您的位置:山东大学 -> 科技期刊社 -> 《山东大学学报(医学版)》

山东大学学报 (医学版) ›› 2018, Vol. 56 ›› Issue (9): 54-58.doi: 10.6040/j.issn.1671-7554.0.2018.516

• • 上一篇    

甲状腺癌术后行IVF/ICSI-ET助孕临床结局

于娜,郭情情,孙梅,盛燕,马增香,秦莹莹   

  1. 山东大学附属生殖医院 国家辅助生殖与优生工程技术研究中心 生殖内分泌教育部重点实验室(山东大学)〓山东省生殖医学重点实验室, 山东 济南 250001
  • 发布日期:2022-09-27
  • 通讯作者: 马增香. E-mail:mazengxiang@sduivf.com

Clinical outcomes of IVF/ICSI-ET after thyroid cancer surgical treatment

YU Na, GUO Qingqing, SUN Mei, SHENG Yan, MA Zengxiang, QIN Yingying   

  1. Center for Reproductive Medicine, Shandong University;
    National Research Center for Assisted Reproductive Technology and Reproductive Genetics;
    Key Laboratory of Reproductive Endocrinology(Shandong University), Ministry of Education;
    Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan 250001, Shandong, China
  • Published:2022-09-27

摘要: 目的 观察甲状腺癌对体外受精/卵泡浆内单精子注射-胚胎移植(IVF/ICSI-ET)妊娠结局及孕产期、新生儿并发症有无影响。 方法 回顾性分析2012年1月1日至2016年12月31日接受甲状腺癌手术治疗后行IVF/ICSI-ET的患者42例(病例组),另选取甲状腺激素检测及甲状腺超声影像均正常者90例(对照组),比较两组超促排卵过程中促性腺激素(Gn)总量、注射人绒毛膜促性腺激素(HCG)日内膜厚度、获卵数、正常受精率、优胚率、着床率、临床妊娠率、流产率、种植率,以及孕产期并发症、新生儿出生体质量、新生儿并发症等指标。 结果 (1)病例组血清促甲状腺激素(TSH)水平低于对照组[(1.70±1.50)μIU/mL vs(2.20±0.84)μIU/mL,P<0.05];(2)两组患者的超促排卵过程Gn总量[(2 084.22±774.40)U vs(1 867.64±899.79)U]、HCG日内膜厚度[(1.08±0.16)cm vs(1.10±0.17)cm]、获卵数[(12.19±7.91)枚vs(10.92±4.65)枚]、正常受精率(57.30% vs 58.09%)、优胚率(61.38% vs 65.10%)差异均无统计学意义(P>0.05);(3)两组患者的临床妊娠率(61.11% vs 61.67%)、种植率(41.43% vs 43.14%)、流产率(9.09% vs 10.81%)、首次移植周期累积活产率(55.55% vs 50.00%)、妊娠期并发症发生率(25.0% vs 6.45%)、新生儿出生体质量[(3.21±0.63)kg vs(3.10±0.56)kg]差异均无统计学意义(P>0.05),病例组新生儿诊断为新生儿甲状腺功能减退症1例;(4)病例组助孕治疗及随访过程中无癌症复发病例。 结论 与对照组相比,甲状腺癌术后患者接受IVF/ICSI-ET助孕,卵巢反应性及妊娠结局均无明显差异,但甲状腺癌术后患者的新生儿有发生甲状腺功能减退风险,孕期需密切随访。

