不同促排卵方案对多囊卵巢综合征患者子宫及卵巢血流的影响

Effects of different ovulation induction schemes on uterine and ovary blood flow in patients with polycystic ovary syndrome

目的探讨多囊卵巢综合征（PCOS）伴不孕患者多种促排卵药物治疗前后子宫及卵巢血流动力学变化。方法对该院行供精人工授精的150例PCOS患者，在自然周期月经的第2—3、16—18和20-25天及不同促排方案[克罗米芬（CC）组、CC＋人绝经期促性腺激素（HMG）组、来曲唑（LE）组、LE＋HMG组、HMG组]的人绒毛膜促性腺激素（HCG）注射日行阴道彩色多普勒超声检查，测量子宫内膜厚度、形态，内膜血流、子宫和卵巢动脉血流收缩期峰值血流速度（PSV）及阻力指数（RI）等参数，然后对不同月经时间、促排前后、不同促排方案间妊娠组与非妊娠组的相关参数进行比较。结果PCOS患者自然周期子宫、卵巢动脉血流PSV、RI值等无周期性变化；使用促排卵药物后子宫内膜厚度、子宫内膜A型率、子宫内膜A型血流率、子宫内膜下、卵巢及子宫动脉血流的PSV等明显增加，子宫内膜下、卵巢及子宫动脉血流的RI明显降低；5种促排卵方案中，LE＋HMG组方案子宫内膜A型血流率、子宫内膜下血流PSV值明显高于其余4组，且该组的妊娠率最高；妊娠患者HCG注射日子宫内膜下、子宫及卵巢动脉血流PSV明显高于非妊娠患者，但RI指数则明显低于非妊娠患者。结论（1）PCOS患者使用促排卵药物，使患者恢复排卵的同时亦能改善子宫内膜容受性，其中以LE＋HMG方案最佳；（2）HCG注射日子宫内膜下、子宫及卵巢动脉血流的改善有助于提高人工授精的成功率。

[Objective] To study the changes of uterine and ovary blood flow in patients with polycystic ovary syndrome （PCOS） before and after different ovulation induction schemes. [Methods] The endometrial thickness, types, the peak systolic blood flow velocity （PSV）, resistance index （RI） and other parameters of endometrial blood flow, and uterine and ovary blood flow were measured by vaginal color doppler ultrasound in 150 patients with polycystic ovary syndrome undergoing artificial insemination with donor semen in our hospi- tal on day 2-3, day 16~18 and day 20-25 of natural menstrual cycle and HCG injection day among different ovulation induction schemes （CC, CC＋HMG, LE, LE＋HMG and HMG）. The related parameters were compared between different phases of menstrual cycle, before and after treatment, among different ovulation induction schemes and between pregnancy and nonpregnancy groups. [Results] There was no significant difference in PSV or RI of the uterine and ovarian blood flow in the patients with PCOS during the different periods of natural menstrual cycle. After using ovulation stimulation drugs, endometrial thickness, endometrial type A rate, endometrial blood flow type A rate, PSV of endometrial, ovarian and uterine artery blood flow increased significantly while RI of：endometrial, ovarian and uterine artery blood flow significantly lowered. Among the five different ovulation induction schemes, PSV of endometrial blood flow, endometrial blood flow type A rate and pregnancy rate in the LE＋HMG group were significantly higher than those in other four groups. PSV of endometrial, ovarian and uterine artery blood flow in the pregnant group were significantly higher than those of the nonpregnant group, while RI was significantly lower. [ Conclusions] （1）After using ovulation stimulation drugs, patients with polycystic ovary syndrome can restore ovulation, meanwhile the receptivity of endometrium is also improved. LE＋HMG is the best among different ovulation induction schemes. （2）Improvement of endometrial, uterine and ovary artery blood flow on the HCG injection day can improve the success rate of artificial insemination.