促排卵治疗对高催乳素血症不孕患者疗程的影响

Ovulation induction drug impact to the course of hyper-prolactinemia infertility treatment

目的:探讨高催乳素血症(hyperprolactinemia,HPRL)不孕患者药物治疗方案及效果。方法:回顾分析垂体微腺瘤引起的HPRL不孕患者70例,根据治疗方案不同分为两组。溴隐亭组38例单用溴隐亭治疗,初始剂量1.25mg/d,后加量使催乳素水平正常后逐渐减量至溴隐亭维持量为1.25～2.5 mg/d,不用促排卵药物。联合用药组32例,溴隐亭初始剂量同溴隐亭组,用维持量后于月经第3-5天加用枸橼酸氯米芬促排卵治疗,枸橼酸氯米芬用药期间溴隐亭用量继续维持在1.25～2.5 mg/d,月经第8-9天B超检查若无优势卵泡生长则加用尿促性腺激素(hMG)75U/d,直至卵泡直径达18 mm时,改用人绒毛膜促性腺激素(hCG)10 000 IU,hCG用药后第2天及第3天指导同房,然后分析两组用药半年及1年的治疗效果。结果:12个月内联合用药组妊娠率50.0%(16/32)高于溴隐亭组的42.1%(16/38),差异无统计学意义(χ2=0.45,P=0.05)。其中半年内妊娠的联合用药组有15例(占妊娠总数的93.8%),而溴隐亭组只有7例(占43.8%)(χ2=6.53,P<0.05)。结论:高催乳素血症不孕患者采用溴隐亭联合促排卵药治疗,与单用溴隐亭治疗比较,妊娠率差别无统计学意义,但可以明显缩短不孕治疗的时间。

Objective： To investigate the therapeutic drugs scheme and their efficacy to the infertility patients with hyper-prolactinemia（HPRL）.Methods： Seventy cases of infertility patients with HPRL treated in out-patient department of gynecology were analysed retrospectively.They were divided two groups according their different therapeutic schemes： Group Ⅰ（n=38）,used bromocriptine mesylate only,1.25 mg/d,at the beginning,and increased gradually until to get a normal level of prolactin,then decreased step by step to its sustaining dosage as 1.25-2.5 mg/d.No ovulation induction drug was used.Group Ⅱ（n=32）： The beginning dose of bromocriptine mesylate was the same to group I;during the sustaining dosage to their 3rd-5th days after menstrual flow,clomifene citrate（cc） was used to induct ovulation;meanwhile the bromocriptine was still used maintaining 1.25-2.5 mg/d.If there was no dominant follicle on menstrual 8th to 9th day monitored by ultrasonic,menotrophin（hMG） 75 U/d was added and was used until the mean diameter of a follicle reached at least 18 mm,then changed by human chorionic gonadotropin（hCG）10 000 IU.By the 2nd or 3rd day after hCG treatment the patient was instructed to have sexual intercourses.The efficacy of both groups treatment were analysed.Results： Pregnancy percentage comparison showed Group Ⅱ 50.0 %（16/32） was a little higher than Group I 42.1 %（16/38）;difference had no significance（χ2 =0.45,P=0.05）.The patients pregnanted in half a year were 93.8 % in Group Ⅱ,but only 43.8 % in Group Ⅰ（χ2=6.53,P0.05）.Conclusion： There was no statistical significance to treat HPRL infertility by bromocriptine only or combined with ovulation induction drug,but the latter could shorten the time for infertility treatment.