来曲唑与克罗米芬治疗多囊卵巢综合征疗效

Efficacy of letrozole and clomiphene citrate for treating infertile women with polycystic ovarian syndrome

目的:比较来曲唑(LE)与克罗米芬(CC)治疗多囊卵巢综合征(PCOS)疗效。方法:选取本院收治的PCOS不孕患者106例,随机分为LE组和CC组各53例。月经周期第4~5天分别口服LE和CC,连续用药5d,当至少1个卵泡直径≥18mm时,注射人绒毛膜促性腺激素(HCG),指导24~48h内同房。于HCG注射当日,检测两组雌二醇(E2)、促黄体生成素(LH)和睾酮(T)水平,超声检查子宫内膜厚度、子宫螺旋动脉血流阻力(RI)、螺旋动脉搏动指数(PI)。排卵后14天检测HCG水平计算生化妊娠率,排卵后30~35天B超检测孕囊、胚芽及胎心搏动并计算临床妊娠率。结果:LE组E2水平低于CC组(P<0.05),LH、T水平两组比较无差异(P>0.05)。LE组RI、PI均低于CC组,而子宫内膜厚度高于CC组(P<0.05)。成熟卵泡个数两组无差异(P>0.05),排卵率LE组低于CC组,生化妊娠率及临床妊娠率LE组均高于CC组(P<0.05)。结论:尽管CC的促排卵效果优于LE,但LE可有效增加子宫内膜厚度,改善子宫内膜容受性,从而提高妊娠率,其总体效果优于CC。

Objective:To compare the efficacy of letrozole(LE)and clomiphene citrate(CC)for treating infertile women with polycystic ovarian syndrome(PCOS).Methods:106 infertile women with PCOS were randomly divided into LE group and CC group(53 cases in each group),and the women were given LE or CC for 5 days from the 4 5th day of the menstrual cycle.When the diameter of one follicle at least was more than 18mm,the women were injected HCG for stimulating ovulation,and the women would complete intercourse in 24 48h.On the day of HCG injection,the levels of estradiol(E 2),luteinizing hormone(LH)and testosterone(T)of women were measured.Endometrial thickness,uterine spiral artery resistance(RI),spiral artery pulsation index(PI)of all women were examined by ultrasound.HCG levels were measured on the 14th day after ovulation for identified and calculating the biochemical pregnancy rate.On the 30 35th day after ovulation,the gestational sac and fetal heart of all women were detected by B ultrasound for calculating the clinical pregnancy rate.Results:The level of E 2 of women in group LE was significant lower than that of women in CC group(P<0.05).There were no significant different in the levels of LH and T of women between the two groups(P>0.05).The values of RI and PI of women in LE group were significant lower than those of women in CC group,while the endometrial thickness of women was significant higher(P<0.05).There was no significant different in the number of mature follicle of women between the two groups(P>0.05).The ovulation rate of women in LE group was significant lower than that of women in CC group,while the biochemical pregnancy rate and clinical pregnancy rate were significant higher(P<0.05).Conclusion:Although CC is better than LE in ovulation induction,LE can improve pregnancy rate by effectively increasing endometrial thickness and improving endometrial receptivity,so the overall effect of LE is better than CC.