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山东大学学报 (医学版) ›› 2020, Vol. 58 ›› Issue (6): 60-64.doi: 10.6040/j.issn.1671-7554.0.2020.109

• • 上一篇    

思则凯在预防早期中重度卵巢过度刺激综合征的应用

哈灵侠1,2,黎维霞1,2,吴阳阳1,2,殷婷1,2,李玉凤1,2   

  1. 1. 宁夏医科大学总医院生殖医学中心, 宁夏 银川 750004;2. 宁夏医科大学生育力保持教育部重点实验室, 宁夏 银川 750004
  • 发布日期:2022-09-27
  • 通讯作者: 哈灵侠. E-mail:hlxny@163.com
  • 基金资助:
    宁夏自然科学基金(2019AAC03191)

Effect of cetrorelix on early moderate and severe ovarian hyperstimulation syndrome

HA Lingxia1,2, LI Weixia1,2, WU Yangyang1,2, YIN Ting1,2, LI Yufeng1,2   

  1. 1.Center for Reproductive Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China;
    2. Key Laboratory of Fertility Preservation and Maintenance, Ministry of Education, Ningxia Medical University, Yinchuan 750004, Ningxia, China
  • Published:2022-09-27

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摘要： 目的 评价思则凯在预防早期中重度卵巢过度刺激综合征(OHSS)高风险妇女中的应用价值。 方法 将263例OHSS高风险行全胚冷冻的患者随机分为对照组和思则凯组:对照组(n=148)自取卵日起,给予常规对症支持治疗(羟乙基淀粉酶、二甲双胍、强的松及肠溶阿司匹林);思则凯组(n=115)在上述治疗的基础上,给予思则凯0.25 mg/d,皮下注射,连用3~5 d。于取卵日、取卵后第3及第5天检测血清雌二醇(E2)水平、红细胞压积、白细胞计数、肝功能、凝血功能等,B超测定卵巢大小及腹水情况,评估OHSS发生率及严重程度。 结果 与对照组比较,取卵后第3及第5天的思则凯组E2水平明显降低(P<0.05);取卵后第5天思则凯组升高的白细胞计数升高、纤维蛋白原升高占比明显降低(P<0.05);思则凯组中重度OHSS发生率、穿刺放腹水比率、住院率明显降低(P<0.05)。 结论 对于OHSS高风险患者,思则凯可降低E2水平,改善凝血功能,联合全胚冷冻可有效降低中重度OHSS发生率。

关键词: 思则凯, 雌激素, 中重度, 卵巢过度刺激综合征

Abstract: Objective To assess the effectiveness of cetrorelix on preventing early moderate and severe ovarian hyperstimulation syndrome(OHSS)in high-risk women. Methods A total of 263 patients with high-risk OHSS undergoing cryopreservation of all embryos were randomly divided into two groups: the control group(n=148)received symptomatic treatment including hydroxyethyl starch, metformin, aspirin, and glucocorticoid administration on day of oocyte retrieval. The cetrorelix group(n=115), in addition to symptomatic treatment, started 0.25 mg of cetrorelix daily on day of oocyte retrieval for 3 or 5 days. On day 3 and day 5 post-oocyte retrieval(POR), serum estradiol(E2)levels, hematocrit values, white blood cell(WBC)count, liver markers and coagulation/fibrinolysis parameters were detected, and maximal ovarian diameter(MOD)and ascites volume were assessed by ultrasound scanning. The incidence and severity of early moderate and severe OHSS were evaluated. Results Compared with the control group, E2 level were significantly lower in the cetrorelix group on day 3 and day 5 POR(P<0.05), and the percent of elevated WBC and fibrinogen were significantly lower in the cetrorelix group on day 5 POR(P<0.05). The incidence of moderate and severe OHSS, frequency of aspiration of the ascitic fluid and hospitalization rate was significantly lower in the cetrorelix group(P<0.05). Conclusion Combined with cryopreservation of all embryos, cetrorelix decreases serum E2 levels, improves coagulate functions, and effectively reduces the incidence of early moderate and severe OHSS in high-risk women.

