Vlahos Nikos F, Gregoriou Odysseas
Second Department of Obstetrics and Gynicology, Aretaieion Hospital, National Kapodestrian University of Athens, School of Medicine, Greece.
Ann N Y Acad Sci. 2006 Dec;1092:247-64. doi: 10.1196/annals.1365.021.
The Ovarian Hyperstimulation Syndrome (OHSS) represents one of the biggest nightmares of all physicians involved in Assisted Reproductive Technologies (ART). Every year, several hundreds of women are hospitalized and to date several deaths have been reported. The pivotal event in the development of OHSS is the disruption of capillary integrity that results in leakage of intravascular fluid and proteins into third space. On the molecular level, human chorionic godadotropin (HCG) either exogenous or endogenous, functions as the triggering point for the production of vascular endothelial growth factor (VEGF) that is the main mediator to increase permeability on the vascular bed. Spontaneous OHSS has also been reported, either due to inappropriate activation of a mutant FSH receptor or due to very high levels of HCG during pregnancy. The available evidence on the several preventive and therapeutic approaches with special attention to level 1 evidence when available is also presented. OHSS is a self-resolving condition and the main role of the physician is to correct and maintain the intravascular volume, to support renal function and respiration and prevent thrombotic events. An algorithm on the management of OHSS on an outpatient basis and in the hospital is based on the previous mentioned principles.
卵巢过度刺激综合征（OHSS）是所有从事辅助生殖技术（ART）的医生最担心出现的情况之一。每年都有数百名女性因此住院，迄今为止已有数例死亡报告。OHSS发生过程中的关键事件是毛细血管完整性遭到破坏，导致血管内液体和蛋白质渗漏到第三间隙。在分子水平上，外源性或内源性人绒毛膜促性腺激素（HCG）是产生血管内皮生长因子（VEGF）的触发因素，而VEGF是增加血管床通透性的主要介质。也有关于自发性OHSS的报道，其原因要么是突变的促卵泡激素（FSH）受体激活不当，要么是孕期HCG水平过高。本文还介绍了几种预防和治疗方法的现有证据，如有一级证据则会特别关注。OHSS是一种可自行缓解的病症，医生的主要职责是纠正并维持血管内容量、支持肾功能和呼吸功能以及预防血栓形成事件。基于上述原则制定了OHSS门诊及住院管理的流程。
