CAJ | 학술논문

目的：比较不同促排卵方案在多囊卵巢综合征（ PCOS）患者行体外受精-胚胎移植（ IVF-ET）中的应用效果。方法104例PCOS患者随机分为两组：促性腺激素释放激素（ GnRH）拮抗剂组41例和GnRH激动剂长方案（对照组）63例，统计比较两组促性腺激素（ Gn）的用量及用药天数、人绒毛膜促性腺激素（ HCG）日的雌二醇（ E2）、黄体生成素（LH）水平、获卵数、受精率、卵裂率、优胚率、种植率、临床妊娠率、周期取消率和卵巢过度刺激综合征（OHSS）的发生率。结果两组的获卵数、受精率、卵裂率、优胚率、临床妊娠率、种植率比较均无明显差异（P﹥0.05）；GnRH拮抗剂组的Gn使用量及天数均少于对照组（P﹤0.05）；GnRH拮抗剂组HCG日的E2水平低于对照组（P﹤0.05）；GnRH拮抗剂组HCG日LH水平高于对照组（P﹤0.05）；GnRH拮抗剂组的周期取消率4.88％低于对照组的25.40％（P﹤0.05），GnRH拮抗剂组的OHSS发生率2.44％低于对照组的12.70％（P﹥0.05）。结论 GnRH拮抗剂方案较GnRH激动剂长方案能减少周期取消率、降低OHSS发生风险，而获卵数、受精率、卵裂率、优胚率、临床妊娠率、种植率方面不受影响；GnRH拮抗剂方案能缩短治疗时间、减少治疗费用，具有较好的安全性和有效性，对PCOS患者行IVF-ET是一种比较理想的选择。
목적：비교불동촉배란방안재다낭란소종합정（ PCOS）환자행체외수정-배태이식（ IVF-ET）중적응용효과。방법104례PCOS환자수궤분위량조：촉성선격소석방격소（ GnRH）길항제조41례화GnRH격동제장방안（대조조）63례，통계비교량조촉성선격소（ Gn）적용량급용약천수、인융모막촉성선격소（ HCG）일적자이순（ E2）、황체생성소（LH）수평、획란수、수정솔、란렬솔、우배솔、충식솔、림상임신솔、주기취소솔화란소과도자격종합정（OHSS）적발생솔。결과량조적획란수、수정솔、란렬솔、우배솔、림상임신솔、충식솔비교균무명현차이（P﹥0.05）；GnRH길항제조적Gn사용량급천수균소우대조조（P﹤0.05）；GnRH길항제조HCG일적E2수평저우대조조（P﹤0.05）；GnRH길항제조HCG일LH수평고우대조조（P﹤0.05）；GnRH길항제조적주기취소솔4.88％저우대조조적25.40％（P﹤0.05），GnRH길항제조적OHSS발생솔2.44％저우대조조적12.70％（P﹥0.05）。결론 GnRH길항제방안교GnRH격동제장방안능감소주기취소솔、강저OHSS발생풍험，이획란수、수정솔、란렬솔、우배솔、림상임신솔、충식솔방면불수영향；GnRH길항제방안능축단치료시간、감소치료비용，구유교호적안전성화유효성，대PCOS환자행IVF-ET시일충비교이상적선택。
Objective To compare in vitro fertilization and embryo transfer( IVF-ET ) outcome of gonadotropin-releasing hormone( GnRH ) antagonist protocol and GnRH agonist long protocol in patients with polycystic ovary syndrome ( PCOS)and to provide reference for rational selection of ovulation stimulation protocol for PCOS patients. Methods One hundred and four patients with PCOS who underwent IVF-ET were randomly divided into two groups. In the study group,41 patients were subjected to the GnRH antagonist protocol;In the control group,63 patients were subjected to a long protocol of GnRH agonist. Doses and duration of gonadotropin therapy,the thickness of endometrium and the profile of hormone level on the day of HCG administration,the number of retrieved oocytes,the ratio of fertilization,the ratio of cleavage,the ratio of the good quantity embryos,implantation rate of embryo,pregnancy rate,the cycle cancellation rate and the incidence rate of ovarian hyperstimulation syndrome( OHSS)were recorded. Results The IVF-ET outcome of the two groups was similar with respects to the number of oocytes,the ratio of fertilization,the ratio of cleavage,implantation rate of embryo and the pregnancy rate( P﹥0. 05). Significant differences were found(P﹤0. 05)between the two groups regarding to the doses and duration of gonadotropin therapy,the levels of serum E2 and LH on the day of HCG administration,and the cycle cancellation rate. The incidence rate of OHSS was not significantly different ( 2. 44% vs. 12. 70%) between the two groups. Conclusion The duration of gonadotropins administration,the cycle cancellation rate,incidence of OHSS and the financial burdern are reduced in patients treated with GnRH antagonist. The growth of follicle,the ratio of fertilization,the ratio of cleavage,implantation rate of embryo and the pregnancy rate are not different between the two methods. The GnRH antagonist protocol is optimal for patients with PCOS.