Key words: Cetrorelix, Estradiol, Moderate and severe, Ovarian hyperstimulation syndrome

中图分类号: 

  • R711.6
[1] Timmons D, Montrief T, Koyfman A, et al. Ovarian hyperstimulation syndrome:review for emergency clinicians[J]. Am J Emerg Med, 2019, 37(8): 1577-1584.
[2] Nastri CO, Teixeira DM, Moroni RM, et al. Ovarian hyperstimulation syndrome: pathophysiology, staging, prediction and prevention[J]. Ultrasound Obstet Gynecol, 2015, 45(4): 377-399.
[3] 冯跃兰, 王树玉, 马延敏. 卵巢过度刺激综合征的预防进展[J].中国临床医生杂志, 2019, 47(10): 1162-1164.
[4] Zhai J, Liu J, Zhao S, et al. Kisspeptin-10 inhibits OHSS by suppressing VEGF secretion[J]. Reproduction, 2017, 154(4): 355-362.
[5] Gaafar S, El-Gezary D, El Maghraby HA. Early onset of cabergoline therapy for prophylaxis from ovarian hyperstimulation syndrome(OHSS): a potentially safer and more effective protocol[J]. Reprod Biol, 2019, 19(2): 145-148.
[6] 梁婷,王道,施晓波,等.血管内皮生长因子及脂联素与卵巢过度刺激综合征相关性的研究[J].中国妇幼保健, 2019, 34(4): 874-876.
[7] Zeng C, Shang J, Jin AM, et al. The effect of luteal GnRH antagonist on moderate and severe early ovarian hyperstimulation syndrome during in vitro fertilization treatment: a prospective cohort study[J]. Arch Gynecol Obstet, 2019, 300(1): 223-233.
[8] Lainas GT, Kolibianakis EM, Sfontouris IA, et al. Serum vascular endothelial growth factor levels following luteal gonadotrophin-releasing hormone antagonist administration in women with severe early ovarian hyperstimulation syndrome[J]. BJOG, 2014, 121(7): 848-855.
[9] 夏旖, 谢青贞. 取卵后黄体期使用促性腺激素释放激素拮抗剂防治卵巢过度刺激综合征的研究进展[J]. 中华生殖与避孕杂志, 2019, 39(3): 243-246. XIA Yi, XIE Qingzhen. The progress of prevention and treatment of ovarian hyperstimulation syndrome by gonadotropin-releasing hormone antagonist administration in the luteal phase after oocyte retrieval[J]. Reproduction and Contraception, 2019, 39(3): 243-246.
[10] Practice Committee of the American Society for Reproductive Medicine. Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline[J]. Fertil Steril, 2016, 106(7): 1634-1647.
[11] Wang R, Lin S, Wang Y, et al. Comparisons of GnRH antagonist protocol versus GnRH agonist long protocol in patients with normal ovarian reserve: a systematic review and meta-analysis[J]. PLoS One, 2017, 12(4): e0175985. doi: 10.1371/journal.pone.0175985.
[12] 任昀, 杨硕, 杨蕊, 等. 促性腺激素释放激素激动剂长方案与拮抗剂方案对体外受精治疗妊娠结局的影响[J]. 北京大学学报(医学版), 2013, 45(6): 877-881. REN Yun, YANG Shuo, YANG Rui, et al. Comparison of gonadotropin releasing hormone agonist long protocol and gonadotropin releasing hormone antagonist protocol in infertile women[J]. Journal of Peking University(Health Sciences), 2013, 45(6): 877-881.
[13] 周冬梅, 宋晖, 滑玮, 等. 取卵后当日添加来曲唑和GnRH-ant预防卵巢过度刺激综合征的疗效观察[J]. 生殖医学杂志, 2020, 29(2): 204-208. ZHOU Dongmei, SONG Hui, HUA Wei, et al. Effect of GnRH antagonist and letrozole for prevention of ovarian hyperstimulation syndrome[J]. Journal of Reproductive Medicine, 2020, 29(2): 204-208.
