不同剂量泼尼松龙联合氯米芬治疗多囊卵巢综合征高雄激素不孕的效果比较

Effect comparison of different dosage of Prednisolone combined with Clomiphene in the treatment of hyperandrogenic infertility in patients with polycystic ovary syndrome

目的比较不同剂量泼尼松龙联合氯米芬治疗多囊卵巢综合征(PCOS)高雄激素不孕的效果。方法选取2017年1月～2018年4月在本院妇科门诊就诊的160例PCOS高雄激素不孕患者作为研究对象,采用随机数字表法分为A、B、C、D组,每组各40例。以D组作为对照组,给予氯米芬50 mg/d×5 d治疗,而A、B和C组在D组基础上分别给予泼尼松龙片20、15和10 mg/d治疗,疗程均为3 d。治疗结束后比较各组间睾酮(T),黄体生产素(LH),雌二醇(E2)和卵泡刺激素(FSH)等生殖激素水平,比较成熟卵泡数量和直径、优势卵泡数量和直径、排卵率和妊娠率等指标。结果 C组患者的T水平明显低于A、B、D组,LH、E2和FSH水平均明显高于A、B、D组,差异有统计学意义(P<0.05);C组的成熟卵泡直径大于A、B、D组,差异有统计学意义(P<0.05);A、B、C、D组的成熟卵泡数、优势卵泡数和子宫内膜厚度比较,差异无统计学意义(P>0.05);A、B、C组患者的排卵率明显高于D组,差异有统计学意义(P<0.05);A、B、C、D组的妊娠率比较,差异无统计学意义(P>0.05)。结论泼尼松龙联合氯米芬治疗PCOS高雄激素不孕最佳剂量为10 mg/d,可有效降低体内雄性激素水平,提高雌性激素水平,对排卵和妊娠具有显著疗效。

Objective To compare the effect of different dosage of Prednisolone combined with Clomiphene in the treatment of hyperandrogenic infertility in patients with polycystic ovary syndrome (PCOS). Methods A total of 160 PCOS patients with hyperandrogenic infertility who visited gynecology clinic in our hospital from January 2017 to April 2018 were selected as the study subjects, and divided into group A, group B, group C and group D by random number table method, with 40 cases in each group. Group D as the control group was treated with Clomiphene 50 mg/d×5 d, while group A, group B and group C were treated with Prednisolone Tablets 20 mg/d, 15 mg/d and 10 mg/d respectively. They were all treated for 3 days. After treatment, the reproductive hormone levels of testosterone (T), luteinizing hormone (LH), estradiol (E2) and follicle stimulating hormone (FSH), the number and diameter of mature follicles, the number and diameter of dominant follicles, ovulation rate and pregnancy rate were compared. Results The T level of group C was significantly lower than that of group A, group B and group D, and the levels of LH, E2 and FSH were significantly higher than those of group A, group B and group D (P<0.05). The diameter of mature follicles in group C was significantly longer than that in group A, group B and group D (P<0.05). There was no significant difference in the number of mature follicles, the number of dominant follicles and the thickness of endometrium among group A, group B, group C and group D (P>0.05). The ovulation rate in group A, group B and group C was significantly higher than that in group D (P<0.05). There was no significant difference in pregnancy rate among group A, group B, group C and group D (P>0.05). Conclusion The optimal dose of Prednisolone combined with Clomiphene in the treatment of PCOS hyperandrogenic infertility is 10 mg/d, which can effectively reduce the level of androgens in vivo, improve the level of estrogen, and has a significant effect on promoting ovulation and pregnancy.