改良超长方案对多囊卵巢综合征不孕患者子宫内膜容受性的改善作用研究

Study on modified ultra-long protocol in improving endometrial receptivity in infertile patients with polycystic ovary syndrome

目的探讨改良超长方案对多囊卵巢综合症(PCOS)不孕患者子宫内膜容受性的影响。方法选择PCOS不孕患者100例,根据随机数字表法分为改良组和对照组,每组50例。改良组给予改良超长方案,对照组给予标准长效长方案。经阴道超声检查观察排卵情况及治疗前后子宫内膜变化情况;着床窗口期对内膜间质和腺体分别进行整合素αv、β3及雌激素受体(ER)、孕激素受体(PR)、雄激素受体(AR)的免疫组织化学染色;治疗后对治疗总有效率进行Salle评分。结果改良组排卵周期数明显多于对照组,排卵率明显高于对照组(P<0.01);改良组、对照组治疗后子宫内膜厚度均较治疗前明显变厚(P<0.01),改良组治疗后子宫内膜厚度明显厚于对照组(P<0.01)。各组治疗后内膜血流量均有增加趋势,改良组治疗后内膜血流量高于对照组(P<0.05)。改良组治疗后Salle评分明显低于对照组(P<0.01)。结论改良超长方案可有效提高PCOS患者排卵率、改善子宫内膜容受性,值得临床推广。

Objective To explore the influence of modified ultra-long protocol on endometri- al receptivity in infertile patients with polycystic ovary syndrome （PCOS）. Methods A total of 100 infertile patients with PCOS were randomly divided into modified group and control group by random number table method, with 50 cases for each group. Modified group was given modified ultra-long protocol while control group was given standard long-acting protocol. Ovulation conditions and endom- etrial changes before and after treatment were observed by transvaginal uhrasonography. In implanta- tion window period, immunohistochemical staining of integrinαv and β3 as well as estrogen receptor （ER） , progesterone receptor （PR） androgen receptor （AR） in endometrial stromal and glands were conducted respectively. Therapeutic total response rate （RR） was evaluated using Salle score after treatment. Results Modified group was evidently larger in the number of ovulation cycles and appar- ently higher in ovulation rate than control group （ P 〈 0.01 ）. Endometrial thickness was obviously thicker in both groups after treatment than treatment before （P 〈 0.01 ）, which was notably thicker in modified group than that in control group （ P 〈 0.01 ）. Endometrial hemorrhagic volume had an in- creasing tendency in both groups after treatment, which was prominently higher in modified group than that in control group （ P 〈 0.05 ）. Meanwhile, modified group was significantly lower in Salle score than control group （P 〈 0.01 ）. Conclusion Modified ultra-long protocol can effectively pro- mote the ovulation rate and improve the endometrial receptivity in patients with PCOS, deserving to be widely used in clinic.