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目的探讨米非司酮预防早发型卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)的临床效果。方法 OHSS高危行全胚胎玻璃化冷冻患者90例,随机分为观察组43例和对照组47例,观察组自取卵日起口服米非司酮25mg/d,连续5d,对照组给予安慰剂1片/d,连续5d。比较2组患者中重度OHSS发生率、人绒毛膜促性腺激素注射日及注射后第5、8、10天血清孕酮、血管内皮生长因子(vascular endothelial growth factor,VEGF)水平。结果人绒毛膜促性腺激素注射后第8、10天,观察组血清孕酮水平[(46.85±6.89)、(7.72±3.67)μg/L]与对照组[(50.72±10.41)、(8.73±4.87)μg/L]比较差异均无统计学意义(P>0.05);人绒毛膜促性腺激素注射后第5、8、10天,观察组血清VEGF水平[(77.25±14.26)、(62.23±13.59)、(50.52±9.52)ng/L]明显低于对照组[(109.25±19.70)、(126.17±14.38)、(145.25±15.52)ng/L](P<0.05);观察组中重度OHSS发生率(2.33%)低于对照组(12.77%),但差异无统计学意义(P>0.05)。结论对需行全胚玻璃化冷冻的OHSS高危患者,取卵即日连续5d口服米非司酮可降低VEGF水平,有助于降低早发型OHSS发生率。
Objective To investigate the clinical efficacy of mifepristone in preventing ovarian hyperstimulation syndrome (OHSS). Methods 90 patients with high-risk and full-life vitrified OHSS were randomly divided into observation group (n = 43) and control group (n = 47). Mifepristone (25mg / d) was given orally for 5 days in observation group and placebo 1 piece / d, continuous 5d. The incidences of severe OHSS, human chorionic gonadotrophin injection and the serum progesterone and vascular endothelial growth factor (VEGF) levels on the 5th, 8th and 10th day after injection were compared between the two groups. Results Serum progesterone levels in the observation group [(46.85 ± 6.89), (7.72 ± 3.67) μg / L] were significantly higher than those in the control group [(50.72 ± 10.41), (8.73 ± 4.87) μg / L] (P> 0.05). On the 5th, 8th and 10th day after human chorionic gonadotrophin injection, the serum levels of VEGF in the observation group [(77.25 ± 14.26) and (62.23 ± 13.59), (50.52 ± 9.52) ng / L] in the observation group was significantly lower than that in the control group [(109.25 ± 19.70), (126.17 ± 14.38), (145.25 ± 15.52) ng / L] The incidence rate (2.33%) was lower than that of the control group (12.77%), but the difference was not statistically significant (P> 0.05). Conclusion OHSS high risk patients who require vitrification of whole embryo orally take orally mifepristone for 5 consecutive days can reduce the level of VEGF and help to reduce the incidence of early-onset OHSS.