芳香酶抑制剂来曲唑促排卵60例临床观察

Clinical observation of the aromatase inhibitor letrozole for 60 cases of induction of ovulation

[背景]观察来曲唑在促排卵治疗中的临床效果.[病例报告]选择120例接受促排卵治疗者,随机分为2个组,分别为来曲唑A组及氯米芬组,每组各为60例,分别口服给予来曲唑、氯米芬3个周期;来曲唑B组为氯米芬组3个周期不排卵或发生卵泡黄素华未破裂(LUF)后停药3个月,改口服来曲唑3个周期的患者.来曲唑A组共为148个周期,氯米芬组为160个周期,来曲唑B组为86个周期.观察来曲唑A组及氯米芬组的子宫内膜厚度、成熟卵泡数、排卵率、发生LUF数、卵巢过度刺激(OHSS)数及妊娠率,并进行比较;观察氯米芬无效而改用来曲唑后的临床效果.来曲唑A组人绒毛膜促性腺激素(hCG)日成熟卵泡数为1.12±0.20,明显少于氯米芬组成熟卵泡数1.45±0.77(P<0.05);HCG日子宫内膜厚度达不到8mm者占7.4%,明显少于氯米芬组的35.6%(P<0.05);来曲唑组发生LUF,OHSS均显著少于氯米芬组(P<0.05);排卵率81.2%明显高于氯米芬组的60.3%(P<0.05).来曲唑B组由氯米芬改服来曲唑后18例排卵,8例妊娠成功.[讨论]来曲唑促排卵临床效果优于氯米芬,并可使部分对氯米芬无效患者成功促排卵,减少LUF,OHSS等并发症,可成为氯米芬的替代药物.

BACKGROUND To study the clinical effects of letrozole （LE） on the induction of ovulation. CASE REPORTS 120 of patients were randomly divided into two groups, and administered with the LE （group LE-A） and clomifene （group CC）, respectively. Both groups have been treated in their three ovulation cycles. Failed ovulation cases in group CC were gathered in group LE-B（86 cyles） and taken LE after three months of withdrawal. Endometrial developments, the numbers of mature follicles, ovulation rates, pregnancy rates, numbers of luteinized unruptured follicle （LUF） and ovarian hyper-stimulation syndrome（OHSS） were compared between group LE-A （148 cycles） and group CC （160 cycles）. The effectiveness of ovulation induction was studied in group LE-B. 1.12 ±0.20 of mature follicles on the day of hCGwere significantly less in LEA group than in group CC（1.45 ± 0.77, P〈0. 05）, and 7.4% of endometrial thickness less than 8 mm was obviously less in group LE-A than in group CC（35, 6%, P〈0.05）. The LUF was happened in LE group, and the OHSS was less in LE group than in group CC. 81.2% of ovulation rate were significantly higher in LE A group than in group CC（60.3%, P〈0.05）. 18 cases in LE group B had ovulation by administrating form CC to LE, and 8 cases had successful pregnancy. DISCUSSION The clinical effects of LE for induction of ovulation are more effective than that of CC, andsome of patients with ineffectiveness of CC are made the induction of ovulation, and LE can avoid the unfavorable effects on the ovaries such as LUF and OHSS, and will be the potential treatment forinduction of ovulation instead of CC.