来曲唑对不同体质指数PCOS患者促排卵治疗效果的影响

Effect of Letrozole on Ovulation Induction Treatment of PCOS Patients with Different Body Mass Indexes

目的分析来曲唑对不同体质指数(BMI)多囊卵巢综合征(PCOS)患者促排卵治疗效果的影响。方法选取2019年1月至2021年1月就诊于山西白求恩医院妇产科门诊的160例PCOS不孕患者为研究对象,按照BMI不同分为低BMI组(BMI<18.5 kg/m^(2),25例)、正常BMI组(18.5 kg/m^(2)≤BMI<23 kg/m^(2),45例)、超重组(23 kg/m^(2)≤BMI<25 kg/m^(2),55例)、肥胖组(BMI≥25 kg/m^(2),35例)。检测所有患者月经来潮第2~3天的基础性激素(睾酮、促黄体生成素、卵泡刺激素)以及空腹胰岛素、空腹血糖、促甲状腺素水平,评估患者基础状态。于月经周期第3天开始口服来曲唑(5 mg/d,连续5 d)促排卵治疗,比较4组患者卵泡成熟时间、人绒毛膜促性腺激素注射日子宫内膜的厚度、成熟卵泡(≥18 mm)个数、排卵率和临床妊娠率。结果160例不孕患者接受了366个来曲唑促排卵治疗周期。4组患者早期流产率、异位妊娠率、生化妊娠率、人绒毛膜促性腺素注射日子宫内膜厚度、卵泡成熟个数比较差异无统计学意义(P>0.05)。4组周期排卵率、临床妊娠率、卵泡成熟时间比较差异有统计学意义(P<0.05或P<0.01),超重组和肥胖组的周期排卵率、临床妊娠率低于低BMI组和正常BMI组[66.9%(91/136)、64.8%(68/105)比77.5%(31/40)、82.4%(70/85);18.7%(17/91)、19.1%(13/68)比32.3%(10/31)、35.7%(25/70)](P<0.05),肥胖组和超重组卵泡成熟时间长于低BMI组和正常BMI组[(14.54±0.99)d、(14.63±0.96)d比(13.80±1.14)d、(13.89±0.49)d](P<0.05),正常BMI组与低BMI组、超重组与肥胖组间的周期排卵率、临床妊娠率、卵泡成熟时间比较差异无统计学意义(P>0.05)。结论超重或肥胖PCOS患者口服来曲唑的促排卵治疗效果欠佳,应在促排卵治疗前控制体重,以提高妊娠率。

Objective To analyze the ovulation promoting effect of letrozole in infertile polycystic ovary syndrome(PCOS)patients with different body mass indexes(BMI).Methods A total of 160 PCOS infertile patients from Department of Obstetrics and Gynecology of Shanxi Bethune Hospital during Jan.2019 and Jan.2021 were included,and separated into four groups according to BMI:low BMI group(BMI<18.5 kg/m^(2),n=25),normal BMI group(18.5 kg/m^(2)≤BMI<23 kg/m^(2),n=45),overweight group(23 kg/m^(2)≤BMI<25 kg/m^(2),n=55)and obesity group(BMI≥25 kg/m^(2),n=35).The levels of basal hormones(testosterone,luteinizing hormone,follicle stimulating hormone)and the fasting insulin,fasting blood glucose and thyrotropin were measured on the second to third days of menstruation to assess the basic state of the patients.Letrozole(oral,5 mg per day for 5 days)was used to promote ovulation on the third day of menstrual cycle.The follicular maturation time,endometrial thickness on the day of human chorionic gonadotropin injection,the number of mature follicles(≥18 mm),ovulation rate and clinical pregnancy rate of the four groups were compared.Results A total of 160 infertile patients received 366 cycles of letrozole ovulation induction.There was no significant difference in early abortion rate,ectopic pregnancy rate,biochemical pregnancy rate,endometrial thickness and the number of mature follicles on the day of human chorionic gonadotropin injection among the four groups(P>0.05).The periodic ovulation rate,clinical pregnancy rate and follicular maturation time of the four groups were significantly different(P<0.05 or P<0.01).The periodic ovulation rate and clinical pregnancy rate of the overweight group and obesity groups were lower than those of the low BMI group and the normal BMI group[66.9%(91/136),64.8%(68/105)vs 77.5%(31/40),82.4%(70/85);18.7%(17/91),19.1%(13/68)vs 32.3%(10/31),35.7%(25/70)](P<0.05).The maturation time of follicles of the obesity group and overweight group was longer than that of the low BMI group and normal BMI group[(14.54±0.99)d,(14.63±0.96)d vs(13.80±1.14)d,(13.89±0.49)d](P<0.05);while there was no significant difference in cycle ovulation rate,clinical pregnancy rate and follicle maturation time between normal BMI group and low BMI group,between overweight group and obesity group(P>0.05).Conclusion In overweight or obese PCOS patients,the effect of oral letrozole on ovulation induction therapy is not good,so weight control should be done before the ovulation induction therapy to increase pregnancy rate.