关键词: 体外受精-胚胎移植, 甲状腺癌, 促甲状腺激素, 妊娠期并发症, 新生儿甲状腺功能减退症

Abstract: Objective To investigate the effect of thyroid carcinoma on the pregnancy outcomes, obstetric and neonatal complications during in vitro fertilization/follicle intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)treatment. Methods Forty-two patients who underwent IVF/ICSI-ET after thyroid cancer surgery from January 1, 2012 to December 31, 2016 were retrospectively analyzed. Ninety patients with normal thyroid hormone level and thyroid ultrasound images were included as control group. The total amount of Gn, endometrial thickness on HCG day, and the number of retrieved oocytes were compared between cases and controls. The normal fertilization rate, good quality embryo rate, implantation rate, clinical pregnancy rate, miscarriage rate, live birth rate, and maternal and neonatal complications were also compared. Results The level of serum thyroid stimulating hormone(TSH)was significantly lower in cases than controls [(1.70±1.50)μIU/mL vs(2.20±0.84)μIU/mL, P<0.05]. The total Gn [(2 048.22± 山 东 大 学 学 报 (医 学 版)56卷9期 -于娜,等. 甲状腺癌术后行IVF/ICSI-ET助孕临床结局 \=-774.40)U vs(1 867.64±899.79)U], endometrial thickness on HCG day [(1.08±0.16)cm vs(1.10±0.17)cm], number of oocytes [(12.19±7.91)vs (10.92±4.65)], normal fertilization rate(57.30% vs 58.09%)and good quality embryo rate(61.38% vs 65.10%)were comparable between cases and controls. No difference was observed in the clinical pregnancy rate(61.11% vs 61.67%), implantation rate(41.43% vs 43.14%), abortion rate(9.09% vs 10.81%), and live birth rate(55.55% vs 50.0%). The incidence of obstetric complications(25.0% vs 6.45%)and birth weight of newborns [(3.21±0.63)kg vs (3.10±0.56)kg] were not statistically different(P>0.05). One baby from case group was diagnosed with neonatal hypothyroidism. There was no recurrence of thyroid carcinoma during IVF/ICSI-ET treatment. Conclusion Compared with controls, patients with history of thyroid cancer surgery present normal ovarian response and pregnancy outcomes undergoing IVF/ICSI-ET treatment. However, more attention is needed for neonatal hypothyroidism after maternal thyroid surgery.

Key words: In vitro fertilization/follicle intracytoplasmic sperm injection-embryo transfer, Thyroid cancer, Thyroid-stimulating hormone, Gestational diabetes, Neonatal hypothyroidism

中图分类号: 

