来曲唑治疗卵巢过度刺激综合征的临床研究
发布时间：2018-07-31 19:35
【摘要】：目的1.评估黄体期应用来曲唑(letrozole,LE)能否有效的降低体外受精(In vitro fertilization,IVF)过程发生卵巢过度刺激征(ovarian hyperstimulation syndrome,OHSS)的高危患者黄体期雌激素的水平以及预防OHSS的发生和严重程度。2.探讨血管活性物质血清白介素-6(Interleukin,IL-6)、白介素-8(Interleukin,IL-8)、肿瘤坏死因子-a(Tumor necrosis factor,TNF-a)的水平在黄体期不同用药治疗后的变化。方法选取2016年1月-2016年10月年于安徽医科大学第一附属医院妇产科生殖中心行IVF/ICSI(长方案)治疗的OHSS高危患者156人,将OHSS高危患者作为受试对象随机给予4种不同药物连续治疗五天,分别为:A组(n=38):Gn RH-A+羟乙基淀粉(hydroxyethyl starch,HES)+葡萄糖酸钙(Calcium gluconate,Ca)治疗组,B组(n=39):来曲唑(letrozole,LE)+HES+Ca治疗组,C组(n=39):对照组即HES+Ca治疗组,D组(n=40):溴隐亭(bromocriptine,BC)+HES+Ca治疗组。所有受试对象于取卵日(d1天)记录阴道超声下卵泡总数,并留取卵泡液。取卵后d2、d4、d6天测量四组患者的卵巢的体积(V=D1x D2x D3x0.523)和盆腔积液、黄体期甾体激素水平(FSH、E2、LH、P)、细胞因子(IL-6,IL-8和TNF-a)的变化,比较四组OHSS高危患者OHSS的发生率以及严重程度。该项临床治疗研究已经我院伦理委员会批准,并且所有受试对象均签署患者知情同意书。结果(1)四组d2、d4、d6天血清E2的比较B组d2天的血清E2水平明显低于A组、C组、D组(2988.79±302.83 pmol/l vs4537.95±435.39 pmol/l vs 4938.23±386.23 pmol/l vs 4832.40±334.67 pmol/l),差异有统计学意义(p0.05);B组d4天的E2血清水平明显低于A组、C组、D组(2532.3±177.08 pmol/l vs 10095.82±655.59 pmol/l vs 7951.08±671.46 pmol/l vs9702.68±702.16 pmol/l),其差异有统计学意义(p0.05);B组d6天的血清E2水平明显低于A组、C组、D组(933.69±97.91 pmol/l vs 7494.13±742.23 pmol/l vs4468.69±448.77 pmol/l vs 8266.12±722.99 pmol/l),其差异有统计学意义(p0.05)。C组的血清E2水平明显低于A组,差异有统计学意义。(2)血清E2水平在d2、d4、d6天与OHSS严重程度的关系d2天、d4、d6天血清E2水平在中、重度OHSS患者水平明显高于轻度OHSS患者(d2天:5107.22±333.50 vs 3782.93±213.02;d4天:10491.38±625.38 vs5534.29±346.20;d6天:8152.62±645.58 vs 3308.12±276.87),差异有统计学意义(p0.05)。(3)四组d2、d4、d6天血清中的细胞因子的变化四组血清中IL-6、IL-8水平在d2天、d6天均无统计学差异(IL-6:p=0.1600.05;IL-8:p=0.0760.05);而d4天血清IL-6在B组明显低于C组、D组,差异有统计学意义(14.69±1.20 vs 20.05±1.46 vs 21.10±2.07,p0.05),血清IL-8在B组明显低于A组、D组,差异有统计学意义(17.54±1.72 vs 25.55±2.24 vs 28.94±3.07,p0.05)。(4)四组OHSS发生率及严重程度的比较比较A、B、C、D组四组中、重度OHSS的发生率,其中A组38例患者中发生轻度OHSS 19例,中度OHSS 9例,重度OHSS 10例;B组39例患者中发生轻度OHSS 33例,中度OHSS 4例,重度OHSS 2例;C组39例患者中发生轻度OHSS20例,中度OHSS 10例,重度OHSS 9例;D组40例患者中发生轻度OHSS 22例,中度OHSS 9例,重度OHSS 9例。结果表明:B组治疗后发生轻、中重度OHSS发生率明显低于其它3组,差异有统计学意义(p0.05)。结论来曲唑可以通过明显降低取卵后黄体期雌激素的水平并且降低中、重度OHSS的发生率,为卵巢过度刺激综合征提供了一个更好的治疗方式
[Abstract]:Objective 1. to evaluate the availability of letrozole (LE) in the luteal phase to effectively reduce the level of luteal estrogens in the corpus luteum phase of the high-risk patients with In vitro fertilization (IVF), ovarian hyperstimulation syndrome (OHSS), and the occurrence and severity of predominance and severity of vasoactive substances in the patients with high risk of ovarian hyperstimulation syndrome (OHSS). The changes in the levels of -6 (Interleukin, IL-6), interleukin -8 (Interleukin, IL-8), tumor necrosis factor -a (Tumor necrosis factor, TNF-a) in the luteal phase after the treatment of different drugs. Method selected January 2016 -2016 year October at the First Affiliated Hospital of Medical University Of Anhui, Department of Gynecology and obstetrics and Gynecology 156 high-risk patients were treated with 4 different drugs for five days for five days, respectively, group A (n=38): Gn RH-A+ hydroxyethyl starch (hydroxyethyl starch, HES) + calcium gluconate (Calcium gluconate, Ca) treatment group, B group (39): control group A treatment group, group D (n=40): bromocriptine, BC +HES+Ca treatment group. All subjects were recorded on the ovum day (D1 days) to record the total number of follicles in the vagina ultrasound and the follicular fluid. The ovarian volume (V=D1x D2x) and pelvic effusion (V=D1x D2x) and the luteal steroid hormone levels were measured in the four groups of patients after the ovum. The incidence and severity of OHSS in four groups of high-risk patients (IL-6, IL-8 and TNF-a) were compared. The clinical treatment study had been approved