来曲唑联合尿促性素治疗克罗米芬抵抗的PCOS不孕疗效及对卵巢血流动力学与临床结局的影响  

Efficacy of letrozole in combination with menotrophin for infertility in clomiphenen-resistant PCOS and its effect on ovarian hemodynamics and clinical outcome

作　　者：车会会 陈洁[1] 苏果[1] 张静[1] CHE Hui-hui;CHEN Jie;SU Guo(Department of Reproductive Medicine,Fuyang People's Hospital,Fuyang Anhui 236000,China)

机构地区：[1]阜阳市人民医院生殖医学科,安徽阜阳236000

出　　处：《临床和实验医学杂志》2022年第6期652-656,共5页Journal of Clinical and Experimental Medicine

基　　金：安徽省卫生健康委科研项目(编号:201649216)。

摘　　要：目的探讨来曲唑联合尿促性素治疗克罗米芬抵抗的多囊卵巢综合征(PCOS)不孕疗效及对卵巢血流动力学与临床结局的影响。方法前瞻性选取2019年1月至2021年1月阜阳市人民医院诊治的克罗米芬抵抗的PCOS不孕患者98例,采用随机数字法分成对照组(n=49)和治疗组(n=49)。对照组接受基础来曲唑促排治疗,治疗组患者在来曲唑的基础上加用尿促性素促排治疗。监测治疗前后患者的卵巢血流动力学[收缩期峰值流速(PSV)、舒张末期血流速(EDV)和搏动指数(PI)]、激素[卵泡刺激素(FSH)、雌激素(E2)水平、促黄体生成素(LH)]水平、诱导卵泡发育成熟时间、HCG日子宫内膜厚度及成熟卵泡个数,计算患者妊娠率,统计患者不良反应。结果治疗组患者妊娠率为63.27%,高于对照组(36.73%),差异有统计学意义(P<0.05)。治疗前,两组患者卵巢基质血流PSV、EDV和PI比较,差异无统计学意义(P>0.05);治疗后,治疗组患者PSV、EDV值为(41.58±3.08)cm/s、(7.24±0.18)cm/s,高于对照组[(36.05±3.06)cm/s、(5.69±0.17)cm/s],PI值0.53±0.14,低于对照组(0.71±0.19),差异均有统计学意义(P<0.05)。治疗后,治疗组患者卵泡成熟时间(9.27±1.92)d,少于对照组[(12.25±1.98)d],HGG日子宫内膜厚度及HGG日平均径线≥18 mm的卵泡个数为(10.41±1.98)mm、(2.51±0.23)个,多于对照组[(9.24±1.92)mm、(1.09±0.21)个],差异均有统计学意义(P<0.05)。治疗前,两组患者FSH、E2、LH水平比较,差异无统计学意义(P>0.05);治疗后,治疗组患者LH和E2水平为(4.62±0.48)IU/L、(33.87±3.19)pg/mL,低于对照组[(4.84±0.54)IU/L、(36.74±3.14)pg/m L],FSH水平为(6.87±1.05)IU/L,高于对照组[(6.01±0.72)IU/L],差异均有统计学意义(P<0.05)。两组患者不良反应发生率比较(12.24%vs.8.16%),差异无统计学意义(P>0.05)。结论来曲唑与尿促性素联合使用能提升克罗米芬抵抗的PCOS不孕患者疗效,改善卵巢血流灌注,提高临床妊娠率,建议使用。Objective To discuss the effect of letrozole in combination with menotrophin for infertility in clomiphenen-resistant polycystic ovary syndrome(PCOS)and its effect on ovarian hemodynamics and clinical outcome.Methods A total of 98 infertile women with PCOS resistant to clomiphene treated in Fuyang People's Hospital from January 2019 to January 2021 were prospectively selected and divided into control group(n=49)and treatment group(n=49)by random number method.The control group received letrozole therapy,and the treatment group was additionally treated with menotrophin treatment on the basis of letrozole.The ovarian hemodynamics[peak systolic velocity(PSV),end diastolic velocity(EDV)and pulsatile index(PI)],hormone[follicle stimulating hormone(FSH),estrogen(E2)and luteinizing hormone(LH)]levels,induced follicular maturation time,intrauterine thickness and number of mature follicles on HCG days were monitored before and after treatment,and pregnancy rate and adverse reaction rate were recorded.Results The pregnancy rate of patients in the treatment group was 63.27%,which was higher than that in the control group(36.73%),and the difference was statistically significant(P<0.05).Before treatment,there was no significant difference in the PSV,EDV and PI of ovarian stromal blood flow between the two groups(P>0.05);after treatment,the PSV and EDV values of the treatment group were(41.58±3.08)cm/s,(7.24±0.18)cm/s,which were higher than those in the control group[(36.05±3.06)cm/s,(5.69±0.17)cm/s],PI value 0.53±0.14,which was lower than that in the control group(0.71±0.19),the differences were statistical significance(P<0.05).After treatment,the follicle maturation time of the treatment group was(9.27±1.92)d,which was less than that of the control group[(12.25±1.98)d],and the number of follicles with endometrial thickness on HGG day and average diameter on HGG day≥18 mm was(10.41±1.98)mm,(2.51±0.23),which was more than that of the control group[(9.24±1.92)mm,(1.09±0.21)],the difference was statistically signif

关 键 词：多囊卵巢综合征 尿促性素 克罗米芬抵抗 不孕 疗效 血流动力学 

分 类 号：R711.75[医药卫生—妇产科学]