  • R711.6
[1] 赵建新, 张弛, 刘荫华, 等. 120例分化型甲状腺癌随访8年的预后因素分析[J]. 中国癌症杂志, 2013, 23(1):51-54. ZHAO Jianxin, ZHANG Chi, LIU Yinhua, et al. Prognosis factors analysis of 120 cases differentiated thyroid cancer after follow-up of 8 years[J]. China Oncology, 2013, 23(1):51-54.
[2] 张钧, 李鸣, 李平. 手术治疗125例分化性甲状腺癌的5年随访结果分析[J]. 西南国防医药, 2007, 17(4): 420-422. ZHANG Jun, LI Ming, LI Ping. Five-years following- up results of surgical treatment of 125 cases with differentiated thyroid carcinoma[J]. Medical Journal of National Defending Forces in Southwest China, 2007, 17(4): 420-422.
[3] Cutting R, Morroll D, Roberts SA, et al. Elective single embryo transfer: guidelines for practice British Fertility Society and Association of Clinical Embryologists[J]. Human Fertility, 2008, 11(3):131-146.
[4] Gardner DK, Lane M, Stevens J, et al. Blastocyst score affects implantation and pregnancy out-come: towards a single blastocyst transfer[J]. Fertil Steril, 2000, 73(6): 1155-1158.
[5] 吴孟超,吴在德,吴肇汉. 外科学[M]. 8版. 北京:人民卫生出版社,2013.
[6] 张艳馨,姚丽芬,冒韵东, 等. 促甲状腺激素(TSH)水平对IVF/ICSI妊娠结局的影响[J]. 生殖与避孕, 2012, 32(1): 17-23. ZHANG Yanxin, YAO Lifen, MAO Yundong, et al. Correlation of thyroid stimulating hormone(tsh)level with pregnancy outcome in women undergoing in vitro fertilization or intracytoplasmic sperm injection[J]. Reproduction & Contraception, 2012, 32(1): 17-23.
[7] Takagi H, Mitsumori K, Onodera H, et al. Improvement of a two—stage carcinogenesis model to detect modifying effects of endocrine disrupting chemicals on thyroid carcinogenesis in rats[J]. Cancer Lett, 2002, 178(1): 1-9.
[8] Vivacqua A, Bonofiglio D, Albanito L, et al. 17beta-estradiol, genistein, and 4-hydroxytamoxifen induce the proliferation of thyroid cancer cells through the g protein-coupled receptor GPR30[J]. Mol Pharmacol, 2006, 70(4): 1414-1423.
[9] Xhaard C, Rubino C, Clero E, et al. Menstrual and reproductive factors in the risk of differentiated thyroid caricionma in young women in France: a population-basted case-control study[J]. Am J Epidemiol, 2014, 180(10): 1007-1017.
[10] Kabat GC, Kim MY, Wactawski-Wende J, et al. Mensturual and reproductive factors, exogenous hormone use, and risk of thyroid carcinoma in postmenopausal women[J]. Cancer Causes Control, 2012, 23(12): 2031-2040.
[11] Althuis MD, Scoccia B, Lamb EJ, et al. Melanoma, thyroid, cervical and colon cancer risk after use of fertility drugs[J]. Am J Obstel Gynecol, 2005, 193(1): 668-674.
[12] Pfeifer S, Butts S, Dumesic D, et al. Fertility drugs and cancer: a guideline[J]. Fertil Stetil, 2016, 106(7): 1617-1626.
[13] He H, Jing S, Gong F, et al. Effect of thyroid autoimmunity perse on assisted reproduction treatment outcomes: a meta-analysis[J]. Taiwanese Journal of Obstetrics and Gynecology, 2016, 55(2): 159-165.
[14] 肖海群. 甲状腺功能减退对妊娠及其结局的影响[J]. 中国现代医学杂志, 2012, 22(18): 53-57. XIAO Haiqun. Influence of hypothyroidism on pregnancy and its outcomes[J]. China Journal of Modern Medicine, 2012, 22(18): 53-57.
