重度卵巢过度刺激综合征患者高凝趋势及预后分析

王璐; 穆莎; 左世栋; 杨怡卓; 王辉; 赵春草; 李晓晗; 焦明月; 彭红梅

doi:10.3969/j.issn.2095-5227.2022.04.004

摘要:

背景卵巢过度刺激综合征(ovarian hyperstimulation syndrome，OHSS)是在控制性超促排卵过程中使用促性腺激素产生的过度反应，是人工辅助生殖(assisted reproductive technology，ART)过程中最严重的并发症，其高凝问题特点和治疗还缺乏深入探讨。

目的探讨凝血指标在重度OHSS患者中的变化，分析高凝状态病因及治疗预后，以指导临床更好地预防血栓形成。

方法回顾性分析2017 - 2021年解放军总医院第一医学中心妇产科生殖中心行ART助孕治疗后发生重度OHSS入院接受干预患者的临床资料，分析其凝血酶时间(thrombin time，TT)、活化部分凝血活酶时间(activated partial thromboplastin time，APTT)、凝血酶原时间(prothrombin time，PT)、国际标准化比值(international standard ratio，INR)、凝血酶原活动度(prothrombin time activity，PTA)、血浆纤维蛋白原测定(fibrinogen，Fib)变化程度，以及红细胞比容(hematocrit，HCT)、白细胞计数(white blood cell，WBC)、中性粒细胞比例(neutrophil，NEUT%)、血小板计数(platelet，PLT)、血清白蛋白(albumin，ALB)、血清Na⁺、血清K⁺、尿量和胸腹腔引流液变化趋势及治疗预后。

结果共收集29例重度OHSS患者，平均年龄为(31.03±4.98)岁。凝血功能相关指标与发病前相比，TT略下降，PT略上升，Fib明显升高，差异有统计学意义(P均＜0.05)，而APTT、血浆凝血酶原活动度、INR等变化不明显；其他指标中，HCT、WBC明显升高，ALB及血清Na⁺明显降低(P均＜0.05)；Pearson相关性分析发现取卵数与PT延长呈正相关(r=0.380，P=0.042)，与腹腔引流液转归时间呈正相关(r=0.468，P=0.010)。29例患者均经腹腔穿刺引流、补液、抗凝等对症支持治疗后出院。

结论重度OHSS患者血液呈高凝状态，主要归因于血容量丢失导致的血液浓缩，且病情严重程度与取卵个数呈正相关，因此针对这类患者，核心诊疗手段应为科学的补液治疗，必要时辅以肝素、降纤酶等抗凝药物对症处理。

Abstract:

Background Ovarian hyperstimulation syndrome (OHSS) is an overreaction to the use of gonadotropin in the process of controlled ovarian hyperstimulation (COH), which is the most serious complication in assisted reproductive technology (ART). The characteristic of hypercoagulability and treatment of OHSS are still lack of in-depth discussion.

Objective To explore the changes of blood coagulation indexes in patients with severe OHSS and analyze the etiology of hypercoagulable state as well as treatment strategy and prognosis, so as to guide clinical practice to better prevent the risk of thrombosis. dexes in patients with severe OHSS and analyze the etiology of hypercoagulable state as well as treatment strategy and prognosis, so as to guide clinical practice to better prevent the risk of thrombosis.

Methods Clinical data about 29 patients hospitalized for severe OHSS in the Department of Obstetrics and Gynecology, the First Medical Center, Chinese PLA General Hospital from 2017 to 2021 were retrospectively analyzed. The changes of blood test indexes were collected before and after OHSS occurred, including thrombin time (TT), activated partial thromboplastin time (APTT), prothrombin time (PT), international standardized ratio (INR), prothrombin time activity (PTA), plasma fibrinogen determination (Fib), hematocrit (HCT), white blood cell (WBC), neutrophil (NEUT%), platelet (PLT), serum albumin (ALB), serum Na⁺, serum K⁺, urine volume, and thoracic or abdominal drainage volume. The treatment strategy and prognosis were also analyzed.

Results The patients’ average age was 31.03 ± 4.98 years. Compared with those before onset, the TT decreased slightly, PT increased slightly, and Fib increased significantly (P＜0.05), however, the APTT, PTA, and INR did not change significantly. In OHSS patients, HCT and WBC increased significantly, while ALB and serum Na⁺ decreased significantly (all P＜0.05). Pearson correlation analysis showed that the number of collected oocytes was positively correlated with the prolongation of PT (r=0.380, P=0.042) and the days took for abdominal drainage volume to recover (r=0.468, P=0.010). All patients were discharged after symptomatic supportive care, including abdominal puncture drainage, rehydration and anticoagulation.

Conclusion The blood of patients with severe OHSS is hypercoagulable, which is mainly due to the blood concentration caused by blood volume loss, and the severity of the disease is positively correlated with the number of collected oocytes. Therefore, for such patients, the core diagnosis and treatment method should be scientific rehydration treatment, supplemented with anticoagulant drugs such as heparin and defibrinogenase if necessary.

重度卵巢过度刺激综合征患者高凝趋势及预后分析

Hypercoagulability and prognosis in patients with severe ovarian hyperstimulation syndrome