4种方法治疗多囊卵巢综合征伴不孕症患者的疗效分析

Clinical analysis of 4 treatments for woman polycystic ovarian syndrome with infertility

目的:探讨4种方法治疗多囊卵巢综合征(PCOS)并不孕的效果。方法:选择120例PCOS并不孕患者分为4组,每组30名。第1组直接使用氯米芬/氯米芬+尿促性素加绒毛膜促性腺激素促排卵治疗;第2组口服去氧孕烯2个周期,停药后按第1组方法治疗;第3组口服去氧孕烯2个周期和二甲双胍8周,停药后按第1组方法治疗;第4组行腹腔镜手术(卵巢多点打孔)。4组均观察治疗前后月经周期、体质量、卵巢体积、血黄体生成素(LH)、睾酮(T)等改变,比较各组治疗后2月内周期排卵率、周期卵泡未破裂黄素化综合征(LUFS)发生率和6月内妊娠率。结果:体质量指数均有显著性下降(均P<0.05或P<0.01),组间比较第2,3组效果显著大于第1,4组,第4组大于第1组;月经周期均有显著性缩短(均P<0.05或P<0.01),组间比较差别无统计学意义(P=0.289);卵巢体积第1组增大,余下3组均缩小,组间比较第4组缩小明显大于第2,3组;血清睾酮均有显著性下降(均P<0.01),组间比较第2,3组效果明显大于第1,4组,第4组明显大于第1组;血清LH均有显著性下降(均P<0.01),组间比较第2,3组效果明显好于第1,4组,第4组明显好于第1组;周期排卵率各组分别为53%,72%,78%,76%,后3组显著高于第1组;周期LUFS发生率各组分别为32%,16%,15%,13%,后3组显著低于第1组(P<0.01);6月内妊娠率分别为20%,47%,50%,57%,后3组显著高于第1组(P<0.01)。结论:对于PCOS合并不孕症患者,使用去氧孕烯或加二甲双胍后促排卵治疗无论是在控制症状还是增加周期排卵率、减少周期LUFS发生率和升高6月内妊娠率方面,效果同于腹腔镜手术者;而单纯促排卵治疗控制症状效果尚可,但周期排卵率和6月内妊娠率效果不良,周期LUFS发生率高。

Objective To investigate the therapeutic effects of 4 different treatments for woman polycystic ovarian syndrome （PCOS） with infertility. Methods One hundred and twenty women PCOS with infertility were divided into 4 Groups ： patients in Group 1 were directly treated with clomiphene （CC）/CC ＋ human menopausal gonadotropin （HMG） ＋ human chorionic gonadotropin （ HCG ） to accelerate ovulation ; patients in Group 2 were treated with the same way as Group 1 after taking marvolon for 2 cycles;patients in Group 3 took marvolon for 2 cycles and metformin for 8 weeks, and then were treated the same as Group 1 ;patients in Group 4 were treated with laparosocopy. The body mess index （ BMI ） , emmertia period, weight, volume of ovary, LH, and T were measured before and after the treatment in all patients. of luteinized unruptued follicle syndrome （ LUFS ） within The cycle ovulatory rate and occurrence rate 2 months and the pregnancy rate within 6 months after the treatment were also observed. Results In all patients, BMI, emmenia period, serum T, and serum LH decreased significantly （ P 〈 0.05 or 0.01 ）. The body mess indexes were significantly lower in Group 2 and Group 3 than those in Group 4 and Group 1 , and Group 4 was also lower than Group 1 （ P 〈 0.05 or 0.01 ）. There was no difference in emmenia period between the 4 groups （ P = 0. 289 ）. The volumes of ovary were enlarged in Group 1 , and they were shrunk in the residual groups, which was significantly lower in Group 4 than in Group 2 and 3 （ P 〈 0.01 ）. The cycle ovulation rates were 53 % , 72 % , 78 % , and 76 % ; the pregnancy rates within 6 months were 20% , 47% , 50% , and 57% , respectively; and they were significantly higher in the Group 2,3 and 4 than in Group 1 （ P 〈 0. 01 ）. The occurrence rates of LUFS were 32 % , 16 % , 15 % , and 13 % , and they were significantly lower in Group 2,3 and 4 than in Group 1 （ P 〈 0.01 ）. Conclusion The effects of marvolon or marvolon and metformin are the same as those of laparoscopy not only in controlling the symptoms of PCOS, but also in increasing the cycle ovulation rate, pregnancy rate within 6 months, and decreasing the occurrence rate of LUFS. The symptoms of PCOS can be controlled better, but the cycle ovulation rate and pregnancy rate within 6 months can not be improved when clomiphene is used alone.