[15] Mannisto T, Mendola P, Grewal J, et al. Thyroid diseases and adverse pregnancy outcome in a contemporary US cohort[J]. J Clin Endocrionl Metab, 2013, 98(7): 2725-2733.
[16] 陈敦芝, 何云琴, 张治洋. 甲状腺功能异常与妊娠期糖尿病及妊娠期高血压的相关性[J]. 西南国防医药, 2017, 27(11): 1224-1226.
[17] 景蓉, 李秀琴. 妊娠期甲状腺功能减退与妊娠期糖尿病对妊娠结局的影响及相关性分析[J]. 解放军医药杂志, 2017, 29(8): 66-71. JING Rong, LI Xiuqin. Relationship between hypothyroidism and gestational diabetes mellitus and their effects on pregnancy outcome[J]. Medical & Pharmaceutical Journal of Chinese Peoples Liberation Army, 2017, 29(8): 66-71.
[18] 张玉花, 黄德胜, 方琳, 等. 妊娠甲状腺功能减退症与妊娠期高血压疾病关系分析[J]. 数理医药学杂志, 2017, 30(11): 1595-1597. ZHANG Yuhua, HUANG Desheng, FANG Lin, et al. Analysis of the relationship between hypothyroidism in pregnancy and hypertensive disorder complicating pregnancy[J]. Journal of Mathematical Medicine, 2017, 30(11):1595-1597.
[19] 中华医学会内分泌学分会,中华医学会围产医学分会.妊娠和产后甲状腺疾病诊治指南[J]. 中华内分泌代谢杂志, 2012, 28(7): 354-371.
[20] 刘彩霞,吴爱红. 妊娠期甲状腺疾病的认知和筛查状况[J]. 中华围产医学杂志, 2015, 18(3): 229-231.
[21] 韩彦青, 叶飘, 石境懿. 母体甲减与新生儿甲减的关系及TSH达标治疗对患儿甲减发病率的影响[J]. 西部医学, 2017, 29(5): 647-651. HAN Yanqing, YE Piao, SHI Jingyi. Study on the relationship between maternal hypothyroidism and neonatal hypothyroidism and the effect of TSH goal-directed therapy on the incidence of hypothyroidism in children[J]. West China, 2017, 29(5): 647-651.
[22] 赵军育. 新生儿生后甲状腺功能检查及影响因素分析[J]. 继续医学教育, 2017, 31(9): 115-117.
[23] Bamberg C, Fotopoulou C, Neissner P, et al. Maternal characteristics and twin gestation outcomes over 10 years: impact of conception methods[J]. Fertil Steril, 2012, 98(1): 95-101.
[24] 张为远, 侯磊. 中国大陆剖宫产状况大数据调查的启示[J]. 中国实用妇科与产科杂志, 2018, 34(1): 38-40.
[25] 陈小芸. 4年剖宫产率及剖宫产手术指征变化研究[D].福州: 福建医科大学, 2017.
[1] 吴日超,刘红,王泽,高姗姗,李秀芳,石玉华. 40岁及以上女性行体外受精-胚胎移植助孕的妊娠结局分析[J]. 山东大学学报 (医学版), 2022, 60(6): 35-39.
[2] 邓晓惠,郭玲. 免疫治疗在胚胎反复种植失败中的应用进展[J]. 山东大学学报 (医学版), 2021, 59(8): 32-37.
[3] 邬晓琳,李萍. 激动剂长方案下促性腺激素使用时长对体外受精胚胎移植妊娠结局的影响[J]. 山东大学学报 (医学版), 2021, 59(7): 32-37.
[4] 柴佳威,朱坤兵,李亚琼,王甜甜. 隐匿性甲状腺癌:1例病例报道和文献回顾[J]. 山东大学学报 (医学版), 2021, 59(1): 83-87.
[5] 庄大勇,贺青卿,李小磊,周鹏,岳涛,徐婧. 达芬奇机器人在儿童及青少年甲状腺癌中的应用[J]. 山东大学学报 (医学版), 2021, 59(1): 45-48.
[6] 陈士岭,周星宇. 早发性卵巢功能不全的临床诊治进展[J]. 山东大学学报 (医学版), 2018, 56(4): 1-7.
[7] 张琳,李敬,王泽,张江涛,马增香,石玉华. 多囊卵巢综合征患者促甲状腺激素对血糖、血脂的影响[J]. 山东大学学报(医学版), 2017, 55(1): 80-84.
[8] 申妍,左常婷. 济南地区正常妊娠妇女各期甲状腺功能指标的参考值范围评估[J]. 山东大学学报(医学版), 2016, 54(5): 34-38.
[9] 王付颖1,刘晓萌2,董庆玉2,梁翠格2,杜文华2,王月丽2,李文侠2,高冠起2. Graves病患者131I治疗后TRAb变化与早发甲减的相关性[J]. 山东大学学报(医学版), 2014, 52(6): 55-57.
[10] 王琦1,2,于春晓3,高聆1,赵家军3,曹铭锋3. 1-7554.0.2013.611促甲状腺激素调节肝脏AMPKα Thr 172而非Ser 173的磷酸化[J]. 山东大学学报(医学版), 2014, 52(6): 22-27.
[11] 哈灵侠, 李向红. 多囊卵巢综合征患者卵泡液中GDF9和BMP15的表达及意义[J]. 山东大学学报(医学版), 2014, 52(10): 77-80,95.
[12] 张雯雯1,张艳玲1,王杰1,高聆2,于春晓1,阎慧丽1,徐进1. 促甲状腺激素对破骨细胞分化的影响[J]. 山东大学学报(医学版), 2013, 51(4): 6-10.
[13] 鹿群,沈浣,王丛,郑兴邦,陈曦,梁蓉,魏丽惠. 脱氢表雄酮对卵巢反应不良患者体外受精-胚胎移植的影响[J]. 山东大学学报(医学版), 2013, 51(2): 84-.
[14] 李建周,刘欣,张凌云,金勇君. 术前血清TSH浓度与分化型甲状腺癌的相关性研究[J]. 山东大学学报(医学版), 2011, 49(1): 10-13.
[15] 刘延鹏,丁向东,刘萍,杨月香,潘祥林 . 全身热化疗治疗甲状腺癌多发性骨转移[J]. 山东大学学报(医学版), 2007, 45(9): 968-969.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!