两种剂量LE和CC对PCOS不孕患者促排卵效果比较

Effect comparison of LE with two different doses and CC for ovulation induction in women with PCOS

目的比较两种不同剂量来曲唑（LE）和克罗米芬（CC）对多囊卵巢综合征（PCOS）不孕患者促排卵的效果。方法选择PCOS不孕症患者179例，于月经第5天A组80例给LE2．5mg／d，B组50例给LE5．0mg／d，C组49例给CC100mg／d，共5天，阴道超声监测排卵，排卵后指导同房。观察人绒毛膜性腺激素（hCG）注射日血雌二醇（E2）水平、子宫内膜厚度、优势卵泡个数、单优势卵泡发生率、排卵率、周期妊娠率、未破裂卵泡黄素化综合征（LUFS）的发生率。结果hCG注射日3组宫内膜厚度、B水平和单优势卵泡发生率比较，差异有统计学意义，子宫内膜厚度F=6．650，P=0．002〈0．01；E2水平F：89．533，P=0．000〈0．01；单优势卵泡发生率χ^2=7．585，P=0．023〈0．05；各组间卵泡成熟天数、排卵率、每周期妊娠率和LUFS发生率，差异均无统计学意义（均P〉0．05）。结论对于PCOS不孕症患者，两种剂量LE促排卵效果与CC相似，5．0mg／d的LE并不明显优于2．5mg／d，尚需加大样本量进一步研究。

Objective To compare the efficacy of two different doses of letrozole （LE） and clomiphene citrate （CC） in the ovulation induction of infertile patients with polycystic ovary syndrome （PCOS）. Methods A total of 179 infertile patients with PCOS were randomly divided into group A, B and C. Three groups were in order treated with LE 2.5mg/d （ n = 80）, with LE 5.0mg/d （ n = 50） and with CC 100 mg/d （ n = 49 ） for five days from day 5 of menses. Ultrasonography was performed to monitor follicular development. Timed intercourse was performed after ovulation. On the hCG injection day, serum estradiol （ E2 ）, endometrium thickness, number of dominant follicles, single follicle rate, ovulation rate, pregnancy rate and the incidence of luteinized unrupture follicle syndrome （LUFS） were observed. Results There were significant differences in endometrium thickness （ F = 6. 650, P = 0. 002 〈 0.01 ） , E2 level （ F = 89. 533, P = 0. 000 〈 0.01 ） and single follicle rate （χ^2= 7. 585, P = 0. 023 〈 0.05 ） on hCG day. The dominant follicles growth time, ovulation rate, pregnancy rate and incidence of LUFS were not significantly different among three groups （ all P 〉 0.05 ）. Conclusion For the infertile patients with PCOS, the effect of two doses of LE on ovarian induction is similar to CC. The effect of 5.0mg/d of LE is not superior to that of 2.5mg/d. Larger samples are needed for further study.