克罗米芬对子宫内膜,卵泡发育和血浆雌、孕激素及白细胞雌激素受体的影响

The Effect of clomiphene citrate on endometrium, follicle development, concentration of serum estradiol, progesterone and estrogen receptor content in peripheral blood white cells

目的：探讨克罗米芬对子宫内膜，卵泡发育，血浆雌、孕激素水平及白细胞雌激素受体的影响。方法：应用阴道超声、放免法和放射配体结合法比较了２２例自然周期和２６例克罗米芬促排卵周期不孕症患者子宫内膜厚度、分型，成熟卵泡数和血浆雌二醇、孕酮浓度及外周血白细胞雌激素受体含量的变化。结果：（１）克罗米芬组围排卵期子宫内膜厚度小于自然周期组（Ｐ＜０．０５）；成熟卵泡数明显多于自然周期组（Ｐ＜０．０１）；子宫内膜分型两组间无明显差异（Ｐ＞０．０５）。（２）围排卵期血浆雌二醇、孕酮浓度，克罗米芬组均显著高于自然周期组（Ｐ＜０．０１）。（３）克罗米芬周期白细胞雌激素受体含量，最大结合容量（Ｂｍａｘ）及平衡解离常数（Ｋｄ）值均低于自然周期组（Ｐ＜０．０１）。结论：（１）克罗米芬使白细胞雌激素受体减少，并可能使子宫内膜雌激素受体减少，对雌二醇、孕酮的正向调节反应减弱，从而影响子宫内膜的容受性。（２）克罗米芬可致发育卵泡过早黄素化，影响促排卵周期妊娠率的提高。

Objective: To evaluate the effect of clomiphene citrate(CC) stimulating cycle on the thickness and type of endometrium, the number of mature follicle, the concentration of serum estradiol(E 2), progesterone(P) and estrogen receptor(ER) content in peripheral blood white cells(PBWC). Methods:Paravaginal ultrasonography was used to identify the thicknes and type of endometrium;the concentration of serum estradiol(E 2), progesterone(P) was measured by radioimmunoassay(RIA); and the capacity of ER in PBWC was measured by radioligand binding assay in 22 natural and 26 stimulating cycles, respectively. Results: (1)In periovulation phase,the thickness of endometrium in CC stimulating cycle was smaller than in natural cycle(P<0.01). (2)The number of mature follicle(D≥18mm) in CC cycle was much more as compared with natural cycle (P<0.01). (3)There were no difference in the echo type of endometrium between CC and natural groups (P>0.05). (4) The concentration of both serum E 2 and P in stimulating cycle are significantly higher than that in natural cycle(P<0.01). (5)The capacity of ER in PBWC and the value of both B max and K d were much lower during periovulation phase in CC cycle(P<0.01). Conclusion: (1)CC can down regulate ER content in PBWC and possibly lessen ER content in endometrium; in addtion, CC could make the effect of up regulation by E 2 on ER in endometrium lowered and then affect the receptivity of endometrium. (2)CC can result in premature luteinization of follicles, then influence the improvement of pregnancy rate.