克罗米酚对子宫内膜发育、血管生成和子宫血流的影响

Effects of clomiphene citrate on the endometrial development, angiogenesis and the uterine blood flow

目的 研究克罗米酚对子宫血流、子宫内膜发育及血管生成的影响。方法 选有正常月经的妇女61例,其中对照组30例,试验组31例。观察2组受试者排卵日(LH+0)天子宫内膜厚度及回声类型,在LH+0天及种植窗期(LH+7)天观察激素环境、内膜厚度、子宫动脉和放射状动脉搏动指数、子宫内膜微血管密度。结果 LH+0天,试验组子宫内膜厚度为8.61mm,大于9 mm者占41.95％;对照组9-84 mm,大于9 mm者占76.67％(P<0.01)。试验组A型内膜占54.84％,对照组占83.33％,2组比较有显著性差异(P<0.05)。LH+7天,试验组期外内膜发生率为80.66％;对照组41.38％,2组比较有显著性差异(P<0.0001)。试验组子宫内膜微血管密度(MVD)为19.40;对照组30.52(P<0.001)。子宫动脉和放射状动脉搏动指数(PI)中位数:试验组分别为2.75和2.15;对照组分别为2.21和1.71(P<0.05),试验组PI大于3者所占比例增加。结论 克罗米酚使子宫内膜厚度及回声类型发生改变,内膜发育延迟,抑制子宫内膜血管生成,减少子宫血液灌注,可能损害了子宫容受性。

Objective To study the effects of clomiphene citrate (CC) on the endometrial development, angiogenesis and the uterine blood flow. Methods A total of 61 women with normal menstrual cycle were divided into two groups, 30 cases in control group; 31 cases in trial group. All patients were observed parameters as follow: endometrial thickness and echo pattern on the day of LH+0; blood level of estradiol, progesterone on the day of LH+0 and LH+7;endometrial thickness, endometrial histology, endometrial angiogenesis, pulsatility index (PI) of uterine artery and radial artery on the day of LH+7. Results In comparison with control group, trial had adverse effects on endometrial thickness on the day of LH+0, 8.61mm versus 9.84 mm (P<0.01), trial group suffered with low level (<9mm, 58.06%) endometrial thickness, endometrial Echo pattern changed after trial stimulation(P <0.05). Trial delayed the endometrial matuity on the day of LH+7, 80.66% versus 41.38% (P<0.0001). Trial decreasedmicrovessculardensity (MVD) of endometrium, 19.40 versus 30.52 (P<0.001). There was a significant correlation with MVD and serum P (P<0.01). Trial increased PI of uterine artery and radial artery ,2.75 and 2.15 versus 2.21 and 1.71, (P<0.05). Conclusion Trial has adverse effects on endometrial enviroment, that is trial inhibit endometrial angiogenesis and decreases uterine perfusion, therefore maybe injure uterine receptivity.