来曲唑用于多囊卵巢综合征患者的促排卵效果及对内脏脂肪素、单核细胞趋化蛋白-1水平的影响

Effects of Letrozole on Ovulation Induction,Visfatin and Monocyte Chemoattractant Protein-1 in Patients with Polycystic Ovary Syndrome

目的:探讨来曲唑(letrozole,LE)用于多囊卵巢综合征患者的促排卵效果及对内脏脂肪素、单核细胞趋化蛋白1(MCP-1)水平的影响。方法:选取2018年1月至2019年6月恩施州土家族苗族自治州中心医院收治的多囊卵巢综合征患者100例,按照随机数字表法分为LE组与枸橼酸氯米芬(clomiphene citrate,CC)组,每组50例。月经周期第3—7日,LE组患者口服来曲唑片,CC组患者口服枸橼酸氯米芬胶囊。观察两组患者的促排卵效果、不同时期子宫内膜厚度,治疗前后血清内脏脂肪素、MCP-1、睾酮(T)、黄体生成素(LH)/促卵泡刺激素(FSH)、胰岛素抵抗指数(HOMA-IR)及体重指数(BMI)水平,记录治疗期间不良反应发生情况。结果:LE组患者成熟卵泡数、卵巢过度刺激综合征发生率、早期流产率明显低于CC组,单卵泡发生率明显高于CC组,差异均有统计学意义(P<0.05);LE组患者卵泡期和黄体期子宫内膜厚度明显大于CC组,差异均有统计学意义(P<0.05)。治疗后,LE组患者血清内脏脂肪素明显高于CC组,MCP-1、T、LH/FSH、HOMA-IR及BMI水平明显低于CC组,差异均有统计学意义(P<0.05)。CC组、LE组患者的不良反应发生率分别为6.00%(3/50)、4.00%(2/50),差异无统计学意义(P>0.05)。结论:LE可促进多囊卵巢综合征患者内脏脂肪素水平升高,抑制MCP-1分泌,是一种有效、安全的促排卵药物,且具有较高的单卵泡发生率,可避免多胎妊娠及卵巢过度刺激综合征,改善子宫内膜容受性。

OBJECTIVE:To investigate the effects of letrozole(LE)on ovulation induction,visfatin,and monocyte chemoattractant protein-1(MCP-1)in patients with polycystic ovary syndrome(PCOS).METHODS:A total of 100 patients with PCOS admitted into Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from Jan.2018 to Jun.2019 were extracted to be divided into the IE group and the clomiphene citrate(CC)group according to the random number table,with 50 cases in each group.The IE group was given oral administration of letrozole tablets on the 3 rd to 7 th d of menstrual cycle,and the CC group received oral administration of clomiphene citrate capsules.The ovulation induction effects,endometrial thickness in different time points,levels of serum visfatin,MCP-1,testosterone(T),luteinizing hormone(LH)/follicle stimulating hormone(FSH),insulin resistance index(HOMAIR)and body mass index(BMI)before and after treatment were observed between two groups,and the occurrence of adverse drug reactions was recorded.RESULTS:The number of mature follicles,incidence of ovarian hyperstimulation syndrome(OHSS)and early abortion rate in the LE group were significantly lower than those in the CC group,and the incidence of single follicle was significantly higher than that in the CC group,with statistically significant difference(P<0.05).The endometrial thickness in follicular phase and luteal phase in the LE group was significantly greater than that in the CC group,with statistically significant difference(P<0.05).After treatment,the serum visfatin in the LE group was significantly higher than that in the CC group,while the levels of MCP-1,T,LH/FSH,HOMA-IR and BMI were significantly lower than those in the CC group,with statistically significant differences(P<0.05).The incidences of adverse drug reactions in the CC group and the LE group were 6.00%(3/50)and 4.00%(2/50),respectively,and the difference was not statistically significant(P>0.05).CONCLUSIONS:LE can promote the increase of visfatin and inhibit the secretion of MCP-1 in patients with PCOS.It is an effective and safe ovulation-promoting drug with high incidence of single follicles,which can avoid the multiple pregnancy and OHSS and improve the endometrial receptivity.