来曲唑联合二甲双胍治疗肥胖型多囊卵巢不孕症的临床研究  

Clinical trial of letrozole combined with metformin on obese polycystic ovary syndrome with infertility

作　　者：廖雪 阳云金 LIAO Xue;YANG Yun-jin(Department of Obstetrics and Gynecology,Jiangjin Hospital Affiliated to Chongqing University,Chongqing 402260,China;Department of Gynecology,Reproductive and Women’s Hospital Affiliated to Chengdu University of Traditional Chinese Medicine,Chengdu 610041,Sichuan Province,China)

机构地区：[1]重庆大学附属江津医院妇产科,重庆402260 [2]成都中医药大学附属生殖妇幼医院妇科,四川成都610041

出　　处：《中国临床药理学杂志》2023年第21期3058-3062,共5页The Chinese Journal of Clinical Pharmacology

摘　　要：目的观察来曲唑联合二甲双胍治疗肥胖型多囊卵巢(PCOS)不孕症的临床疗效。方法将肥胖型PCOS不孕症患者按照随机数字表法分为对照组和试验组。对照组于月经第5天给予来曲唑2.5 mg·d^(-1)口服5 d,试验组在对照组基础上给予二甲双胍口服,每次0.5 mg,tid。2组治疗3个月经周期。比较2组患者疗效、体质量指数(BMI)、血脂指标、血糖指标、胰岛素抵抗指标、生殖内分泌指标、子宫内膜受容性、卵巢反应性和妊娠情况。结果试验过程中退出脱落4例,最终试验组和对照组分别入组49例和47例。治疗3个月经周期后,试验组总有效率为91.84%,高于对照组的76.60%,试验组和对照组BMI分别为(24.52±2.38)和(26.16±2.57)kg·m^(-2),空腹血糖(FPG)分别为(4.52±0.59)和(4.97±0.62)mmol·L^(-1),空腹胰岛素(FNIS)分别为(13.34±1.33)和(14.12±1.62)mU·L^(-1),胰岛素抵抗指数(HOMA-IR)分别为2.68±0.62和3.12±0.82,睾酮(T)分别为(1.72±0.48)和(2.03±0.54)nmol·L^(-1),雌二醇(E2)分别为(45.47±10.65)和(50.14±11.46)pg·mL^(-1),黄体生成素/卵泡生成激素(LH/FSH)分别为1.42±0.36和1.69±0.44,抗米勒管激素(AMH)分别为(7.29±2.04)和(8.24±2.37)ng·mL^(-1),子宫内厚度分别为(9.52±0.79)和(8.37±0.84)mm,子宫内膜螺动脉搏动指数(PI)分别为1.29±0.28和1.71±0.33,阻力指数(RI)分别为0.53±0.12和0.66±0.16,差异均有统计学意义(均P<0.05)。治疗及随访期间,试验组和对照组卵泡生成时间分别为(10.21±2.43)和(12.49±2.76)d,优势卵泡分别为(1.87±0.46)和(1.43±0.43)个,排卵率分别为85.71%和68.09%,周期妊娠率分别为48.98%和27.66%,差异均有统计学意义(均P<0.05)。试验组和对照组药物不良反应发生率分别为26.53%和17.02%,差异无统计学意义(P>0.05)。结论来曲唑联合二甲双胍治疗肥胖型PCOS不孕症可调节生殖内分泌和糖脂代谢水平、降低胰岛素抵抗,还可改善患者子宫内膜容受性、卵巢反应性,进而提高�Objective To observe the clinical efficacy of letrozole combined with metformin in the treatment of obese polycystic ovary syndrome(PCOS)with infertility.Methods Patients with obese PCOS and infertility were divided into control group and treatment group by the random number table method.The control group was orally given 2.5 mg·d^(-1) letrozole on the 5^(th) day of menstruation for 5 days,and the tre atm ent group was given metformin orally(0.5 mg every time,tid)on the basis of the control group,and both groups were treated for 3 menstrual cycles.Efficacy,body mass index(BMI),blood lipids indicators,blood glucose indicators,insulin resistance indicators,reproductive endocrine indicators,endometrial receptivity,ovarian reactivity and pregnancy were compared between the two groups of patients.Results During trial,4 cases fell off due to withdrawal,thus 49 cases were included in treatment group and 47 cases in control group.After 3 menstrual cycles of treatment,the total effective rate in treatment group(91.84%)was higher than control group(76.60%);and the BMI in treatment group and control group were(24.52±2.38)and(26.16±2.57)kg·m^(-2);fasting plasma glucose(FPG)levels were(4.52±0.59)and(4.97±0.62)mmol·L^(-1);fasting insulin(FNIS)levels were(13.34±1.33)and(14.12±1.62)mU·L^(-1);thehomeostasis model assessment of insulin resistance(HOMA-IR)values were 2.68±0.62 and 3.12±0.82;testosterone(T)levels were(1.72±0.48)and(2.03±0.54)nmol·L^(-1);estradiol(E2)levels were(45.47±10.65)and(50.14±11.46)pg·mL^(-1);luteinizing hormone/follicle-stimulating hormone(LH/FSH)values were 1.42±0.36 and 1.69±0.44;anti-Mullerian hormone(AMH)levels were(7.29±2.04)and(8.24±2.37)ng·mL^(-1);intrauterine thicknesses were(9.52±0.79)and(8.37±0.84)mm;endometrial spiral artery pulsatility index(PI)values were 1.29±0.28 and 1.71±0.33,and the resistance index(RI)values were 0.53±0.12 and 0.66±0.16,the difference were all statistically significant(all P<0.05).During treatment and follow-up,the follicle formation times in tr

关 键 词：来曲唑 二甲双胍 肥胖型多囊卵巢综合征 不孕症 子宫内膜容受性 卵巢反应性 妊娠率 

分 类 号：R97[医药卫生—药品]