本文關(guān)鍵詞：控制性卵巢刺激對(duì)不孕患者促甲狀腺激素的影響　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 體外受精胚胎移植 控制性卵巢刺激方案 促性腺激素釋放激素激動(dòng)劑 促甲狀腺激素 妊娠結(jié)局

【摘要】：目的:研究甲狀腺功能正常的不孕患者行體外受精/單精子細(xì)胞內(nèi)注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)過程中應(yīng)用長效促性腺激素釋放激素激動(dòng)劑(gonadotropin releasing hormone agonist,GnRH-a)降調(diào)后促甲狀腺激素(thyrotropin,thyroid stimulating hormone,TSH)的改變及后續(xù)的控制性促排卵(controlled ovarian stimulation,COS)過程中TSH變化趨勢,并探討不同TSH界值對(duì)妊娠結(jié)局的影響。材料與方法:本研究為前瞻性隊(duì)列研究。選擇2016年1月~2016年12月于河北醫(yī)科大學(xué)第二醫(yī)院生殖醫(yī)學(xué)中心行IVF/ICSI助孕的甲狀腺功能正常(0.35mIU/LTSH4.5mIU/L;An-TPOAb35IU/ml;2.76pmol/LFT36.45pmol/L;8.75pmol/LFT422pmol/L)且無甲狀腺疾病史的患者207例。COS方案均選擇長效促性腺激素釋放激素激動(dòng)劑長方案(long GnRH-a protocol,長效長方案)。根據(jù)基礎(chǔ)血清TSH值分為A組(0.35mIU/LTSH2.5mIU/L,N=137人)和B組(2.5mIU/L≤TSH4.5mIU/L,N=70人)。分別于6個(gè)時(shí)間點(diǎn)檢測血清TSH水平:(1)COS前(月經(jīng)2-5天,注射GnRH-a前)(2)Gn第1天(注射GnRH-a后)(3)Gn第5天(4)HCG日(5)移植后14天(6)移植后28天。觀察長效Gn RH-a注射前后血清TSH變化,分析GnRH-a降調(diào)對(duì)于甲狀腺功能的影響,進(jìn)一步連續(xù)觀察使用促性腺激素(Gn)后血清TSH的變化,分析TSH值不同的助孕患者臨床妊娠率和流產(chǎn)率,了解基礎(chǔ)TSH值對(duì)于IVF/ICSI助孕結(jié)局有無影響。應(yīng)用SPSS19.0統(tǒng)計(jì)學(xué)軟件進(jìn)行數(shù)據(jù)分析,P0.05表示差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:兩組患者的年齡、BMI、不孕年限等一般條件均衡可比(P0.05)。(1)注射長效GnRH-a后血清TSH值比注射前升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。A組與B組均表現(xiàn)為注射后血清TSH升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。207例患者血清TSH升高者131人(63.3%),其中TSH4.5 mIU/L者20人(15.3%);降低者76人(36.7%),其中2人TSH0.35mIU/L(2.6%)。17人(8.2%)TPOAb高于正常值。A組血清TSH升高者79人(57.7%),3人(3.8%)TPOAb高于正常值,TSH4.5mIU/L者共4人(5.1%);TSH降低者58人(42.3%),TSH0.35mIU/L者1人,伴隨TPOAb高于正常值。B組TSH升高者52人(74.3%),13人(25.0%)TPOAb高于正常值,TSH4.5 mIU/L者共16人(30.8%);TSH降低者18人(25.7%),其中1人TSH0.35mIU/L。兩組相比,B組TSH升高人數(shù)比例高于A組,有統(tǒng)計(jì)學(xué)差異(P0.05)。(2)使用促性腺激素(Gn)過程中,A組與B組的血清TSH值均呈現(xiàn)出升高的趨勢,高于血清激素基礎(chǔ)值(time1),并于HCG日達(dá)到峰值,后略有回落。(3)A組臨床妊娠率高于B組,結(jié)果有統(tǒng)計(jì)學(xué)差異(P0.05),B組流產(chǎn)率低于A組,但無統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:GnRH-a垂體降調(diào)節(jié)可使不孕癥患者血清TSH升高。對(duì)于個(gè)體而言,血清TSH水平變化多種多樣,嚴(yán)重者出現(xiàn)亞臨床甲狀腺功能亢進(jìn)癥、亞臨床甲狀腺減退癥和自身免疫性甲狀腺疾病等表現(xiàn)。血清TSH2.5mIU/L的不孕患者更容易受到GnRH-a的影響。使用促性腺激素后,血清TSH值呈現(xiàn)升高趨勢。基礎(chǔ)TSH2.5mIU/L者,在接受IVF/ICSI助孕時(shí)可能獲得更高的臨床妊娠率。
[Abstract]:Objective: to study in vitro fertilization / intracytoplasmic sperm injection-embryo transfer in infertile patients with normal thyroid function. In vitro fertilization/intracytoplasmic sperm injection-embryo. Transfer. The use of long-acting gonadotropin releasing hormone agonists in IVF / ICSI-ETS. Gonadotropin releasing hormone agonist. The thyrotropin stimulating hormone was decreased by GnRH-a. The change of TSHs and the trend of TSH changes in the process of controlled ovarian stimulation (COSs). The effects of different TSH cutoff values on pregnancy outcome were discussed. Materials and methods:. This study was a prospective cohort study. The thyroid function of IVF/ICSI pregnant women was normal from January 2016 to December 2016 at the Reproductive Medicine Center of the second Hospital of Hebei Medical University. 0.35mIUP LTSH4.5mIUP / L; An-TPOAb35IUP / ml; 2.76 pmol / L FT 36.45 pmol / L; A total of 207 patients with no history of thyroid disease (8.75pmol / L FT 422pmol / L) selected a long-acting gonadotropin releasing hormone agonist regimen (. Long GnRH-a protocol. According to the basic serum TSH value, group A was divided into two groups: group A: 0.35mIUs / LTSH2.5mIUP / L. (n = 137) and group B (2.5 MIUL 鈮，

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