来曲唑联合炔雌醇环丙孕酮片 二甲双胍治疗耐克罗米芬性多囊卵巢综合征的临床研究  

A clinical study on treatment of Clomiphene-resistant PCOS on Letrozole in combination with Diane-35 and Metformin

作　　者：王治鸿[1] 刘翔华[2] 张红梅[1] 薛志红[1] 常焕英 高丽萍[1] 杨丽洪 游敏[1] 王媛[2] 

机构地区：[1]山西医科大学第一医院生殖中心,太原030001 [2]山西医科大学第一临床医学院

出　　处：《中国药物与临床》2016年第6期788-791,共4页Chinese Remedies & Clinics

基　　金：山西省科技攻关项目(20120313025-9)

摘　　要：目的评价来曲唑联合炔雌醇环丙孕酮片、二甲双胍治疗耐克罗米芬(CC)性多囊卵巢综合征(PCOS)患者的有效性和安全性,探索来曲唑促排卵效果的最佳方案和最佳剂量。方法选取300例PCOS患者,分为对照组和促排卵组。对照组患者规律服用炔雌醇环丙孕酮片及二甲双胍,促排卵组在基础治疗上服用不同浓度的来曲唑(2.5,5,7.5,20 mg)。检测服药前、服药4周及8周血清生殖激素,空腹血糖,空腹胰岛素,体质量指数(BMI),盆腔超声相的变化,以及排卵率、排卵周期率、妊娠率和妊娠周期率。结果和对照组相比,来曲唑促排卵治疗后促黄体生成素(LH)、睾酮(T)、催乳素(PRL)、BMI水平明显减低,而性激素结合球蛋白(SHBG)明显升高(P<0.05);子宫体积明显增加,子宫内膜厚度减少,双测卵巢体积及卵泡直径均减少,卵泡数也减少(P<0.05);排卵率、排卵周期率、妊娠率和妊娠周期率明显升高(P<0.05)。而且,随着来曲唑浓度的升高(2.5,5,7.5,20 mg),血清生殖激素,空腹血糖,空腹胰岛素,BMI,盆腔超声相的变化,以及排卵率、排卵周期率、妊娠率和妊娠周期率改善更明显。结论来曲唑联合炔雌醇环丙孕酮片、二甲双胍治疗耐克罗米芬性PCOS患者,可使血清生殖激素、空腹血糖、空腹胰岛素、卵巢形态、子宫内膜及BMI得到明显改善,并提高耐克罗米芬性PCOS患者对克罗米芬促排卵的敏感性。Objective To evaluate the efficacy and safety of Letrozole combined with Diane-35 and Metformin in treatment of Clomiphene -resistant polycystic ovary syndrome （PCOS）, to explore the best solutions and optimal dose of Letrozole in promoting ovulation. Methods Three hundred PCOS patients were divided into the basic treatment group （control group） and the promoted ovulation group. Patients on basic treatment received Diane-35 and Metformin, and those in promoted ovulation group received different doses of Letrozole （2.5, 5, 7.5 and 20 mg） in addition to the basic treatment. At baseline and at weeks 4 and 8 of the medication, serum reproductive hormones, fasting blood glu-cose, fasting insulin, body mass index （BMI）, pelvic ultrasonography, ovulation rate ovulation periodicity, pregnancy rate and pregnancy periodicity were measured in the patients. Results Compared with control group, Letrozole ther-apy which was intended to promote ovulation led to significantly reduced levels of LH, T, PRL and BMI, and elevated level of sex hormone binding globulin （SHBG） （P＆lt;0.05）. Moreover, Letrozole also led to significantly increased size of the uterus, reduction in endometrial thickness, bilateral ovarian volume, follicle diameter, and the number of follicles （P＆lt;0.05）. The ovulation rate, ovulation periodicity, pregnancy rate and pregnancy periodicity was significantly higher with Letrozole therapy （P＆lt;0.05）. With the increasing doses of letrozole （2.5, 5, 7.5 to 20 mg）, there appeared to be bet-ter improvements in serum reproductive hormone, fasting blood glucose, fasting insulin, BMI, pelvic ultrasonography, ovulation rate, ovulation periodicity, pregnancy rate and pregnancy periodicity. Conclusion Letrozole used in combi-nation with Diane-35 and Metformin for treatment of Clomiphene-resistant PCOS may allows for significant improve-ment in serum reproductive hormone, fasting blood glucose, fasting insulin, ovarian morphology, endometrial thickness and BMI, and may also impro

关 键 词：多囊卵巢综合征 二甲双胍 来曲唑 

分 类 号：R711.75[医药卫生—妇产科学]