摘要
目的：探讨不同剂量来曲唑联合氯米芬对不孕多囊卵巢综合征（PCOS）患者助孕和生殖激素变化的影响。方法：选取2012年1月～2014年1月该院收治的PCOS患者150例为研究对象,按数字随机法分为A组、B组和C组,每组50例。另选取同期月经正常的育龄妇女30例作为对照组。A组、B组和C组均于月经周期或黄体酮撤药性出血第3～5天口服氯米芬100 mg/d和来曲唑,A组、B组和C组来曲唑的剂量分别为2.5 mg/d、5.0 mg/d和7.5 mg/d。监测4组卵泡发育情况,并在A组、B组和C组最大卵泡直径〉18 mm时应用人绒毛膜促性腺激素（h CG）诱发排卵。取h CG日空腹静脉血测定4组生殖激素水平,并统计分析4组排卵情况、排卵率、妊娠率及子宫内膜厚度等。结果：与对照组比较,A组、B组和C组黄体生成素、雌二醇及卵泡刺激素等生殖激素水平均降低,睾酮水平则升高;C组黄体生成素、雌二醇及卵泡刺激素等生殖激素水平高于A组和B组,睾酮水平低于A组和B组,且B组黄体生成素、雌二醇及卵泡刺激素等生殖激素水平也高于A组,睾酮水平低于A组,差异有统计学意义（P〈0.05）。4组成熟卵泡数、优势卵泡数、子宫内膜厚度和排卵率比较差异均无统计学意义（P〉0.05）。对照组成熟卵泡直径大于A组、B组和C组,C组成熟卵泡直径也大于A组和B组,且B组成熟卵泡直径也大于A组（P〈0.05）。A组、B组、C组和对照组的妊娠率分别为10.00%、30.00%、40.00%和53.33%,对照组妊娠率高于A组、B组和C组,C组妊娠率也高于A组和B组,且B组妊娠率也高于A组（P〈0.05）。结论：来曲唑联合氯米芬治疗PCOS患者的助孕效果较好,可促进生殖激素的分泌,且不会影响子宫内膜正常生长,其中以连续3天剂量为7.5 mg/d来曲唑联合氯米芬治疗的效果最优,值得临床推广使用。
Objective： To explore the effects of different doses of letrozole combined with clomifene on assisted reproduction and reproductive hormones changes of patients with polycystic ovary syndrome（ PCOS）. Methods： A total of 150 PCOS patients were selected from the hospital from January 2012 to January 2014,then they were divided into group A,group B,and group C according to random number table,50 patients in each group. Thirty women of childbearing age with normal menstruation were selected as control group during the same period. The patients in group A,group B,and group C were treated with oral administration of clomifene（ 100 mg / d） combined with letrozole during menstrual cycle or from the third day to the fifth day of progesterone withdraw medicinal bleeding,the doses of letrozole in group A,group B,and group C were 2. 5 mg / d,5. 0 mg / d,and 7. 5 mg / d,respectively. The follicular development situations in the four groups were monitored,h CG was used to induce ovulation when the diameter of the largest follicle was larger than 18 mm in group A,group B,and group C. Fasting venous blood specimens were obtained on the day of h CG administration to detect reproductive hormones levels in the four groups,ovulation,ovulation rate,pregnancy rate,and endometrial thickness in the four groups were statistically analyzed. Results：Compared with control group,luteinizing hormone（ LH）,estradiol,and follicle stimulating hormone（ FSH） levels in group A,group B,and group C decreased,testosterone level increased; LH,estradiol,and FSH levels in group C were higher than those in group A and group B,testosterone level was lower than those in group A and group B,LH,estradiol,and FSH levels in group B were higher than those in group A,testosterone level was lower than that in group A,there were statistically significant differences（ P 〈0. 05）. There was no statistically significant difference in the numbers of mature follicles and dominant follicles,endometrial thickness,and ovulation rate among the four groups（ P 〉0. 05）. The mean diameter of mature follicles in control group was larger than those in group A,group B,and group C,the mean diameter of mature follicles in group C was larger than those in group A and group B,the mean diameter of mature follicles in group B was larger than those in group A（ P 〈0. 05）. The pregnancy rates in group A,group B,group C,and control group were 10. 00%,30. 00%,40. 00%,53. 33%,respectively,the pregnancy rates in control group was higher than those in group A,group B,and group C,the pregnancy rate in group C was higher than those in group A and group B,the pregnancy rate in group B was higher than that in group A（ P 〈0. 05）. Conclusion： The effect of letrozole combined with clomifene in assisted reproduction of PCOS patients is good,letrozole combined with clomifene can promote endocrine of reproductive hormones and it does not affect normal proliferation of endometrium,continuous7. 5 mg / d letrozole for 3 days combined with clomifene can achieve the best effect,which is worthy of clinical popularization and application.
出处
《中国妇幼保健》
CAS
2015年第16期2593-2595,共3页
Maternal and Child Health Care of China
关键词
不同剂量
来曲唑
氯米芬
多囊卵巢综合征
助孕
生殖激素
Different doses
Letrozole
Clomifene
Polycystic ovary syndrome
Assisted reproduction
Reproductive hormone
