目的 探讨体外受精-胚胎移植(IVF)助孕中长方案人绒毛膜促性腺激素(hCG)注射前后血清雌二醇(E2)水平变化对临床结局的预测价值.方法 选择2012年1月至2015年12月在南京大学医学院附属鼓楼医院采用长效长方案降调节IVF-ET治疗不孕症的患者1440例进行回顾性分析,测定IVF治疗周期中hCG扳机当日及hCG扳机后一日E2水平变化情况,即hCG后一日与hCG日血清E2的差值除以hCG日血清E2值.根据增幅不同分成3组:453例(A组)E2水平降低 ≥10％,584例E2水平变化介于 ±10％(B组),403例(C组)E2水平升高 ≥10％.比较各组患者临床资料及妊娠结局之间的关系.结果 三组患者年龄 、BMI、不孕年限 、基础FSH、基础E2、基础窦卵泡数 、内膜厚度 、hCG日E2、优质胚胎冷冻数 、早期流产率差异均无统计学意义(F/χ2=0.091～2.790,均P>0.05).A组和B组临床妊娠率 、植入率 、多胎妊娠率 、健康婴儿出生率差异均无统计学意义(χ2值分别为0.683、2.993、2.180、0.592,均P>0.05),两组均显著低于C组(χ2值分别为19.095、33.158、11.94、8.258,均P<0.05).三组间Gn总量 、Gn促排时间 、hCG后一日E2水平 、优质卵子获取数差异均有统计学意义(F值分别为71.447、14.496、71.458、19.401,均P<0.05).结论 长效长方案垂体降调节IVF-ET患者中E2水平的变化对妊娠结局有一定的影响,E2水平在hCG扳机后一日较当日幅度 ≥10％ 以上,患者Gn使用少,促排时间相对短,获取优质卵子数目多,临床妊娠率 、健康婴儿出生率高,临床结局良好.hCG扳机后E2水平变化可作预判IVF助孕结局的一个参考指标.%Objective To investigate the value of serum estradiol (E2 ) change after human chorionic gonadotropin (hCG ) administration in predicting the clinical outcome in long protocol in vitro fertilization-embryo transfer (IVF-ET ) .Methods A retrospective analysis was done on 1440 infertile patients who received long acting long protocol down regulation IVF-ET in Drum Tower Hospital Affiliated to Nanjing University School of Medicine from January 2012 to December 2015 .Estradiol level change between the day of hCG administration and one day after hCG administration was detected ,that was the difference of E2 between one day after hCG administration and hCG administration day divided by E2 value on hCG administration day .Patients were divided into three groups based on E2 change ,with 453 cases exhibiting E2 reduction ≥ 10％ in group A ,584 cases showing E2 change at ± 10％ in group B and 403 cases revealing E2 increase ≥ 10％ in group C .Clinical data and pregnancy outcomes in every group were compared .Results There were no significant differences in age ,BMI ,duration of infertility ,basic FSH ,E2 ,basic antral follicle count ,endometrial thickness ,E2 level on the day of hCG ,number of high quality frozen embryos ,early abortion rate in three groups (F/χ2 value ranged 0 .091 - 2 .790 ,all P > 0 .05) .Differences in clinical pregnancy rate ,embryo implantation rate ,multiple pregnancy rate and healthy infant birth rate in group A and B had no statistical significance (χ2 value was 0 .683 ,2 .993 ,2 .180 and 0 .592 ,respectively ,all P > 0 .05) .Clinical pregnancy rate ,embryo implantation rate ,multiple pregnancy rate and healthy infant birth rate in group A and B were significantly lower than those in group C (χ2 value was 19 .095 ,33 .158 ,11 .94 and 8 .258 , respectively ,all P < 0 .05) .There were significant differences in Gn total dose ,Gn ovulation induction time ,E2 level at one day after hCG administration , high quality oocyte number in three groups ( F value was 71 .447 ,14 .496 , 71 .458 and 19 .401 , respectively ,all P < 0 .05) .Conclusion Variation of serum E2 level has some impact on clinical outcome of patients receiving long acting long protocol pituitary down regulation IVF-ET .Patients whose E2 level at one day after hCG increases by ≥ 10％ compared with that on the day of hCG have less Gn dosage ,shorter ovulation induction time ,more high quality oocyte ,higher clinical pregnancy rate and healthy infant birth rate and good clinical outcome .E2 level change after hCG administration can be a reference for IVF outcome judgement .
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