三苯氧胺促排卵效果的探讨

Efficacy of tamoxifen to induce ouulation and its mechanism

本文作者测定了因对克罗米芬（ＣＣ）抗药而改用三苯氧胺（ＴＭＸ）治疗的患者血中卵泡刺激素（ＦＳＨ），促黄体生成素（ＬＨ），雌二醇（Ｅ２）及孕酮（Ｐ）的浓度。观察了宫颈粘液的变化。以Ｂ超监测卵泡发育情况。结果发现：用ＴＭＸ后，卵泡期血ＦＳＨ、Ｅ２浓度较治疗前显著上升，黄体期血Ｅ２和Ｐ浓度明显高于正常组。用ＴＭＸ治疗２３个月经周期（１３例）．１４个月经周期有排卵，２例妊娠。ＴＭＸ对宫颈粘液影响比ＣＣ小。在卵泡发育方面，ＴＭＸ组与ＣＣ组类似。以上结果说明：ＴＭＸ诱导排卵是通过下丘脑－垂体－卵巢轴。部分对ＣＣ抗药的病人改用ＴＭＸ后可获得良好的促排卵效果。

The level of follicle-stimulating hormone(FSH),leuteinizing hormone(LH), estradiol(E2)and progesterone(P)was determined in the women who were resistant to clomiphene(CC)and were changed to receive tamoxifen(TMX).The changes of cervical mucus were observed and the development and maturation of ovarian follicles were monitored with ultrasonography.It was found that after the administration of TMX,the serum level of FSH and E2 was significantly increased in the follicular phase as compared with that before TMX administration and the serum level of E2 and P in luteal phase was obviously higher than that of the normal control.After TMX treatment for 23 menstrual cycles ,ovulation was induced in l4 cycles and 2 patients conceived.The effect of TMX on cervical mucus was less obvious than that of CC and the effect of TMX and CC on the development and maturation of ovarian follicles was similar. The above findings suggest that the site of TMX action to induce ovulation is the hypothalamus-pituitary-ovary axis and TMX can be used to induce ovulation successfully in some CC-resistant patients.