來曲唑治療卵巢過度刺激綜合征的臨床研究
發(fā)布時間：2018-07-31 19:35
【摘要】：目的1.評估黃體期應(yīng)用來曲唑(letrozole,LE)能否有效的降低體外受精(In vitro fertilization,IVF)過程發(fā)生卵巢過度刺激征(ovarian hyperstimulation syndrome,OHSS)的高危患者黃體期雌激素的水平以及預(yù)防OHSS的發(fā)生和嚴重程度。2.探討血管活性物質(zhì)血清白介素-6(Interleukin,IL-6)、白介素-8(Interleukin,IL-8)、腫瘤壞死因子-a(Tumor necrosis factor,TNF-a)的水平在黃體期不同用藥治療后的變化。方法選取2016年1月-2016年10月年于安徽醫(yī)科大學(xué)第一附屬醫(yī)院婦產(chǎn)科生殖中心行IVF/ICSI(長方案)治療的OHSS高�；颊�156人,將OHSS高危患者作為受試對象隨機給予4種不同藥物連續(xù)治療五天,分別為:A組(n=38):Gn RH-A+羥乙基淀粉(hydroxyethyl starch,HES)+葡萄糖酸鈣(Calcium gluconate,Ca)治療組,B組(n=39):來曲唑(letrozole,LE)+HES+Ca治療組,C組(n=39):對照組即HES+Ca治療組,D組(n=40):溴隱亭(bromocriptine,BC)+HES+Ca治療組。所有受試對象于取卵日(d1天)記錄陰道超聲下卵泡總數(shù),并留取卵泡液。取卵后d2、d4、d6天測量四組患者的卵巢的體積(V=D1x D2x D3x0.523)和盆腔積液、黃體期甾體激素水平(FSH、E2、LH、P)、細胞因子(IL-6,IL-8和TNF-a)的變化,比較四組OHSS高危患者OHSS的發(fā)生率以及嚴重程度。該項臨床治療研究已經(jīng)我院倫理委員會批準,并且所有受試對象均簽署患者知情同意書。結(jié)果(1)四組d2、d4、d6天血清E2的比較B組d2天的血清E2水平明顯低于A組、C組、D組(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),差異有統(tǒng)計學(xué)意義(p0.05);B組d4天的E2血清水平明顯低于A組、C組、D組(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),其差異有統(tǒng)計學(xué)意義(p0.05);B組d6天的血清E2水平明顯低于A組、C組、D組(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),其差異有統(tǒng)計學(xué)意義(p0.05)。C組的血清E2水平明顯低于A組,差異有統(tǒng)計學(xué)意義。(2)血清E2水平在d2、d4、d6天與OHSS嚴重程度的關(guān)系d2天、d4、d6天血清E2水平在中、重度OHSS患者水平明顯高于輕度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),差異有統(tǒng)計學(xué)意義(p0.05)。(3)四組d2、d4、d6天血清中的細胞因子的變化四組血清中IL-6、IL-8水平在d2天、d6天均無統(tǒng)計學(xué)差異(IL-6:p=0.1600.05;IL-8:p=0.0760.05);而d4天血清IL-6在B組明顯低于C組、D組,差異有統(tǒng)計學(xué)意義(14.69±1.20 vs 20.05±1.46 vs 21.10±2.07,p0.05),血清IL-8在B組明顯低于A組、D組,差異有統(tǒng)計學(xué)意義(17.54±1.72 vs 25.55±2.24 vs 28.94±3.07,p0.05)。(4)四組OHSS發(fā)生率及嚴重程度的比較比較A、B、C、D組四組中、重度OHSS的發(fā)生率,其中A組38例患者中發(fā)生輕度OHSS 19例,中度OHSS 9例,重度OHSS 10例;B組39例患者中發(fā)生輕度OHSS 33例,中度OHSS 4例,重度OHSS 2例;C組39例患者中發(fā)生輕度OHSS20例,中度OHSS 10例,重度OHSS 9例;D組40例患者中發(fā)生輕度OHSS 22例,中度OHSS 9例,重度OHSS 9例。結(jié)果表明:B組治療后發(fā)生輕、中重度OHSS發(fā)生率明顯低于其它3組,差異有統(tǒng)計學(xué)意義(p0.05)。結(jié)論來曲唑可以通過明顯降低取卵后黃體期雌激素的水平并且降低中、重度OHSS的發(fā)生率,為卵巢過度刺激綜合征提供了一個更好的治療方式
[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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.8
本文編號：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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.8
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