抑郁、焦虑等和IVF结果之间联系

链接：http://www.news-medical.net/news/20160308/New-study-assesses-link-between-depression-anxiety-and-antidepressants-and-outcome-of-IVF.aspx

瑞典Karolinska学院的一项新研究发现，抑郁和焦虑会在IVF治疗中降低妊娠和活胎出生率，而这一现象并不一定是由抗抑郁药物导致的。该研究结果最近发表在杂志《生殖和不孕不育》上。对于那些正在治疗不孕不育患者的临床医生以及患有抑郁症或焦虑症的妇女而言，这篇文章可能提供有帮助的信息。

在过去的几十年中，在普通人群及育龄妇女中采用抗抑郁药进行治疗的比例都有所上升。特别需要指出的是，选择性5-羟色胺再摄取抑制剂（SSRIs）的使用量显著增加。然而，抗抑郁药对生殖能力及怀孕能力的影响仍旧鲜为人知。

本文所述研究随访了超过23,000名女性，因此这是迄今为止最大规模对抑郁症、焦虑症及抗抑郁药物与IVF结果之间关联性所做的研究。在该研究中，研究人员使用了来自瑞典辅助生殖质量登记局的匿名数据，并且调查了瑞典境内从2007以来所有的IVF治疗记录。研究人员将这些IVF信息与瑞典全国范围的患者和处方药登记记录内与抑郁症和焦虑症有关的信息做了关联性研究。研究发现，这项研究所采纳的所有女性样本中，4.4%在开始IVF疗程的前两年有抑郁症或焦虑症的确诊经历，或者在IVF周期开始前六个月内有过开具抗抑郁药的历史。研究人员计算了这些有抑郁症相关经历的女性中妊娠率、活产率及流产率，并将其与那些没有抑郁症的女性中相关数据进行对比。“我们发现，如果在接受她们的第一个IVF周期之前便已经被确诊为抑郁症或者焦虑症患者，或者在此之前服用过抗抑郁症药物，则这些女性比那些没有抑郁症经历的女性有较低的妊娠率和活产率”，该研究的第一作者、流行病学和生物统计学系博士生Carolyn Cesta说：“最重要的是，我们发现那些虽然被确诊为抑郁症或焦虑症但没有服用抗抑郁药的妇女有最低的怀孕率及活胎率。”

SSRIs抗抑郁药是瑞典最常见的抗抑郁药类型。虽然在当前对于那些服用SSRIs的女性所做的大规模研究中，并没有发现SSRIs对患者IVF周期的妊娠率或活胎率有任何影响。然而，另有一些女性服用SSRIs之外的抗抑郁药，虽然她们的数量较小，但她们通常有更复杂的抑郁或焦虑症病情。研究发现这些女性的IVF怀孕率和活胎率都比对照组有所降低，并且有更高的流产风险。“总之，这些结果表明，抑郁症和焦虑症的诊断可能是导致这些女性患者低妊娠率和活产率的潜在因素，”该研究的首席研究员、流行病学和生物统计学系副教授Anastasia Nyman Iliadou说。不过，她警告说，因为该研究不是完全随机的，因此相关结果也可能是由于不可测的生活方式及与抑郁症和焦虑症有关的遗传因素导致的。

New study assesses link between depression, anxiety and antidepressants and outcome of IVF

Depression and anxiety, and not necessarily the use of antidepressant medication, are associated with lower pregnancy and live birth rates following in vitro fertilisation, according to a large register study from Karolinska Institutet in Sweden. The findings are published in the journal Fertility & Sterility and can be of interest to clinicians treating infertility and for women with depression or anxiety planning to undergo fertility treatment.

Treatment with antidepressants has increased both in general and among women of reproductive age in the last few decades. In particular, the use of selective serotonin re-uptake inhibitors, SSRIs, has increased. However, little is known about the effect of antidepressants on fertility and the ability to conceive.

The new study, including more than 23,000 women, is the largest so far assessing the association between depression, anxiety and antidepressants and the outcome of in vitro fertilisation, IVF. The investigators used anonymized data on all IVF procedures performed in Sweden from 2007 and onwards, extracted from the Swedish Quality Register of Assisted Reproduction. They linked it to information on depression, anxiety and antidepressant prescription dispensations from the nationwide Swedish Patient and Prescribed Drug Registers.

Of all women in the study, 4.4 per cent had a depression or anxiety diagnosis in the two years before the start of their IVF cycle and/or an antidepressant dispensation in the six months prior to the cycle start. The researchers compared the rates of pregnancy, live birth and miscarriage in these women to rates in women without a diagnosis or antidepressant dispensation.

"We found that women undergoing their first IVF treatment who either had been diagnosed with depression or anxiety or had dispensed an antidepressant had lower rates of pregnancy and live birth rates compared to women who did not suffer from these conditions or take antidepressants before beginning their IVF treatment", says first author Carolyn Cesta, doctoral student at the Department of Medical Epidemiology and Biostatistics. "Importantly, we found that women with a depression or anxiety diagnosis without a prescription of antidepressants had an even lower chance of becoming pregnant or having a live birth."

SSRIs are the most common type of antidepressant prescribed in Sweden. In the large group of women in the current study taking SSRIs, there was no difference in pregnancy or live birth rates following IVF treatment. However, the small group of women taking antidepressants other than SSRIs, who had more complex cases of depression and anxiety, had reduced odds of pregnancy and live birth as well as an increased risk for miscarriage following their IVF treatment.

"Taken together, these results indicate that the depression and anxiety diagnoses may be the underlying factor leading to lower pregnancy and live birth rates in these women", says the study's principal investigator Anastasia Nyman Iliadou, associate professor at the Department of Medical Epidemiology and Biostatistics.

However, she cautions that since the study was not randomised the results could also be explained by unmeasured lifestyle and/or genetic factors associated with depression and anxiety.

（文章来自沈阳九州医院官方网站）