中重度卵巢过度刺激综合征最佳预测因素的初步探讨
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摘要
目的探讨中、重度OHSS发生的最佳预测指标,以期更好地指导临床工作,降低中、重度OHSS的发生。方法回顾性分析2014年1月至2018年7月于本中心接受IVF/ICSI-ET治疗的5 225个周期的临床资料。选择发生中、重度OHSS进行住院治疗的45例患者作为OHSS组;选择同期接受IVF治疗、但未发生OHSS的53例患者作为非OHSS组。比较两组之间促排卵过程中的临床数据和实验室数据,并对筛选出的危险因素做回归分析,利用ROC曲线确定诊断界值。结果 (1)中、重度OHSS的发生率为0.86%,发生时间为取卵后(13.9±5.3)d;进行新鲜移植的患者为37例,均成功妊娠。(2)OHSS组的PCOS患者比例和窦卵泡数均显著高于非OHSS组(P<0.05);OHSS组的Gn用量、HCG日的E_2值和直径大于11mm的卵泡数均显著高于非OHSS组(P<0.05)。(3)窦卵泡数与OHSS发生有关,且为独立危险因素(P<0.05)。(4)ROC曲线显示AFC的诊断界值为≥16.5个,敏感性为70.5%,特异性为66%;HCG日直径大于11mm的卵泡数的诊断界值为≥13.5个,敏感性为79.5%,特异性为56.6%;HCG日E_2水平的诊断界值为≥13 347.79pmol/L。结论窦卵泡数≥16.5时能够更好地预测中、重度OHSS的发生,其次是HCG日直径在11mm以上的卵泡数≥13.5时能够较好的预测中、重度OHSS的发生。
Objective: To explore the best predictive factor of the moderate-severe ovarian hyperstimulation syndrome(OHSS).Methods:The data of 5 225 patients undergone IVF/ICSI cycles in our productive center from January2014 to July 2018 were retrospectively analyzed.Forty five patients who had moderate-severe OHSS were selected as OHSS group,and 53 patients without OHSS were selected as control group during the same period.Clinical and laboratory data were analyzed and compared between the two groups,and the risk factors were screened by regression analysis.The cutoff value was determined by ROC curve.Results:The incidence of moderate-severe OHSS was 0.86%in our center.OHSS often happened in(13.9±5.3)days after oocyte retrieval.Thirty seven patients with fresh embryo transfer were pregnancy successfully among the OHSS patients.The percentage of PCOS and the antral follicles count(AFC)inOHSS group were significantly higher than those in the control group(P<0.05).The total Gn dose,E_2 level and the number of follicles>11 mm on the HCG day were significantly higher than those in control group(P<0.05).The antral follicles count was related with OHSS and was the independent risk factor.The ROC curve showed that the cutoff value of AFC was≥16.5(70.5%sensitivity and 66%specificity).The cutoff value of the number of follicles>11 mm on the HCG day was≥13.5(79.5% sensitivity and56.6%specificity).The cutoff value of E_2 on the HCG day was≥13 347.79 pmol/L.Conclusions:Antral follicle count≥16.5 is the best predictive factor of occurrence of moderate-severe OHSS.Secondly,the number of follicles with diameter>11 mm on HCG day≥13.5 can also predict the occurrence of moderate and severe OHSS.
Objective: To explore the best predictive factor of the moderate-severe ovarian hyperstimulation syndrome(OHSS).Methods:The data of 5 225 patients undergone IVF/ICSI cycles in our productive center from January2014 to July 2018 were retrospectively analyzed.Forty five patients who had moderate-severe OHSS were selected as OHSS group,and 53 patients without OHSS were selected as control group during the same period.Clinical and laboratory data were analyzed and compared between the two groups,and the risk factors were screened by regression analysis.The cutoff value was determined by ROC curve.Results:The incidence of moderate-severe OHSS was 0.86%in our center.OHSS often happened in(13.9±5.3)days after oocyte retrieval.Thirty seven patients with fresh embryo transfer were pregnancy successfully among the OHSS patients.The percentage of PCOS and the antral follicles count(AFC)inOHSS group were significantly higher than those in the control group(P<0.05).The total Gn dose,E_2 level and the number of follicles>11 mm on the HCG day were significantly higher than those in control group(P<0.05).The antral follicles count was related with OHSS and was the independent risk factor.The ROC curve showed that the cutoff value of AFC was≥16.5(70.5%sensitivity and 66%specificity).The cutoff value of the number of follicles>11 mm on the HCG day was≥13.5(79.5% sensitivity and56.6%specificity).The cutoff value of E_2 on the HCG day was≥13 347.79 pmol/L.Conclusions:Antral follicle count≥16.5 is the best predictive factor of occurrence of moderate-severe OHSS.Secondly,the number of follicles with diameter>11 mm on HCG day≥13.5 can also predict the occurrence of moderate and severe OHSS.
