克罗米芬联合尿促性素对多囊卵巢综合症患者促排卵效果及其对妊娠的影响研究

The Study of Ovulation Effect and Its Influence on Pregnancy for Polycystic Ovary Syndrome Patients Using Clomiphene Citrate Combined with Gonadotrop

目的:探讨克罗米芬(CC)联合尿促性素(HMG)对多囊卵巢综合症(PCOS)患者促排卵效果及其对妊娠的影响。方法:以126例PCOS不孕症患者为研究对象,随机等分为CC组、来曲唑组和CC+HMG组,3组各42例。观察3种治疗方案对患者排卵周期、子宫内膜、卵泡情况、激素水平、卵巢过度刺激综合征(OHSS)以及妊娠的影响。结果:CC+HMG组完成周期171个,其中有排卵周期67.8%(116/171),高于LE组,差异有统计学意义(χ2=8.782,P<0.001)。CC+HMG组注射人促绒毛膜性腺激素(HCG)日子宫内膜厚度及成熟卵泡均高于其它两组,差异均有统计学意义(P<0.001),雌二醇(E2)水平明显高于LE组,但是和CC组间比较差异没有统计学意义(q=1.932,P>0.05)。CC+HMG组促排卵中出现OHSS 4例(9.5%,4/42),略高于其它两组,但是3组OHSS发生率差异没有统计学意义(χ2=1.941,P>0.05)。CC+HMG组妊娠率57.2%,高于其它两组,和CC组比较差异有统计学意义(χ2=3.892,P<0.05)。3组流产率和多胎妊娠发生率组间比较差异没有统计学意义(P>0.05)。CC+HMG组临床妊娠者平均用药周期(2.8±0.4)周,明显短于CC组和LE组,差异有统计学意义(F=17.335,P<0.001)。结论:克罗米芬联合小剂量尿促性素注射方案用于多囊卵巢综合症性不孕症患者的治疗,促排卵效果好,用药周期短,临床妊娠率高,为克罗米芬抵抗的患者以及卵巢低反应患者提供了选择的方案。

Objective: To investigate the ovulation effect and its influence on pregnancy for polycystic ovary syndrome (PCOS) patients using clomiphene citrate (CC) combined with gonadotrop (HMG). Methods:A total of 126 cases of PCOS patients with infertility as the research objects were randomly divided into CC group (given CC), letrozole (LE) group (given LE) and CC+HMG group (given CC combined with HMG injection) with 42 cases in each group, respectively. The ovulation cycle, endometrial, ovarian follicle, levels of the hormone, ovarian hyperstimulation syndrome (OHSS) and the impacts on pregnancy of the three therapeutic schemes were observed. Results: The CC+HMG group completed 171 cycles, 67.8% of the cycles (116/171) were ovulation, which was higher than that of the LE group (χ2=8.782, P<0.001). The values of endometrial thickness and mature follicles of the CC+HMG group on HCG day were higher than those of the other two groups (P<0.001). The E2 levels of the CC+HMG group were significantly higher than that of the LE group (P<0.05), but similar to the CC group (q=1.932, P>0.05). In the CC+HMG group, there were 4 cases of OHSS during ovulation induction (9.5%, 4/42), but the differences of the incidence of OHSS among the three groups were not statistically significant (χ2=1.941, P>0.05). The clinical pregnancy rate of the CC+HMG group was 57.2%, which was statistically higher than that of the CC group (χ2=3.892, P<0.05). The difference of abortion rates and multiple pregnancy rates among the groups was not statistically significant (P>0.05). The average medication period of the CC+HMG group (2.8+0.4 weeks) was significantly shorter than the CC and LE groups (F=17.335, P<0.001). Conclusion: The treatment scheme of clomiphene citrate combined with small dose of gonadotropin injection for polycystic ovary syndrome patients with infertility, having good ovulation induction effect, short treatment cycle and high clinical pregnancy rate, is a choice for patients of clomiphene resistant and with poor ovarian response.