不同雌激素对克罗米芬促排卵周期子宫内膜、子宫动脉血流及临床妊娠率的影响

Comparation of different estrogen on the endometrium development,uterine artery flow and the outcome of pregnancy in ovulation induction cycle by clomiphene citrate

目的：比较小剂量戊酸雌二醇（补佳乐）与结合雌激素（倍美力）对克罗米芬（CC）促排卵周期子宫内膜、子宫动脉血流及临床妊娠率的影响。方法：对60例原因不明性不排卵的病人进行前瞻性研究。根据随机应用不同的药物分为克罗米芬组（Ⅰ组），克罗米芬＋倍美力（Ⅱ组）和克罗米芬＋补佳乐组（Ⅲ组），每组各20例；将25例因男方因素就诊、排卵正常的不孕妇女作为对照组。观察3组病人HCG日的子宫内膜厚度、子宫内膜类型、子宫动脉搏动指数（PI）、子宫动脉血流阻力指数（RI）；排卵后7天子宫内膜厚度、孕酮（P）水平、PI、砌和临床妊娠率。结果：Ⅰ组病人HCG日子宫内膜厚度、A型内膜所占比例和排卵后7天子宫内膜厚度、P值显著低于对照组（P〈0．05），HCG日和排卵后7天PI值、砌值高于对照组（P〈0．05）；与Ⅰ组相比，Ⅱ组和Ⅲ组HCG日A型子宫内膜所占比例、排卵后7天子宫内膜厚度、P值高于Ⅰ组（P〈0．05-P〈0．01），Ⅲ组HCG日子宫内膜厚度高于Ⅰ组（P〈0．05）；Ⅱ组和Ⅲ组HCG日和排卵后7天PI值和砌值与Ⅰ组相比差异无显著性（P〉0．05）；Ⅲ组HCG日和排卵后7天子宫内膜厚度、P值及临床妊娠率高于Ⅱ组（P〈0．05）。结论：卵泡期小剂量雌激素不增加子宫动脉血流。可纠正克罗米芬促排卵引起的子宫内膜发育不良，提高妊娠率，戊酸雌二醇优于结合雌激素。

Objective： To compare the effects of progynova and premarin on endometrium development, uterine artery flow and clinical pregnancy rate in ovulation induction cycle. Methods： A prospective study involved total 60 patients as observation group with unexplained anovulation problems. The observation group was divided into 3 groups randomly, which were treated with clomiphene citrate （CC） only, CC added with premarin, and CC added with progynova respeetivcly. Endometrium thickness, echogenic pattern of the endometrium and pulsatility index （PI） and resistant index （RI） of uterine artery as well as progesterone （P） and cilinical pregnancy rate were determined. Results： Endometrium thickness of hCG day and the 7th day after ouvlation as well as A - type echogenic rate of group Ⅰ were lower than those in control group （ P 〈 0. 05 ）, and PI and RI were higher than those in control group （ P 〈 0. 05） . Endometrium thickness of the 7th day after ouvlation, A - type echogenic rate and progesterone of the 7th day after ovulation of group Ⅱ and group Ⅲ were higher than those in group Ⅰ （ P 〈 0. 05 - P 〈 0. 01 ）, and endometrium thickness of group Ⅲ on hCG day was higher than that in group Ⅰ （ P 〈 0. 05 ） . No significances were found in PI and RI among three groups （ P 〉 0. 05） . Statistical significances were also found on endometrium thickness and progesterone between group Ⅲ and group Ⅱ （ P 〈 0. 05 ） Conclusion： Estrogen added during follicular phase has no effect on uterine artery flow, but it can partly reverse the side effect by the clomiphene citrate on endometrium which may increase clinical pregnancy rate.