卵巢过度刺激综合征与无卵巢过度刺激综合征试管婴儿患者的妊娠结局分析

发布时间：2018-04-18 23:26

本文选题：受精 + 体外　；参考：《北京协和医学院》2014年硕士论文

【摘要】：背景和目的卵巢过度刺激综合征(ovarian hyperstimulation syndrome, OHSS)是辅助生殖技术中药物刺激卵巢方案常见的医源性并发症。其潜在病因和发病机制尚不清楚,但卵巢来源的血管活性因子参与了血管通透性的增加和新生血管的生成,表现为卵巢囊性增大,液体从血管内迅速转移至第三间隙,血容量急剧降低,引发急性血流动力学改变,继而引起腹水、胸水、心包积液甚至全身水肿,出现腹胀腹痛、血液浓缩、低血容量、少尿、肝肾功能障碍,严重者可引起血栓形成、急性呼吸窘迫综合症(ARDS)、肾功能衰竭甚至危及生命。上述病理生理过程以及针对OHSS所采取的对症处理措施是否会对IVF患者的妊娠结局造成不良影响尚不可知,本研究的目的：比较OHSS与无OHSS的IVF患者的妊娠结局,探讨并发OHSS对IVF患者妊娠结局有无不良影响。资料和方法收集2002年1月～2012年12月在北京协和医院生殖中心接受体外受精-胚胎移植(IVF-ET)(包括ICSI)的5487例患者的周期资料,选择其中发生中重度OHSS住院治疗的190例患者作为研究组,按照年龄及所获成熟卵子数目配对选择同期未发生OHSS的197例患者作为对照组。对两组患者的临床资料进行回顾性分析,比较两组患者IVF-ET治疗后的妊娠结局。结果 OHSS患者临床妊娠率为91.8%(168/183),无OHSS患者临床妊娠率为45.1%(80/184),差异有统计学意义(P0.001)；两组的活产率分别为82.7%(139/168)和78.8%(63/80),流产率分别为16.1%(27/168)和17.5%(14/80),胎儿丢失率分别为1().1%(17/168)和10).0%(8/80),早产率分别为20.9%(29/139)和17.5%(11/63),差异均无显著性(P0.05)；两组≤3,4周分娩率分别为8.6%(12/139)和7.9%(5/63)、胎儿宫内窘迫发生率分别为2.9%(4/139)和3.2%(2/63)、剖宫产率分别为84.9%(118/139)和66.3%(53/63),差异均无显著性(P0.05)；两组平均分娩孕周分别为37.7±2.3周和37.7±2.0周、新生儿平均出生体重分别为2813±620g和2880±607g、足月低体重出生儿比率分别为13.0%(25/139)和10.6%(9/63)、早产低体重出生儿比率分别为6.3%(12/139)和3.5%(3/63),差异均无显著性(P0.05) 结论 OHSS患者临床妊娠率显著高于无OHSS患者,而流产率、胎儿丢失率、早产率、低体重出生儿等不良围生儿并发症与无OHSS患者相比未见升高。
[Abstract]:Background and purposeOvarian hyperstimulation syndrome (OHSS) is a common iatrogenic complication of ovarian hyperstimulation therapy in assisted reproductive technology.The underlying etiology and pathogenesis are unknown, but vasoactive factors derived from the ovary are involved in increased vascular permeability and angiogenesis, which are characterized by cystic enlargement of the ovary and rapid transfer of fluid from the intravascular to the third space.A sharp decrease in blood volume leads to acute hemodynamic changes, which in turn cause ascites, pleural effusion, pericardial effusion and even systemic edema, abdominal distention and abdominal pain, blood concentration, hypovolemia, oliguria, liver and kidney dysfunction,Severe cases can cause thrombosis, acute respiratory distress syndrome (ARDS), renal failure and even life-threatening.It is not known whether the pathophysiological process mentioned above and the measures taken to deal with OHSS will have adverse effects on the pregnancy outcome of IVF patients. The purpose of this study was to compare the pregnancy outcomes of OHSS patients with IVF patients without OHSS.To investigate the adverse effects of OHSS on pregnancy outcome in IVF patients.Information and methodologyFrom January 2002 to December 2012, 5487 patients who received IVF-ETX (including OHSS) at the Reproductive Center of Peking Union Hospital were collected as the study group, and 190 patients with moderate and severe OHSS were selected as the study group.According to age and the number of mature eggs, 197 patients without OHSS were selected as control group.The clinical data of the two groups were analyzed retrospectively and the pregnancy outcomes after IVF-ET treatment were compared between the two groups.ResultThe clinical pregnancy rate in patients with OHSS was 91.88 / 183 and that in patients without OHSS was 45.1a / 80 / 1844, the difference was statistically significant (P 0.001); the live births in the two groups were 82.7 / 139- / 139168) and 78.8 / 63.80 / 80, respectively, and the abortion rates were 16.1- 2727168) and 17.5/ 14- / 80m, respectively, and the fetal loss rates were 1 / 17168) and 10.0 / 880, respectively, and the premature rate was 20.90.29r.r.139.The average birth weight of newborns was 2813 卤620g and 2880 卤607g, respectively. The ratio of full-term low birth weight infants was 13.010 / 139and 10.6 / 9 / 63g, respectively. The ratio of preterm low birth weight newborns was 6.3p / 139and 3.5b / 3.63g, respectively. There was no significant difference (P0.05).ConclusionThe clinical pregnancy rate in patients with OHSS was significantly higher than that in patients without OHSS, while the rate of abortion, fetal loss, premature delivery, low birth weight and other adverse perinatal complications did not increase compared with those without OHSS.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.8

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