多囊卵巢综合征氯米芬抵抗的预测及促排卵治疗  

Predictors and Ovulation Induction Therapy for Polycystic Ovary Syndrome Patients with Clomiphene Resistance

作　　者：马丽娜[1] 马红丽[2] 李建 丛晶[2] 高敬书[2] 王宇[2] 吴效科(审校)[2,4] MA Li-na;MA Hong-li;LI Jian;CONG Jing;GAO Jing-shu;WANG Yu;WU Xiao-ke(Heilongjiang University of Chinese Medicine,Harbin 150040,China;Department of Obstetrics and Gynecology,First Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin 150040,China;Department of Obstetrics and Gynecology,The Affiliated Hospital of Gui Zhou Medical University,Guiyang 550004,China;Heilongjiang Provincial Hospital,Harbin 150040,China)

机构地区：[1]黑龙江中医药大学,哈尔滨150040 [2]黑龙江中医药大学附属第一医院妇产科 [3]贵州医科大学附属医院妇产科 [4]黑龙江省医院

出　　处：《国际妇产科学杂志》2022年第3期256-260,共5页Journal of International Obstetrics and Gynecology

基　　金：国家自然科学基金(82004403)。

摘　　要：多囊卵巢综合征(polycystic ovary syndrome,PCOS)是无排卵性不孕症最常见的原因,对于有生育要求的PCOS患者,促排卵是其首选治疗方案。枸橼酸氯米芬(clomiphene citrate,CC)是目前国内外指南推荐治疗PCOS不孕症的传统一线促排卵药物,但CC的治疗反应性个体差异显著,其中约40%的患者对CC不反应,即CC抵抗。综述近年来CC抵抗的PCOS患者预测指标及替代的促排卵策略的研究进展,主要从表型、生化特征和基因组学角度阐述PCOS不孕症患者CC抵抗预测指标,从来曲唑(Letrozole,LE)、促性腺激素(gonadotropin,Gn)、腹腔镜卵巢打孔术(laparoscopic ovarian drilling,LOD)、体外受精(in vitro fertilization,IVF)及中医辅助治疗等治疗方式中选用单一或联合的方案阐述其替代促排卵策略,并比较各种方案或方案组合的优势与潜在不足,以期为临床PCOS不孕症患者提供更加精准、个体化的促排卵方案。Polycystic ovary syndrome(PCOS)is the most common cause of anovulatory infertility.Ovulation induction is the first choice of treatment for PCOS patients with fertility requirements.According to the current domestic and international treatment guidelines,clomiphene citrate(CC)is the traditional first-line drug to induce ovulation for infertile women with PCOS.However,the response of CC ovulation treatment varies significantly for different patients.It was reported that about 40%of PCOS patients cannot respond to CC,that is,CC resistance.This paper provides a review on the research progress of predictive indicators for PCOS infertile women with CC resistance as well as alternative ovulation induction strategies in recent years.This paper mainly expounds the predictive indicators for PCOS patients with CC resistance from the perspective of phenotype,biochemical characteristics and genetics.Single or combined schemes are selected in the treatment methods of letrozole(LE),gonadotropin(Gn),laparoscopic ovarian perforation(LOD),in vitro fertilization(IVF)and adjunctive therapy of traditional Chinese medicine to elaborate their alternative ovulation induction strategies,and the advantages and potential shortcomings of these single and combined schemes are discussed to provide more accurate and individualized ovulation induction schemes for PCOS infertile women.

关 键 词：多囊卵巢综合征 不育 女(雌)性 氯米芬 排卵诱导 治疗 

分 类 号：R711.75[医药卫生—妇产科学] R714.8[医药卫生—临床医学]