戊酸雌二醇对多囊卵巢综合征妊娠率的影响

Effect of progynova on pregnancy rate of women with anovulatory infertility

目的探讨枸橼酸克罗米酚加用小剂量戊酸雌二醇对多囊卵巢综合征排卵障碍性不孕症的治疗效果。方法将168例多囊卵巢综合征排卵障碍性不孕症患者随机分为3组,枸橼酸克罗米酚组(A组)65例,单纯给予枸橼酸克罗米酚治疗;枸橼酸克罗米酚+戊酸雌二醇组(B组)65例,给予枸橼酸克罗米酚+戊酸雌二醇治疗;人绝经期促性腺激素组(C组)38例,给予人绝经期促性腺激素治疗。比较3组患者子宫内膜厚度、成熟卵泡数、雌二醇和孕激素的浓度。结果B组和C组围排卵期子宫内膜厚度显著高于A组,经比较有显著性差异(t分别为20.333、22.324,均P<0.01)。C组成熟卵泡数及月经第21天孕酮浓度明显高于A组和B组,成熟卵泡数经比较有显著性差异(t分别为7.453、7.413,均P<0.01);孕酮浓度比较也有显著性差异(t分别为31.512、32.205,均P<0.01);B组和A组成熟卵泡数比较有显著性差异(t=21.242,P<0.01),孕酮浓度比较也有显著性差异(t=10.215,P<0.01)。C组雌二醇浓度明显高于A组(t=16.452,P<0.05)。B组和C组的周期妊娠率明显高于A组,经比较有显著性差异(2χ分别为5.656、0.063,均P<0.01)。结论枸橼酸克罗米酚联合应用小剂量戊酸雌二醇与单纯应用枸橼酸克罗米酚比较,能够提高妊娠率,其临床疗效与人绝经期促性腺激素相当。

Objective To observe therapeutic effect of clomiphene citrate combined with low dose of progynova （PGV） for anovulatory infertility. Methods 168 patients with PCOS and anovulatory infertility were randomly divided into 3 groups： clomiphene citrate treatment group （ group A, n = 65 ）, clomiphene citrate combined with PGV treatment group （ group B, n -- 65 ） and humanmenopausal gonadotropin treatment group （ group C, n = 38）. 65 infertile women in the group A were given only clomiphene citrate, other 65 infertile women in the group B ,were given clomiphene citrate combined with PGV and 38 infertile women in the group C were given humamenopausal gonadotropin. Transvaginal ultrasonography was performed on all patients to measure endometrial thickness, number of matured follicles and ELISA was used to determine serum levels of estradiol （E2 ） and progesterone （P）. The endometrial thickness, number of matured follicles, and levels of serum E2 and P of the infertile women in the three groups were compared. Results In the perio^lation phase, the endometrial thickness of the women in either group B or group C was both significantly thicker than group A and the difference was statistically significant （t =20.333, 22. 324, respectively, both P 〈0.01 ）. The number of matured follicles and serum level of P at the 21th day of the menstrual cycle of the women in the group C was much more than that in either group A or group B and there were significant differences between the three groups （for number of matured follicles： t = 7. 452, 7. 413, respectively, both P 〈 0.01 ; for serum level of P： t = 31. 512, 32. 324, respectively, both P 〈 0.01 ）. Between group B and group A there were significant differences in number of matured follicles and serum level of P（for number of matured follicles： t =21. 242, P 〈0. 01 ; for serum level of P： t = 10. 215, P 〈 0.01 ）. The serum level of E2 of the women in group C was significantly higher than that in group A （t = 16. 452, P 〈 0.05 ）. The pregnancy rates of the women in group B and group C were significantly higher than that in group A and the differences were significant （χ^2 =5. 656, 0.063, respectively, both P 〈0.01 ）. Conclusion As compared with single clomiphene citrate therapy, clomiphene citrate combined with low dose of progynova therapy can improve the pregnancy rate of the infertile women, its clinical therapeutic effect is comparative to that of humanmenopausal gonadotropin.