引文
[1] Alper MM,Smith LP,Sills ES.Ovarian hyperstimulation syndrome:current views on pathophysiology,risk factors,prevention,and management[J].J Exp Clin Assist Reprod.2009,6:3.
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[3] Aboulghar M.Prediction of ovarian hyperstimulation syndrome(OHSS).Estradiol level has an important role in the prediction of OHSS[J].Hum Reprod,2003,18:1140-1141.
[4] Steward RG,Lan L,Shah AA,et al.Oocyte number as a predictor for ovarian hyperstimulation syndrome and live birth:an analysis of 256,381in vitro fertilization cycles[J].Fertil Steril,2014,101:967-973.
[5] Tarlatzi TB,Venetis CA,Devreker F,et al.What is the best predictor of severe ovarian hyperstimulation syndrome in IVF?A cohort study[J].J Assist Reprod Genet,2017,34:1341-1351.
[6]王含必,汤鲜,温晓晓,等.卵泡输出率在下丘脑垂体性闭经患者体外受精-胚胎移植中的应用研究[J].生殖医学杂志,2017,26:442-446.
[7] Practice Committee of the American Society for Reproductive Medicine.Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome:aguideline[J].Fertil Steril,2016,106:1634-1647.
[8] Sharara FI,McClamrock HD.High estradiol levels and high oocyte yield are not detrimental to in vitro fertilization outcome[J].Fertil Steril,1999,72:401-405.
[9] Griesinger G,Verweij PJ,Gates D,et al.Prediction of ovarian hyperstimulationsyndromeinpatientstreatedwith corifollitropin alfa or rFSH in a GnRH antagonist protocol[J/OL].PLoS One,2016,11:1-14.
[10] Kaiser UB.The pathogenesis of the ovarian hyperstimulation syndrome[J].N Engl J Med,2003,349:729-732.
[11] Montanelli L,Delbaere A,Di Carlo C,et al.A mutation in the follicle-stimulating hormone receptor as a cause of familial spontaneous ovarian hyperstimulation syndrome[J].J Clin Endocrinol Metab,2004,89:1255-1258.
[12] Ng EH,Tang OS,Ho PC.The significance of the number of antral follicles prior to stimulation in predicting ovarian responses in an IVF programme[J].Hum Reprod,2000,15:1937-1942.
[13]文彩荷,张润驹,江圣洁.中-重度卵巢过度刺激综合征的预测及其妊娠结局[J].医学研究杂志,2016,45:137-141.
[14] Swanton A,Storey L,McVeigh E,et al.IVF outcome in women with PCOS,PCO and normal ovarian morphology[J].Eur J Obstet Gynecol Reprod Biol,2010,149:68-71.
[15] Ocal P,Sahmay S,Cetin M,et al.Serum anti-Müllerian hormone and antral follicle count as predictive markers of OHSS in ART cycles[J].J Assist Reprod Genet,2011,28:1197-1203.
[16] Fleming R,Seifer DB,Frattarelli JL,et al.Assessing ovarian response:antral follicle count versus anti-Müllerian hormone[J/OL].Reprod Biomed Online,2015,31:486-496.
[17] Shahrokh Tehraninezhad E,Mehrabi F,Taati R,et al.Analysis of ovarian reserve markers(AMH,FSH,AFC)in different age strata in IVF/ICSI patients[J].Int J Reprod Biomed(Yazd),2016,14:501-506.
[18] Broer SL,Dólleman M,Opmeer BC,et al.AMH and AFC as predictors of excessive response in controlled ovarian hyperstimulation:a meta-analysis[J].Hum Reprod Update,2011,17:46-54.
