不同剂量来曲唑促排卵效果及对内膜、性激素影响的研究

Ovulation induction efficacy of different doses of letrozole and their effect on endometrium and sexual hormones

目的:比较3种不同剂量来曲唑(letrozol,LE)促排卵效果及对内膜、性激素的影响。方法:选择Ⅱ型排卵障碍的不孕患者92例,随机分为3组,第1组(30例)及第2组(32例)在月经第3天分别给予来曲唑2.5 mg/d、5 mg/d,共5 d,第3组(30例)在月经第3天顿服来曲唑20 mg。观察人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)注射日的卵泡成熟天数、成熟卵泡数目、子宫内膜厚度、血雌二醇(estradiol,E2)、黄体生成素(luteinizing hormone,LH)、总睾酮(testosterone,T)水平、排卵率、未破卵泡黄素化综合征(luteinized unruptured follicle syndrome,LUFS)的发生率及排卵后7 d血E2、孕酮水平。结果:3组间HCG注射日的卵泡成熟天数、成熟卵泡数目、子宫内膜厚度、血E2、LH、T水平、排卵率以及排卵后7 d血孕酮水平差异均无统计学意义(P>0.05)。3组间LUFS发生率、排卵后7 d血E2水平差异有统计学意义。结论:3组方案均能有效促进卵泡发育,HCG日内膜厚度均达到0.8 cm以上,排卵后血孕酮水平均高于60 nmol/L。仅LE 20 mg单次口服组排卵后7 d血E2水平可达自然生理周期黄体期正常水平,而总体给药剂量较低,使用方便,推荐可作为LE促排卵首选方案。

Objective ：To explore the ovulation induction efficacy of different doses of letrozole （LZ） and their effect on endometrium and sexual hormones in infertility patients. Methods ：A total of 100 infertility patients were randomly divided into three groups. The patients of the first group（n=30） and the second group（n=32） were treated with LE 2.5 mg/d and 5 mg/d respectively for five days from 3 d of menses. The patients of the third group（n=30） took LE 20 mg on 3 d of menses. On the HCG injection day,follicle matu- rity days, number of mature follicles, endometrial thickness, serum estradiol （E2）, luteinizing hormone （LH）, testosterone （ T ） level, ovu lation rate,incidence of luteinized unruptured follicle syndrome（LUFS） and the level of E2 and progesterone on 7 d after ovulation were observed. Results：There was no significant difference in the 3 groups of HCG days after injection, follicle maturity days, number of mature follicles, endometrium thickness, E2, LH,T, ovulation rate and the level of progesterone in blood of 7 d after ovulation （all P〉0.05）. There were significant difference in the 3 groups in the incidence of LUFS and the level of E2 in blood of 7 d after ovulation （P〈0.05）. Conclusion：The therapy of all three groups can effectively promote the development of ovarian follicle, and ensure the en- dometrial thickness above 0.8 cm on HCG injection day,and the level of progesterone in blood higher than 60 nmol/L after ovulation. But only in LE 20 mg single oral group,blood E2 level can reach normal level of natural physiological cycle after 7 d of ovulation. Taking LE 20 mg on 3 d of menses is easy to perform, therefore is recommended as the first choice for LE ovulation induction pro- gram.