来曲唑联合尿促性素对难治性多囊卵巢综合征患者妊娠率及预后的影响

Effects of letrozole combined with human menopausal gonadotropin on pregnancy rate and prognosis in patients with refractory polycystic ovary syndrome

目的观察来曲唑联合尿促性素(HMG)对难治性多囊卵巢综合征(PCOS)患者妊娠率及预后的影响。方法选取金华宏玥妇女儿童医院2019年5月至2020年5月收治的难治性PCOS患者102例为观察对象,采用随机数字表法分为观察组与对照组,每组51例。两组前期治疗方案相同,后期促排卵治疗方案中,对照组给予HMG,观察组在对照组基础上加以来曲唑治疗,比较两组治疗前、治疗3个月后的性激素[促卵泡生成激素(FSH)、黄体生成素(LH)、雌二醇(E2)、睾酮(T)]、卵泡周围动脉相关血流动力学指标[舒张末期流速(EDV)、收缩期峰值流速(PSV)、搏动指数(PI)]、子宫内膜厚度及分型,并记录其治疗周期内排卵率、妊娠率及随访6个月的妊娠结局。结果治疗3个月后,两组患者FSH、LH、E2、T水平均较治疗前下降,差异均有统计学意义(均P<0.05),且观察组FSH[(1.85±0.45)U/L]、LH[(9.86±1.47)U/L]、E2[(81.25±10.47)pmol/L]、T[(1.75±0.26)nmol/L]水平均明显低于对照组[(3.12±1.47)U/L、(12.58±2.14)U/L、(109.25±27.14)pmol/L、(3.58±0.76)nmol/L](t=5.90、7.48、6.87、16.27,均P<0.001);两组患者EDV水平较治疗前均显著下降(均P<0.05),且观察组[(3.12±1.42)cm/s]明显低于对照组[(5.14±1.89)cm/s](t=21.14,P<0.001);两组PSV水平较治疗前均显著上升(均P<0.05),且观察组[(13.36±2.01)cm/s]明显高于对照组[(10.24±2.47)cm/s](t=4.21,P<0.001);两组PI水平较治疗前差异均无统计学意义(均P>0.05);治疗后,观察组子宫内膜厚度[(9.09±1.58)mm]明显高于对照组[(8.41±1.42)mm](t=2.28,P<0.05),排卵率[88.24%(45/51)]明显高于对照组[70.59%(36/51)](χ^(2)=4.85,P<0.05),两组子宫内膜类型、生化妊娠、临床妊娠率、流产及早产发生率差异均无统计学意义(均P>0.05)。结论来曲唑联合HMG治疗难治性PCOS效果理想,在改善患者性激素水平的同时恢复卵巢基质血流动力学状态,还可提高排卵率。

Objective To investigate the effects of letrozole combined with human menopausal gonadotropin(HMG)on pregnancy rate and prognosis in patients with refractory polycystic ovary syndrome(PCOS).Methods A total of 102 patients with refractory PCOS who received treatment in Jinhua Hongyue Women's and Children's Hospital between May 2019 and May 2020 were included in this study.They were randomly assigned to observation and control groups(n=51/group).All patients received the same treatment in the early period.During later ovulation induction period,patients in the control group were administered HMG and those in the observation group were given letrozole combined with HMG.Before treatment and 3 months after treatment,sex hormones[follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),testosterone(T)],arterial hemodynamic indicators around the follicle[end diastolic velocity(EDV),peak systolic velocity(PSV),pulsation index(PI)],endometrial thickness and classification were compared between the two groups.The ovulation rate and pregnancy rate as well as pregnancy outcomes at 6 months of follow-up were recorded in each group.Results After 3 months of treatment,FSH,LH,E2 and T levels in each group were significantly decreased compared with those before treatment(all P<0.05).FSH,LH,E2 and T levels in the observation group were(1.85±0.45)U/L,(9.86±1.47)U/L,(81.25±10.47)pmol/L,(1.75±0.26)nmol/L,respectively,which were significantly lower than those in the control group[(3.12±1.47)U/L,(12.58±2.14)U/L,(109.25±27.14)pmol/L,(3.58±0.76)nmol/L,t=5.90,7.48,6.87,16.27,all P<0.05.EDV in each group was significantly decreased after 3 months of treatment compared with that before treatment(both P<0.05)].After treatment,EDV in the observation group was significantly lower than that in the control group[(3.12±1.42)cm/s vs.(5.14±1.89)cm/s,t=21.14,P<0.001].PSV in each group was significantly increased after treatment compared with that before treatment(both P<0.05).After treatment,PSV in the observation group was significantly higher than that in the control group[(13.36±2.01)cm/s vs.(10.24±2.47)cm/s,t=4.21,P<0.001].In each group,PI measured after treatment was not significantly different from that measured before treatment(both P>0.05).After treatment,endometrial thickness in the observation group was significantly higher than that in the control group[(9.09±1.58)mm vs.(8.41±1.42)mm,t=2.28,P<0.05].Ovulation rate in the observation group was significantly higher than that in the control group[88.24%(45/51)vs.70.59%(36/51),χ^(2)=4.85,P<0.05].There were no significant differences in endometrial type,biochemical pregnancy,clinical pregnancy rate,abortion rate,and premature delivery rate between the two groups(all P>0.05).Conclusion Letrozole combined with HMG has an ideal effect on refractory PCOS.It can improve the levels of sex hormones,restore the hemodynamic status in ovarian stroma and increase ovulation rate.