[19] Kwee J,Elting ME,Schats R,et al.Ovarian volume and antral follicle count for the prediction of low and hyper responders with in vitro fertilization[J].Reprod Biol Endocrinol,2007,5:9.
[2] Papanikolaou EG,Pozzobon C,Kolibianakis EM,et al.Incidence and prediction of ovarian hyperstimulation syndrome in women undergoing gonadotropin-releasing hormone antagonist in vitro fertilization cycles[J].Fertil Steril,2006,85:112-120.
[3] Aboulghar M.Prediction of ovarian hyperstimulation syndrome(OHSS).Estradiol level has an important role in the prediction of OHSS[J].Hum Reprod,2003,18:1140-1141.
[4] Steward RG,Lan L,Shah AA,et al.Oocyte number as a predictor for ovarian hyperstimulation syndrome and live birth:an analysis of 256,381in vitro fertilization cycles[J].Fertil Steril,2014,101:967-973.
[5] Tarlatzi TB,Venetis CA,Devreker F,et al.What is the best predictor of severe ovarian hyperstimulation syndrome in IVF?A cohort study[J].J Assist Reprod Genet,2017,34:1341-1351.
[6]王含必,汤鲜,温晓晓,等.卵泡输出率在下丘脑垂体性闭经患者体外受精-胚胎移植中的应用研究[J].生殖医学杂志,2017,26:442-446.
[7] Practice Committee of the American Society for Reproductive Medicine.Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome:aguideline[J].Fertil Steril,2016,106:1634-1647.
[8] Sharara FI,McClamrock HD.High estradiol levels and high oocyte yield are not detrimental to in vitro fertilization outcome[J].Fertil Steril,1999,72:401-405.
[9] Griesinger G,Verweij PJ,Gates D,et al.Prediction of ovarian hyperstimulationsyndromeinpatientstreatedwith corifollitropin alfa or rFSH in a GnRH antagonist protocol[J/OL].PLoS One,2016,11:1-14.
[10] Kaiser UB.The pathogenesis of the ovarian hyperstimulation syndrome[J].N Engl J Med,2003,349:729-732.
[11] Montanelli L,Delbaere A,Di Carlo C,et al.A mutation in the follicle-stimulating hormone receptor as a cause of familial spontaneous ovarian hyperstimulation syndrome[J].J Clin Endocrinol Metab,2004,89:1255-1258.
[12] Ng EH,Tang OS,Ho PC.The significance of the number of antral follicles prior to stimulation in predicting ovarian responses in an IVF programme[J].Hum Reprod,2000,15:1937-1942.
[13]文彩荷,张润驹,江圣洁.中-重度卵巢过度刺激综合征的预测及其妊娠结局[J].医学研究杂志,2016,45:137-141.
[14] Swanton A,Storey L,McVeigh E,et al.IVF outcome in women with PCOS,PCO and normal ovarian morphology[J].Eur J Obstet Gynecol Reprod Biol,2010,149:68-71.
[15] Ocal P,Sahmay S,Cetin M,et al.Serum anti-Müllerian hormone and antral follicle count as predictive markers of OHSS in ART cycles[J].J Assist Reprod Genet,2011,28:1197-1203.
[16] Fleming R,Seifer DB,Frattarelli JL,et al.Assessing ovarian response:antral follicle count versus anti-Müllerian hormone[J/OL].Reprod Biomed Online,2015,31:486-496.
[17] Shahrokh Tehraninezhad E,Mehrabi F,Taati R,et al.Analysis of ovarian reserve markers(AMH,FSH,AFC)in different age strata in IVF/ICSI patients[J].Int J Reprod Biomed(Yazd),2016,14:501-506.
[18] Broer SL,Dólleman M,Opmeer BC,et al.AMH and AFC as predictors of excessive response in controlled ovarian hyperstimulation:a meta-analysis[J].Hum Reprod Update,2011,17:46-54.
[19] Kwee J,Elting ME,Schats R,et al.Ovarian volume and antral follicle count for the prediction of low and hyper responders with in vitro fertilization[J].Reprod Biol Endocrinol,2007,5:9.