他莫昔芬用于薄型子宫内膜患者冻融胚胎移植疗效观察的随机对照临床研究  

A randomized controlled clinical trial: the treatment effects of tamoxifen on patients with thin endometrium undergoing frozen-thawed embryo transfer

作　　者：孙琴[1] 李鸿儒[1] 邵一丹[1] 梁元姣[1] 姚兵[1] 陈莉[1] 

机构地区：[1]南京军区南京总医院生殖医学中心,南京医学硕士210002

出　　处：《医学研究生学报》2017年第1期52-56,共5页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81503655)

摘　　要：目的既往关于他莫昔芬治疗薄型子宫内膜的研究较少,文中旨在采用随机对照临床试验观察他莫昔芬应用于薄型子宫内膜患者行冻融胚胎移植(FET)时子宫内膜准备的临床效果。方法随机选择2014年1月至2016年6月在南京军区南京总医院生殖医学中心接受FET周期的薄型子宫内膜患者共133例,随机分为来曲唑组(n=72)和他莫昔芬组(n=61),所有患者于月经来潮第3天开始口服戊酸雌二醇4 mg/d,第8天开始6 mg/d,共服10~12 d后超声监测子宫内膜厚度,期间监测子宫内膜厚度和血雌二醇(E2)、孕酮水平,以上为激素替代周期子宫内膜准备方法。来曲唑组、他莫昔芬组促排卵周期子宫内膜准备方法为:分别于月经第3日起口服来曲唑2.5 mg/d、他莫昔芬40 mg/d,连服5 d,超声监测加用人绒毛膜促性腺素(HCG)的时机,此日简称为HCG日;等待优势卵泡排卵后给予肌肉注射黄体酮40mg/d,口服地屈孕酮20mg/d,进行子宫内膜转化,于用药后3 d或5 d移植卵裂胚或囊胚,此日为移植日,他莫昔芬组子宫内膜准备方法为他莫昔芬周期。比较2组HCG日血清激素水平、移植日雌孕激素、临床妊娠率、胚胎着床率等临床指标,并比较他莫昔芬周期、既往HRT周期子宫内膜厚度及血清E2、孕酮水平。结果来曲唑组HCG日E2、移植日E2值均低于他莫昔芬组[(1 193.80±629.64)ng/L vs(2 776.30±157.34)ng/L;(1 195.90±820.30)ng/L vs(2 129.40±1208.71)ng/L,P=0.000],HCG日LH值高于他莫昔芬组[(20.48±15.50)IU/L vs(10.59±8.34)IU/L],差异均有统计学意义(P=0.000)。来曲唑组胚胎着床率低他莫昔芬组(39.32%vs 45.83,P=0.001)。他莫昔芬组他莫昔芬周期子宫内膜厚度均高于激素替代周期[(8.49±1.36)mm vs(6.43±0.96)mm,P=0.018],血清E2、孕酮水平亦高于激素替代周期(P<0.05)。结论对于薄型子宫内膜患者,在FET周期中他莫昔芬促排方案较来曲唑胚胎更容易着床,他莫昔芬周期更能显著增加子宫内Objective Previous studies regarding the effects of tamoxifen（ TAM） on the thin endometrium are rare. The aim of this study was to explore the effects of TAM on patients with thin endometrium undergoing frozen thawed embryo transfer（ FET）. Methods One hundred and thirty three patients with thin endometrium undergoing FET treatment were recruited from January 2014 to June 2016,who canceled embryo transfer（ ET） or after FET due to thin endometrium in natural cycle or hormone replacement therapy cycle.Patients were randomly divided into letrozole（ LE,n = 72） group or tamoxifen（ TAM,n = 61） group. All of the patients started to have oral pills of Estradiol Valerate 4 mg/d on the third day of menstruating cycles,then 6mg/d on the eighth day,after 10 - 12 days then having ultrasonic monitoring of endometrial thickness and blood estradiol（ E2）,progesterone levels,It＇s called endometrial preparation for hormone replacement cycle. To letrozole,tamoxifen group,the way of endometrial preparation were as follows： patients started to have oral pills of LE 2.5mg/d,TAM 40 mg/d on the third day of menstruating cycles for 5 days,then having ultrasonic monitoring and used drug of human chorionic gonadotropic hormone,It＇s called HCG day.After the dominant follicle ovulation then took progesterone intramuscular injection 40 mg/d,oral progesterone 20 mg/d to change endometrium,then to transplant cleavage embryos or blastocysts after taking 3 or 5 days of progesterone,It＇s called embryo transplanting day.The way of TAM endometrium preparation was called TAM cycle. The general data,hormone levels and clinical outcome between two groups were analyzed. Results The serum estradiol level of LE group both on HCG and transfer day[（ 1 193.80±629.64） ng/L vs（ 2 776.30±157.34） ng/L;（ 1 195.90±820.30） ng/L vs（ 2 129.40±1 208.71） ng/L,P = 0.000]were statistically lower,serum luteinizing hormone level were statistically higher than TAM group[（ 20.48±15.50） IU/L vs（ 10.59±8.34） IU/L,P〈

关 键 词：他莫昔芬 薄型子宫内膜 冻融胚胎移植 

分 类 号：R711.74[医药卫生—妇产科学]