来曲唑联合拮抗剂方案在多囊卵巢综合征患者的应用  

Application of letrozole inhibitors in polycystic ovary syndrome receiving gonadotropin-releasing hormone antagonist protocols

作　　者：侯艳茹[1] 韩红敬[1] 沈浣[1] 吴丹[1] 王艳槟[1] 蒋励[1] Hou Yanru;Han Hongjing;Shen Huan;Wu Dan;Wang Yanbin;Jiang Li(Reproductive Center,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院生殖中心,100044

出　　处：《中华生殖与避孕杂志》2019年第3期217-221,共5页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨来曲唑联合拮抗剂超促排卵方案治疗多囊卵巢综合征(PCOS)患者的临床应用价值。方法选取2014年1月—2016年12月期间北京大学人民医院生殖中心收治的进行体外受精/卵胞质内单精子显微注射(IVF/ICSI)的PCOS患者132例进行回顾分析,其中来曲唑+拮抗剂组(A组)50例,拮抗剂组(B组)82例,比较组间临床资料及妊娠结局。结果患者的年龄、不孕年限、体质量指数(BMI)组间差异均无统计学意义(P>0.05);A组患者促性腺激素(Gn)总用量、Gn使用时间、Gn平均用量、Gn起始剂量均小于B组(P<0.05);A组患者人绒毛膜促性腺激素(hCG)注射日血清雌二醇、孕酮、促黄体生成素(LH)水平与B组比较差异均有统计学意义(P<0.05),hCG注射日内膜厚度组间差异无统计学意义(P>0.05);雌二醇水平低于B组[(1777.66±1491.30)ng/L比(3256.07±1666.42)ng/L],而孕酮水平[(1.72±1.07)μg/L]、LH水平[(4.68±3.32)IU/L]均高于B组[(1.16±0.61)μg/L,(2.58±3.16)IU/L]。获卵数、MII卵子数、可利用胚胎数、优质胚胎数组间差异均无统计学意义(P>0.05)。卵巢过度刺激综合征(OHSS)发生率A组为0%(0/50),B组为1.22%(1/82),新鲜胚胎移植率A组为46.80%(22/47),B组为42.30%(33/78),胚胎种植率A组为42.42%(14/33),B组为46.42%(26/56),周期取消率A组为6.00%(3/50),B组为4.87%(4/82),差异均无统计学意义(P>0.05)。每周期新鲜胚胎移植临床妊娠率A组为50.00%(11/22),B组为51.52%(17/33),每移植周期活产率A组为50.00%(11/22),B组为42.42%(14/33),自然流产率A组为0%(0/11),B组为5.88%(1/17),差异均无统计学意义(P>0.05)。结论对于PCOS患者应用来曲唑联合拮抗剂方案可以明显减少Gn用量和使用时间,并可降低OHSS发生率,但并不降低每周期临床妊娠率和活产率。Objective To investigate the effectiveness and safety of letrozole combined with gonadotropin-releasing hormone antagonist(GnRH-A)protocol in patients with polycystic ovary syndrome(PCOS)and receiving in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI).Methods We retrospectively reviewed the medical documents of PCOS patients receiving IVF/ICSI in the Reproductive Medicine Center of Peking University People’s Hospital from January 2014 to December 2016.Totally 132 patients were included and divided into two groups.Group A(n=50)received letrozole combined with GnRH-A protocol for controlled ovarian hyperstimulation(COH).Group B(n=82)received GnRH-A protocol.The clinical characteristics and pregnancy outcomes of the two groups were analyzed and compared.Results There were no significant differences in age,duration of infertility,body mass index(BMI)of the two groups(P>0.05).The initial and total dosage of gonadotropin(Gn)used and the duration of COH were significantly lower and shorter in group A than in group B(P<0.05),so as the serum estradiol on human chorionic gonadotrophin(hCG)injection day[(1 777.66±1 491.30)ng/L vs.(3 256.07±1 666.42)ng/L,P<0.05].On the contrary,the serum progesterone[(1.72±1.07)μg/L vs.(1.16±0.61)μg/L,P<0.05]and luteinizing hormone[(4.68±3.32)IU/L vs.(2.58±3.16)IU/L,P<0.05]on hCG injection day were significantly higher in group A than in group B.Nevertheless,there was no significant difference in the endometrial thickness of the two groups on hCG injection day(P>0.05).We found no significant differences in the number of retrieved oocytes,MII oocytes and high-quality embryos between the two groups(P>0.05).There were no differences in the prevalence of ovarian hyperstimulation syndrome(OHSS)(0%vs.1.22%),fresh embryo transplantation rate(46.80%vs.42.30%),implantation rate(42.42%vs.46.42%)and cycle cancellation rate(6.00%vs.4.87%)between group A and group B(P>0.05).The clinical pregnancy rate,the live birth rate and the spontaneous abortion rate per embryo transfer were

关 键 词：来曲唑 多囊卵巢综合征 促性腺激素释放激素拮抗剂 超促排卵 

分 类 号：R711.75[医药卫生—妇产科学]