 2及VEGF水平,降低中/重度OHSS发生风险,并能改善患者的凝血功能,降低血栓风险。

Objective:To evaluate the value of GnRH antagonist(GnRH-ant)in prevention and treatment of moderate and severe ovarian hyperstimulation syndrome(OHSS).Methods:A total of 160 patients who received the GnRH antagonist protocol for assistant pregnancy and underwent whole-embryo freezing due to the high risk of OHSS in the Reproductive Medicine Department of the Second Affiliated Hospital of Zhengzhou University from October 2019 to October 2022 were collected as research objects.According to the medication used after oocyte retrieval,they were divided into control group(n=80)and GnRH-ant group(n=80).The patients in the control group was treated with routine treatment and low molecular weight heparin calcium treatment for 5 days starting from the second day after oocyte retrieval,while the GnRH-ant group received GnRH-ant treatment for 3-7 days starting from the day after oocyte retrieval on the basis of treatment in the control group,The general information,ovulation induction,clinical status related OHSS and laboratory indicators,and clinical outcomes were compared between the two groups.Spearman correlation analysis was used to investigate the relationship between various clinical indicators and moderate to severe OHSS in the GnRH-ant group.Results:The numbers of oocytes retrieved,2PN embryos,and frozen embryos in the GnRH-ant group were significantly higher than those in the control group(P<0.05).The proportion of patients who experienced early menstruation after oocyte retrieval in the GnRH-ant group was significantly higher than that in the control group(P<0.05).The proportion of ascites drainage,incidence of moderate and severe OHSS,estradiol(E 2)level,WBC count,hemoglobin(Hb),hematocrit(HCT),vascular endothelial growth factor(VEGF),and fibrinogen(FIB)in the GnRH-ant group were significantly lower than those in the control group(P<0.05).Spearman correlation analysis results showed that the occurrence of moderate to severe OHSS in the GnRH-ant group was negatively correlated with the total dose of GnRH-ant after oocyte retrieval(r=-0.224,P<0.05),and positively correlated with the number of oocytes retrieved(r=0.252,P<0.05).Conclusions:The use of GnRH-ant after oocyte retrieval can accelerate luteolysis and significantly reduce E 2 and VEGF levels in the patients with high-risk of OHSS,reduce the risk of moderate to severe OHSS,improve coagulation function in patients,and reduce the risk of thrombosis.