摘要
目的比较来曲唑(LE)与氯米芬(CC)分别联合人绝经后促性腺激素(HMG)对多囊卵巢综合征(PCOS)患者的促排卵效果及对生殖激素的影响。方法拟行促排卵治疗的126例PCOS患者,分为LE组50例70周期和CC组76例82周期。LE组月经周期第3～第7天口服来曲唑5mg.d-1,CC组月经周期第5～第9天口服氯米芬100mg.d-1。阴道超声监测卵泡发育,给予HMG。当最大卵泡的平均直径≥18mm时,肌内注射人绒毛膜促性腺激素(HCG)5000U诱发排卵。于长到优势卵泡的持续时间(HCG日)取静脉血测雌二醇(E2)、促黄体激素(LH)、睾酮(T)、孕酮(P)水平以及排卵后第7天取静脉血测E2、P水平。观察排卵率、子宫内膜厚度及形态、妊娠率、流产率及生殖激素水平的变化。结果两组临床特征具有可比性。两组的HMG用量、HCG日天数、HCG日子宫内膜厚度相似。HCG日LE组直径≥14mm的卵泡数目显著低于CC组,但直径≥18mm的卵泡数目两组相似。HCG日LE组E2、排卵后+7dE2及排卵后+7dP/E2均显著低于CC组。两组HCG日LH、T、P相似。两组妊娠率、流产率、双胎妊娠率、防卵巢过度刺激综合征(OHSS)例数无显著差异。无反应放弃率LE组显著低于CC组。结论LE可作为PCOS患者促排卵的一种选择,特别是对CC无反应、OHSS和子宫内膜薄的患者。
Objective To evaluate the clinical effect of letrozole （LE） with HMG or clomiphene citrate （CC） with HMG in treatment of polycystic ovarian syndrome （PCOS） . Methods One hundred and twenty-six patients with PCOS were divided into 2 groups treated with letrozole （ 70 cycles） or CC （82 cycles）. Letrozole 5 mg was given daily d 3-7 of menses and CC 100 mg was given daily d5-9 of menses. Patients were monitorized with transvaginal ultrasonography and combined with HMG if needed. When the dominant follicle diameter reached 18 mm, HCG （5 000 U ,IM） was given to trigger ovulation. Levels of serum E2 ,LH,T,P were detected on the day of HCG administration and E2 ,P on more than 7 days after follicular rupture. The primary endpoints were the number of follicles, endometrial thickness, pregnancy rate and miscarriage rate. Results No significant difference was found between LE group and CC group for endometrial thickness measured on the day of HCG, the duration to reach a dominant follicle and the total dose of HMG. The number of follicles ≥ 14 mm were significantly less in the LE group, but no significant differences in the ≥18 mm follicles. Levels of serum E2 ,P/E2 were more lower in LE group, but similar for LH, T, P. The rates of pregnancy, twin gestation, ectopic pregnancy and OHSS were almost consistent in 2 groups. Moreover, withdrawal rate as inefficacy was significantly lower in the LE group. Conclusion LE might be an alternative method in PCOS to induce ovulation, especially for patients no responsing to CC , or with OHSS or thin endometrium.
出处
《医药导报》
CAS
2008年第6期647-650,共4页
Herald of Medicine