[14] Cheng ZX, Kong G, Zhang CL, et al. Letrozole versus gonadotropin-releasing hormone antagonist during luteal phase in the prevention of ovarian hyperstimulation syndrome: a randomized controlled trial[J]. Zhonghua Fu Chan Ke Za Zhi, 2020, 55(1): 9-14.
[15] Eftekhar M, Miraj S, Mortazavifar Z. The effect of luteal phase gonadotropin-releasing hormone antagonist administration on IVF outcomes in women at risk of OHSS[J]. Int J Reprod Biomed(Yazd), 2016, 14(8): 507-510.
[16] Yilmaz N, Uygur D, Ozgu E, et al. Does coasting, a procedure to avoid ovarian hyperstimulation syndrome, affect assisted reproduction cycle outcome? [J]. Fertil Steril, 2010, 94(1): 189-193.
[17] Nardo LG, Cheema P, Gelbaya TA, et al. The optimal length of ‘coasting protocol’ in women at risk of ovarian hyperstimulation syndrome undergoing in vitro fertilization[J]. Hum Fertil(Camb), 2006, 9(3): 175-180.
[18] Tshzmachyan R, Hambartsoumian E. The role of Letrozole(LE)in controlled ovarian stimulation(COS)in patients at high risk to develop ovarian hyper stimulation syndrome(OHSS). A prospective randomized controlled pilot study[J]. J Gynecol Obstet Hum Reprod, 2020, 49(2): 101643. doi: 10.1016/j.jogoh.2019.101643.
[19] Bassiouny YA, Dakhly DMR, Bayoumi YA, et al. Randomized trial of combined cabergoline and coasting in preventing ovarian hyperstimulation syndrome during in vitro fertilization/intracytoplasmic sperm injection cycles[J]. Int J Gynaecol Obstet, 2018, 40(2): 217-222.
[20] Salama KM, Abo Ragab HM, El Sherbiny MF, et al. Sequential E2 levels not ovarian maximal diameter estimates were correlated with outcome of cetrotide therapy for management of women at high-risk of ovarian hyperstimulation syndrome: a randomized controlled study[J]. BMC Womens Health, 2017, 17(1): 108. doi: 10.1186/s12905-017-0466-z.
[21] Centurione L, Giampietro F, Sancilio S, et al. Morphometric and ultrastructural analysis of human granulosa cells after gonadotrophin-releasing hormone agonist or antagonist[J]. Reprod Biomed Online, 2010, 20(5): 625-633.
[22] 石玉华, 蒋琪. 辅助生殖治疗中卵巢过度刺激综合征的防治[J]. 山东大学学报(医学版), 2019, 57(10): 13-19. SHI Yuhua, JIANG Qi. Prevention and treatment of ovarian hyperstimulation syndrome in assisted reproductive therapy[J] Journal of Shandong University(Health Science), 2019, 57(10): 13-19.
[23] 光晓燕, 于琳, 李璟. 卵巢过度刺激综合征并发深静脉血栓临床研究并文献复习[J]. 医学综述, 2013, 19(10): 1910-1912. GUANG Xiaoyan, YU Lin, LI Jing. Clinical research of ovarian hyperstimulation syndrome complicated with deep vein thrombosis and review of the literature[J]. Medical Recapitulate, 2013, 19(10): 1910-1912.
[24] Rogolino A, Coccia ME, Fedi S, et al. Hypercoagulability, high tissue factor and low tissue factor pathway inhibitor levels in severe ovarian hyperstimulation syndrome: possible association with clinical outcome[J]. Blood Coagul Fibrinolysis, 2003, 14(3): 277-282.
[25] Chan WS. The ‘ART’ of thrombosis: a review of arterial and venous thrombosis in assisted reproductive technology[J]. Curr Opin Obstet Gynecol, 2009, 21(3): 208-218.
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