来曲唑联合HCG治疗多囊卵巢综合征不孕患者的临床观察

Clinical observation of Letrozole combined with HCG in trearment of infertile patients with polycystic ovary syndrome

目的探究来曲唑联合绒毛膜促性腺激素(HCG)治疗对多囊卵巢综合征(PCOS)不孕患者性激素水平、胰岛素抵抗指数(HOMA-IR)、临床妊娠率及妊娠结局的影响。方法回顾性分析2014年1月—2018年10月郑州大学第二附属医院行来曲唑+HCG治疗(观察组)及枸橼酸氯米芬+HCG治疗(对照组)的PCOS不孕患者各68例临床资料。比较两组治疗前(月经周期第5 d)及治疗后(排卵后6~8 d)性激素[雌二醇(E2)、孕酮(P)]水平、HOMA-IR及血浆皮质醇(Cor)水平差异,并记录两组卵巢过度刺激综合征(OHSS)发生情况、临床妊娠率及妊娠结局(早期流产情况)差异。结果治疗后,两组性激素(E2)水平均较治疗前升高(P<0.05),且对照组高于观察组(P<0.05);两组性激素(P)水平也均较治疗前升高(P<0.05),而观察组高于对照组(P<0.05);两组HOMA-IR水平均较治疗前降低(P<0.05),血浆Cor水平则较治疗前升高,且观察组变化幅度大于对照组(P<0.05)。观察组OHSS发生率明显低于对照组(P<0.05),临床妊娠率则高于对照组(P<0.05)。两组早期流产率比较,差异无统计学意义(P>0.05)。结论来曲唑联合HCG治疗可促进PCOS不孕患者性激素水平稳定,也能调节患者血脂代谢紊乱状态,减少OHSS发生,还能提高其妊娠率,于改善患者妊娠结局有积极意义。

Objective To explore the effects of letrozole combined with human chorionic gonadotropin(HCG)on sex hormones levels,insulin resistance index(HOMA-IR),clinical pregnancy rate and pregnancy outcomes in infertile patients with polycystic ovary syndrome(PCOS).Methods The clinical data of each 68 infertile PCOS patients treated with letrozole+HCG(observation group)and clomiphene citrate+HCG(control group)in our hospital were retrospectively analyzed.The levels of sex hormones[estradiol(E2),progesterone(P)],HOMA-IR and plasma cortisol(Cor)were compared between the two groups before treatment(at 5 th d of menstrual cycle)and after treatment(at 6-8 d after ovulation),and the occurrence of ovarian hyperstimulation syndrome(OHSS),clinical pregnancy rate and pregnancy outcomes(early abortion)were recorded in the two groups.Results After treatment,the level of sex hormone(E2)in the two groups was higher than that before treatment(P<0.05),and the level in control group was higher than that of observation group(P<0.05).The sex hormone(P)level was also higher than that before treatment(P<0.05),and the level in observation group was higher than that of control group(P<0.05).The levels of HOMA-IR in the two groups were lower than those before treatment(P<0.05),and the plasma Cor level was higher than that before treatment,and the changes in observation group were greater than those in control group(P<0.05).The incidence rate of OHSS in observation group was significantly lower than that of control group(P<0.05),and the clinical pregnancy rate was higher than that of control group(P<0.05).There was no significant difference in the early abortion rate between the two groups(P>0.05).Conclusion Letrozole combined with HCG can promote the stability of sex hormones levels in infertile PCOS patients.And it can also regulate the disorder of lipid metabolism,reduce the occurrence of OHSS,and increase the pregnancy rate,and it has positive significance in improving the pregnancy outcomes of patients.