CAJ | 학술논문

[目的]探讨体外受精-胚胎移植周期(in vitro fertilization-embryo transfer,IVF-ET)早期应用温阳健脾中药干预对卵巢过度刺激综合征（ovarian hyperstimulation syndrome，OHSS）发生发展的影响。[方法]采用前瞻性随机对照研究，将107例接受体外受精（IVF）或单精子卵浆内注射（ICSI）治疗且具有OHSS高危风险的不孕妇女分为中药组、强的松组和联合组3组，分别在促排卵5～7d开始予五苓散合五皮饮加味、强的松、五苓散合五皮饮加味联合强的松不同措施进行干预，均用药至取卵后3d。动态监测启动日、人绒毛膜促性腺激素（human chorionic gonadotropin, HCG）注射日、取卵日、胚胎移植日血清血管内皮生长因子（vascular endothelial growth factor，VEGF）、雌二醇（E2）水平及卵泡液中VEGF。[结果]中药组HCG注射日E2、移植日E2水平低于强的松组；取卵日E2水平低于强的松组和联合组；中药组卵泡液VEGF水平低于强的松组，差异有统计学意义（P＜0.05）。3个组均未发生重度OHSS，总OHSS发生率及轻、中度发生率差异无统计学意义（P＞0.05），但中药组中度OHSS发生率仅9.30%，相对联合组及强的松组有降低趋势。各组实验室及临床结果之间差异均无统计学意义（P＞0.05）。[结论]运用温阳健脾中药温阳行气、健脾利水早期预防，可降低HCG注射日、取卵日、移植日E2水平及卵泡液VEGF水平，避免重度OHSS的发生，并有降低总OHSS及中度OHSS发生率的趋势。
[목적]탐토체외수정-배태이식주기(in vitro fertilization-embryo transfer,IVF-ET)조기응용온양건비중약간예대란소과도자격종합정（ovarian hyperstimulation syndrome，OHSS）발생발전적영향。[방법]채용전첨성수궤대조연구，장107례접수체외수정（IVF）혹단정자란장내주사（ICSI）치료차구유OHSS고위풍험적불잉부녀분위중약조、강적송조화연합조3조，분별재촉배란5～7d개시여오령산합오피음가미、강적송、오령산합오피음가미연합강적송불동조시진행간예，균용약지취란후3d。동태감측계동일、인융모막촉성선격소（human chorionic gonadotropin, HCG）주사일、취란일、배태이식일혈청혈관내피생장인자（vascular endothelial growth factor，VEGF）、자이순（E2）수평급란포액중VEGF。[결과]중약조HCG주사일E2、이식일E2수평저우강적송조；취란일E2수평저우강적송조화연합조；중약조란포액VEGF수평저우강적송조，차이유통계학의의（P＜0.05）。3개조균미발생중도OHSS，총OHSS발생솔급경、중도발생솔차이무통계학의의（P＞0.05），단중약조중도OHSS발생솔부9.30%，상대연합조급강적송조유강저추세。각조실험실급림상결과지간차이균무통계학의의（P＞0.05）。[결론]운용온양건비중약온양행기、건비이수조기예방，가강저HCG주사일、취란일、이식일E2수평급란포액VEGF수평，피면중도OHSS적발생，병유강저총OHSS급중도OHSS발생솔적추세。
[Objective]To study the effect of Wenyang Jianpi Chinese medicine on preventing ovarian hyper-stimulation syndrome(OHSS) during early stim-ulation stage of in vitro fertilization-embryo transfer(IVF-ET).[Method] Prospectively randomized case-control study was conducted.107 infertile women with high risk of OHSS underwent IVF or intracytoplasmic sperm injection(ICSI) were divided into three groups after five to seven days of ovarian sit-mulation. Wenyang Jianpi Chinese medicine group(n=43): anti-OHSS prescription, one dose ever day; prednisone group(n=32): 5mg tid po; Combina-tion group(n=32): Chinese medicine combined with prednisone. Al the medicine was used until three days after ovum pick-up. Dynamic monitoring serum vascular endothelial growth factor(VEGF) and estradiol(E2) levels on the days of stimulation starting, HCG injection, ovum pick-up(OPU), embryo transfer(ET), and VEGF level in fol icular fluid.[Result] Serum estradiol level in Chinese medicine group was lower than in prednisone group on HCG in-jection day ,and it was lower than prednisone and combination group on OPU day. Fol icular fluid VEGF level in Chinese medicine group was lower than in prednisone group, the difference had significant statistical meaning.There was no severe OHSS in three groups, total rate of OHSS and mild to moderate OHSS had no significant difference, but moderate OHSS occurrence in Chinese medicine group was only 9.30%, seemed a trend of decreasing compared with the other two groups. The clinical and Laboratory outcomes among three groups had no difference of statistical meaning. [Conclusion] Through testing VEGF and E2 of patients at high risk of 0HSS, forecasts the occurrence of OHSS. Administrating Wenyang Jianpi Chinese medicine warms yang for activating qi-flowing and invigorates spleen for diuresis on early stage of ovarian stimulation can decrease the serum E 2 level on days of HCG injection, OPU, ET and decrease fol icular fluid VEGF level, avoid severe OHSS and has a trend of reducing total occurrence of OHSS as wel as moderate OHSS.