戊酸雌二醇片联合克罗米芬治疗对排卵障碍性不孕症患者子宫内膜厚度及血清E_2、孕酮水平的影响

Effect of estradiol valerate combined with clomiphene on endometrial thickness and serum E_2 and progesterone levels in patients with infertility caused by ovulatory disorder

目的探讨戊酸雌二醇片联合克罗米芬治疗对排卵障碍性不孕症患者子宫内膜厚度及血清雌二醇(E2)、孕酮(P)水平的影响,为临床治疗提供参考依据。方法按照随机数字表法将2013年12月-2016年8月收治的96例排卵障碍性不孕症患者分为观察组与对照组,各48例。对照组给予克罗米芬治疗,观察组在对照组基础上联合戊酸雌二醇片治疗。对比两组治疗前、后子宫内膜厚度变化及血清性激素[E_2、P、黄体生成素(LH)、卵泡刺激素(FSH)]水平,统计两组治疗期间不良反应发生率,随访3个月,对比两组排卵率及妊娠率。结果 (1)子宫内膜厚度:治疗前,两组子宫内膜厚度比较差异无统计学意义(P>0.05);治疗后,两组子宫内膜厚度均明显增加,且观察组大于对照组,差异有统计学意义(P<0.05)。(2)血清性激素:治疗前,两组FSH、LH、E_2、P水平比较差异均无统计学意义(均P>0.05);治疗后,观察组E2、P水平均高于对照组,差异均有统计学意义(均P<0.05),FSH、LH水平与对照组比较差异均无统计学意义(均P>0.05)。(3)不良反应:观察组不良反应发生率为14.58%(7/48),对照组为10.42%(5/48),两组不良反应发生率比较,差异无统计学意义(P>0.05)。(4)排卵率及妊娠率:两组治疗后排卵率[85.42%(41/48)vs.70.83%(34/48)]比较,差异无统计学意义(P>0.05),观察组妊娠率38.58%(19/48)vs.20.83%(10/48)高于对照组,差异有统计学意义(P<0.05)。(5)负性情绪:治疗前,两组焦虑自评量表(SAS)、抑郁自评量表(SDS)评分比较,差异均无统计学意义(均P>0.05);治疗后3个月,观察组SAS、SDS评分低于对照组,差异均有统计学意义(均P<0.05)。结论给予排卵障碍性不孕症患者戊酸雌二醇片联合克罗米芬治疗,可有效增加子宫内膜厚度,提高患者血清E_2、P水平,临床效果显著,且具有一定安全性,有利于提高患者妊娠率、缓解负性情绪。

Objective To explore the effect of estradiol valerate combined with clomiphene on endometrial thickness and serum estradiol(E2） and progesterone levels in patients with infertility caused by ovulatory disorder,provide a reference basis for clinical treatment.Methods From December 2013 to August 2016,96 patients with infertility caused by ovulatory disorder were selected and divided into observation group and control group according to random number table,48 patients in each group. The patients in control group were treated with clomiphene,and the patients in observation group were treated with estradiol valerate combined with clomiphene. Endometrial thicknesses and the levels of serum sex hormones [E2,progesterone,luteinizing hormone(LH）,follicle-stimulating hormone(FSH） ]before and after treatment in the two groups were compared. The patients in the two groups were followed up for three months. Ovulation rates and pregnancy rates in the two groups were compared. Results Before treatment,there was no statistically significant difference in endometrial thickness between the two groups(P〉0. 05）. After treatment,endometrial thicknesses in the two groups increased significantly,endometrial thickness in observation group was statistically significantly thicker than that in control group(P〈0. 05）. Before treatment,there was no statistically significant difference in the levels of serum FSH,LH,E2,and progesterone between the two groups(P〉0. 05）. After treatment,the levels of serum E2 and progesterone in observation group were statistically significantly higher than those in control group(P 〈0. 05）; there was no statistically significant difference in the levels of serum FSH and LH between the two groups(P〉 0. 05）. The incidence rates of adverse reactions in observation group and control group were 14. 58%(7/48） and 10. 42%(5/48）,respectively,There was no statistically significant difference in the incidence rates of adverse reactions between the two groups(P 〉 0. 05）. After treatment,the ovulation rates in the two groups were 85. 42%(41/48） and 70. 83%(34/48）,respectively,there was no statistically significant difference in ovulation rate between the two groups(P〉0. 05）,pregnancy rate in observation group was statistically significantly higher than that in control group(P〈0. 05）. Before treatment,there was no statistically significant difference in SAS and SDS scores between the two groups(P〉0. 05）. At three months after treatment,SAS and SDS scores in observation group were statistically significantly lower than those in control group(P〈0. 05）. Conclusion The clinical effect of estradiol valerate combined with clomiphene in treatment of patients with infertility caused by ovulatory disorder is significant,the therapy can effectively increase endometrial thickness,improve the levels of serum E2,progesterone and pregnancy rate,relieve negative emotions with a certain safety.