by the ethics committee of our hospital, and all subjects signed the patient's informed consent. Results (1) the four groups of D2, D4, D6 day serum E2 were compared to the B group D2 day of the serum E2 level was significantly lower than that of the group, group, In group D (2988.79 + 302.83 pmol/l vs4537.95 + 435.39 pmol/l vs 4938.23 + 386.23 pmol/l vs 4832.40 + 334.67 pmol/l), the difference was statistically significant (P0.05); the E2 serum level of D4 days in B group was significantly lower than that of the group. The difference was statistically significant (P0.05), and the serum E2 level of D6 days in group B was significantly lower than that in group A, group C, D group (933.69 + 97.91 pmol/l vs 7494.13 + 742.23 pmol/l vs4468.69 448.77 pmol/l 8266.12 + 722.99), and the difference was statistically significant. The relationship between D2, D4, D6 days and OHSS severity was D2 days, D4, D6 day serum E2 level, and the level of severe OHSS patients was significantly higher than that of mild OHSS patients (D2 days: 5107.22 + 333.50 vs 3782.93 + 213.02; 10491.38 + 625.38 346.20 + 346.20; 8152.62 + 645.58 3308.12 +). Changes in serum levels of cytokines in four groups of serum IL-6, IL-8 levels in D2 days and D6 days were not statistically significant (IL-6:p=0.1600.05; IL-8:p=0.0760.05), while D4 days serum IL-6 in B group was significantly lower than C group and D group (14.69 + 1.20 vs 20.05 + 1.46 21.10 + 2.07, 21.10 + 2.07). The difference was statistically significant (17.54 + 1.72 vs 25.55 + 2.24 vs 28.94 + 3.07, P0.05). (4) the incidence and severity of OHSS in the four groups were compared to A, B, C, and D group four, and the incidence of severe OHSS in the four group of 38 patients of the A group was mild OHSS 19, moderate OHSS 9 and severe 10 cases; 4 cases of S, 2 cases of severe OHSS, 39 cases in group C, mild OHSS20, moderate OHSS, 9 cases of severe OHSS, 40 cases of D in D group, mild OHSS, moderate OHSS, and severe OHSS 9. The results showed that the incidence of moderate and severe OHSS in B group was lower than that of other 3 groups, and the difference was statistically significant. Conclusion letrozole was statistically significant. Conclusion letrozole was statistically significant. Conclusion letrozole was statistically significant. Conclusion letrozole was statistically significant. Conclusion letrozole It is possible to provide a better treatment for ovarian hyperstimulation syndrome by significantly reducing the level of estrogens in the corpus luteum and decreasing the incidence of severe OHSS.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8
本文编号：2156614
[Abstract]:Objective 1. to evaluate the availability of letrozole (LE) in the luteal phase to effectively reduce the level of luteal estrogens in the corpus luteum phase of the high-risk patients with In vitro fertilization (IVF), ovarian hyperstimulation syndrome (OHSS), and the occurrence and severity of predominance and severity of vasoactive substances in the patients with high risk of ovarian hyperstimulation syndrome (OHSS). The changes in the levels of -6 (Interleukin, IL-6), interleukin -8 (Interleukin, IL-8), tumor necrosis factor -a (Tumor necrosis factor, TNF-a) in the luteal phase after the treatment of different drugs. Method selected January 2016 -2016 year October at the First Affiliated Hospital of Medical University Of Anhui, Department of Gynecology and obstetrics and Gynecology 156 high-risk patients were treated with 4 different drugs for five days for five days, respectively, group A (n=38): Gn RH-A+ hydroxyethyl starch (hydroxyethyl starch, HES) + calcium gluconate (Calcium gluconate, Ca) treatment group, B group (39): control group A treatment group, group D (n=40): bromocriptine, BC +HES+Ca treatment group. All subjects were recorded on the ovum day (D1 days) to record the total number of follicles in the vagina ultrasound and the follicular fluid. The ovarian volume (V=D1x D2x) and pelvic effusion (V=D1x D2x) and the luteal steroid hormone levels were measured in the four groups of patients after the ovum. The incidence and severity of OHSS in four groups of high-risk patients (IL-6, IL-8 and TNF-a) were compared. The clinical treatment study had been approved by the ethics committee of our hospital, and all subjects signed the patient's informed consent. Results (1) the four groups of D2, D4, D6 day serum E2 were compared to the B group D2 day of the serum E2 level was significantly lower than that of the group, group, In group D (2988.79 + 302.83 pmol/l vs4537.95 + 435.39 pmol/l vs 4938.23 + 386.23 pmol/l vs 4832.40 + 334.67 pmol/l), the difference was statistically significant (P0.05); the E2 serum level of D4 days in B group was significantly lower than that of the group. The difference was statistically significant (P0.05), and the serum E2 level of D6 days in group B was significantly lower than that in group A, group C, D group (933.69 + 97.91 pmol/l vs 7494.13 + 742.23 pmol/l vs4468.69 448.77 pmol/l 8266.12 + 722.99), and the difference was statistically significant. The relationship between D2, D4, D6 days and OHSS severity was D2 days, D4, D6 day serum E2 level, and the level of severe OHSS patients was significantly higher than that of mild OHSS patients (D2 days: 5107.22 + 333.50 vs 3782.93 + 213.02; 10491.38 + 625.38 346.20 + 346.20; 8152.62 + 645.58 3308.12 +). Changes in serum levels of cytokines in four groups of serum IL-6, IL-8 levels in D2 days and D6 days were not statistically significant (IL-6:p=0.1600.05; IL-8:p=0.0760.05), while D4 days serum IL-6 in B group was significantly lower than C group and D group (14.69 + 1.20 vs 20.05 + 1.46 21.10 + 2.07, 21.10 + 2.07). The difference was statistically significant (17.54 + 1.72 vs 25.55 + 2.24 vs 28.94 + 3.07, P0.05). (4) the incidence and severity of OHSS in the four groups were compared to A, B, C, and D group four, and the incidence of severe OHSS in the four group of 38 patients of the A group was mild OHSS 19, moderate OHSS 9 and severe 10 cases; 4 cases of S, 2 cases of severe OHSS, 39 cases in group C, mild OHSS20, moderate OHSS, 9 cases of severe OHSS, 40 cases of D in D group, mild OHSS, moderate OHSS, and severe OHSS 9. The results showed that the incidence of moderate and severe OHSS in B group was lower than that of other 3 groups, and the difference was statistically significant. Conclusion letrozole was statistically significant. Conclusion letrozole was statistically significant. Conclusion letrozole was statistically significant. Conclusion letrozole was statistically significant. Conclusion letrozole It is possible to provide a better treatment for ovarian hyperstimulation syndrome by significantly reducing the level of estrogens in the corpus luteum and decreasing the incidence of severe OHSS.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8
【参考文献】
相关期刊论文 前5条
1 张宇晖;何巧花;李杭生;;不同剂量来曲唑预防早发型卵巢过度刺激综合征的临床研究[J];生殖与避孕;2016年09期
2 何巧花;徐嘉宁;崔世红;李杭生;张翠莲;;取卵后应用来曲唑与发生早发型卵巢过度刺激综合征的关系[J];中华妇产科杂志;2014年12期
3 王雅琴;杨菁;徐望明;谢青贞;闫文杰;尹太郎;程丹;肖卓妮;李洁;;取卵后黄体期应用来曲唑降低血中雌激素水平不降低卵巢过度刺激综合征发生率[J];北京大学学报(医学版);2013年06期
4 蒋亚玲;邢福祺;李冰;全松;冯健怀;;口服泼尼松在预防中、重度卵巢过度刺激综合征中的应用[J];实用医学杂志;2011年01期
5 全松;陈薪;;卵巢过度刺激综合征的防治[J];中国实用妇科与产科杂志;2010年10期
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