三种药物方案对PCOS伴不孕患者促排卵效果及妊娠结局的影响

Influence of three kinds of drug regimens on the ovulation promoting effects and pregnancy outcome of PCOS patients with infertility

目的探讨枸橼酸氯米芬50 mg/d、来曲唑2.5 mg/d及5.0 mg/d方案对多囊卵巢综合征(PCOS)伴不孕患者促排卵效果及妊娠结局水平的影响。方法选择我院2015年1月至2016年7月收治的150例PCOS伴不孕患者为研究对象,以随机数字表法分为A组(50例)、B组(50例)及C组(50例),分别给予枸橼酸氯米芬50 mg/d、来曲唑2.5 mg/d及5.0 mg/d治疗。比较三组患者排卵率、周期妊娠率、HMG和戊酸雌二醇应用率,排卵日子宫内膜厚度及卵泡指标水平等。结果 B、C组患者排卵率和周期妊娠率均显著高于A组(P<0.05);B、C组患者HMG应用率显著高于A组(P<0.05);B、C组患者戊酸雌二醇应用率显著低于A组(P<0.05);B、C组患者排卵日子宫内膜厚度均显著厚于A组(P<0.05);B、C组患者排卵率、周期妊娠率、HMG应用率、戊酸雌二醇应用率及排卵日子宫内膜厚度比较,无显著性差异(P>0.05);三组患者排卵日直径≥18 mm卵泡数量比较,差异无统计学意义(P>0.05);C组患者排卵日直径≥18 mm卵泡内E2水平显著低于A、B组(P<0.05);B组患者排卵日直径≥18 mm卵泡内E2水平显著低于A组(P<0.05)。结论相较于氯米芬,采用来曲唑治疗PCOS伴不孕在提高排卵率和周期妊娠率,保护子宫内膜方面具有优势,且来曲唑5.0 mg/d方案更有助于改善子宫内膜容受性。

Objective To investigate the influence of three kinds of drug regimens including clomifene citrate for 50 mg/d, letrozole for 2.5 mg/d and 5.0 mg/d on ovulation promoting effects and pregnancy outcome in polycystic ovariansyndrome （PCOS） patients with infertility. Methods A total of 150 PCOS patients with infertility treated in our hospital formJanuary 2015 to July 2016 were selected as study objects and randomly divided into group A （50 cases, with clomifene citratefor 50 mg/d）, groupB （50 cases, with letrozole for 2.5 mg/d） and group C （50 cases, with letrozole for 5.0 mg/d）. Theovulation rate, cycle pregnancy rate, application rates of HMG and estradiol valerate, endometrial thickness and follicularindexes level on ovulation day were compared among the three groups. Results The ovulation rate and cycle pregnancy ratein the group B and groupC were significantly higher than those in the groupA （P〈0.05）. The HMG utilization rate in thegroupB and group C were significantly higher than that in the group A（P〈0.05）. The utilization rate of estradiol valerate inthe group B and groupC were significantly lower than that in the group A（P〈0.05）. The endometrial thickness of ovulationday in the group B and groupC were significantly thicker than that in the group A（P〈0.05）. There were no significantdifferences in ovulation rate, cycle pregnancy rate, HMG utilization rate, estradiol valerate utilization rate and endometrialthickness of ovulation day between the group B and group C（P〉0.05）. There were no significant differences in the numbersof follicle for diameter逸18 mm among the three groups（P〉0.05）. The level ofE2 in follicle for diameter逸18 mm of thegroupC was significantly lower than that of the group A and groupB （P〈0.05）. The level ofE2 in follicle for diameter逸18mm of the group B was significantly lower than that of the group A（P〈0.05）. Conclusion Compared with clomifene citrate,letrozole for 2.5 mg/d and 5.0 mg/d in the treatment of PCOS patients with infertility possess the advantages including ofhigher ovulation rate, cycle pregnancy rate and the endometrium protection; letrozole for 5.0 mg/d can efficiently improvethe receptivity of endometrial.