维生素D联合炔雌醇环丙孕酮及克罗米芬治疗多囊卵巢综合征并不孕症患者对内分泌激素水平及妊娠结局的影响

Effects of vitamin D combined with ethinylestradiol and cyproterone acetate tablets and clomiphene on endocrine hormones levels and pregnancy outcomes in patients with polycystic ovary syndrome and infertility

目的 探究维生素D(VD)联合炔雌醇环丙孕酮(ECAT)及克罗米芬对多囊卵巢综合征(PCOS)并不孕症患者疗效的影响。方法 选取2019年4月至2021年7月邵阳学院附属第一医院收治的210例PCOS并不孕症患者作为研究对象,采用随机单双号法将其分为A组(n=105,ECAT和克罗米芬治疗,单号)和B组(n=105,A组给药基础上增加VD,双号)。比较两组治疗前后激素水平、子宫内膜容受性、糖代谢指标,并随访排卵情况和妊娠结局。结果 两组子宫动脉搏动指数(PI)、子宫动脉阻力指数(RI)、卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T)、空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)与治疗前相比均显著降低,且B组低于A组(P<0.05);两组孕酮(P)、子宫内膜厚度(EN)与治疗前相比显著增加,且B组大于A组(P<0.05)。B组排卵率、妊娠率、活产率显著高于A组(P<0.05);两组流产率无显著差异(P>0.05)。结论 VD联合ECAT及克罗米芬可有效改善PCOS并不孕症患者子宫内膜容受性,调节激素和糖代谢状况,有助于获得满意的妊娠结局。

Objective To explore the effects of vitamin D(VD)combined with ethinylestradiol and cyproterone acetate tablets(ECAT)and clomiphene on the efficacy in patients with polycystic ovary syndrome(PCOS)complicated with infertility.Methods A total of 210 patients with PCOS and infertility admitted from April 2019 to July 2021 in the First Affiliated Hospital of Shaoyang University were selected as the research subjects and were divided into group A(n=105,ECAT and clomiphene,odd number)and group B(n=105,VD added on the basis on group A,even number)by means of the random odd-even number method.Hormones levels,endometrial receptivity and glucose metabolism indicators were compared between the two groups of patients before and after treatment.Ovulation and pregnancy outcomes were followed up.Results Uterine artery pulsatility index(PI),uterine artery resistance index(RI),follicle-stimulating hormone(FSH),luteinizing hormone(LH),testosterone(T),fasting plasma glucose(FPG),fasting insulin(FINS)and homeostasis model assessment of insulin resistance(HOMA-IR)in both groups were reduced compared with those before treatment,and the above indicators in group B were lower than those in group A(P<0.05).The progesterone(P)and endometrial thickness(EN)in the two groups were significantly increased compared to those before treatment,and the indicators were higher in group B than those in group A(P<0.05).The ovulation rate,pregnancy rate and live birth rate in group B were significantly higher than those in group A(P<0.05).There was no significant difference in abortion rate between the two groups(P>0.05).Conclusions VD combined with ECAT and clomiphene can effectively improve the endometrial receptivity,regulate the hormones and glucose metabolism status and contribute to satisfactory pregnancy outcomes in patients with PCOS and infertility.