不同剂量来曲唑对肥胖型多囊卵巢综合征合并不孕症患者性激素、排卵、卵巢超声特征及妊娠情况的影响

Effect of Different Dosages of Letrozole on Hormonal Levels,Ovulation,Ovarian Ultrasound Characteristics and Pregnancy Outcomes in Obese Polycystic Ovary Syndrome Patients with Infertility

目的:探究不同剂量来曲唑对肥胖型多囊卵巢综合征(PCOS)合并不孕症患者性激素、排卵、卵巢超声特征及妊娠情况的影响。方法:选取2021年3月~2022年3月期间于某院接受治疗的138例肥胖型PCOS合并不孕症患者作为研究对象,采用随机数字表法分为A、B和C三组,每组46例。所有患者在月经的第5天开始口服来曲唑片,A组患者给予2.5mg/d,B组患者给予5mg/d,C组患者给予7.5mg/d,均持续服用5天。比较三组患者排卵效果[卵泡成熟天数、人绒毛膜促性腺激素(HCG)日子宫内膜厚度、最大卵泡直径、HCG日≥18mm卵泡数、HCG日≥15mm卵泡数]、卵巢超声特征[卵巢总面积(TA)、卵巢体积(2D-OV)、搏动指数(PI)和阻力指数(RI)]、注射HCG日雌二醇(E_(2))水平、不良反应发生及妊娠情况。结果:治疗后,三组患者HCG日子宫内膜厚度及最大卵泡直径比较均无统计学差异(P>0.05)。B和C组患者卵泡成熟天数均短于A组(P<0.05),HCG日≥18mm卵泡数及HCG日≥15mm卵泡数均高于A组(P<0.05),B和C两组比较无统计学差异(P>0.05)。B和C组患者TA、2D-OV和PI均高于A组(P<0.05),且C组高于B组(P<0.05);RI均低于A组(P<0.05),且C组低于B组(P<0.05)。B和C组患者治疗后HCG日E_(2)水平均高于A组(P<0.05),B和C两组比较无统计学差异(P>0.05)。三组患者治疗期间不良反应发生情况比较无统计学差异(P>0.05)。三组患者总妊娠率、生化妊娠、临床妊娠、双胎妊娠及早期流产情况比较均无统计学差异(P>0.05)。结论:不同剂量来曲唑治疗肥胖型PCOS合并不孕症患者时,5mg/d和7.5mg/d来曲唑治疗可更有效促进卵泡成熟,提高雌激素水平,改善患者卵巢超声表现及排卵条件,促进排卵。

Objective:To explore the effects of different dosages of letrozole on hormonal levels,ovulation,ovarian ultrasound characteristics and pregnancy outcomes in obese polycystic ovary syndrome(PCOS)patients with infertility.Methods:A total of 138 obese PCOS patients with infertility treated in a hospital between March 2021 and March 2022 were selected and assigned to groups A,B and C by random number table method,with 46 patients in each group.All patients initiated treatment with letrozole tablets orally on the fifth day of their menstrual cycle,with dosages of 2.5mg/d,5mg/d,and 7.5mg/d for groups A,B,and C respectively,for five days.The effects of ovulation[maturity days of follicles,endometrial thickness on human chorionic gonadotropin(HCG)day,maximum follicle diameter,number of follicles≥18mm and≥15mm on HCG day],ovarian ultrasound characteristics[total area(TA),2D ovarian volume(2D-OV),pulsatility index(PI),resistance index(RI)],estradiol(E_(2))levels on HCG injection day,occurrence of adverse reactions and pregnancy were compared among the three groups.Results:Following treatment,no statistically significant difference was observed in endometrial thickness on HCG day and maximum follicle diameter among the three groups(P>0.05).The maturation days of follicles were shorter in groups B and C compared to group A(P<0.05),with a higher count of follicles≥18mm and≥15mm on HCG day were higher in groups B and C than in group A(P<0.05),although no statistically significant difference was observed between groups B and C(P>0.05).TA,2D-OV and PI exhibited higher level in groups B and C compared to group A(P<0.05),and were higher in group C than those in group B(P<0.05);RI was lower than that in group A(P<0.05),and was lower in group C than that in group B(P<0.05).E_(2) levels on HCG injection day was higher in groups B and C compared to group A(P<0.05),with no statistically significant difference between groups B and C(P>0.05).No statistically significant difference was observed in adverse reactions during treatment across the groups(P>0.05).Similarly,no significant differences were noted in total pregnancy,biochemical pregnancy,clinical pregnancy,twin pregnancy and early miscarriage rates among the groups(P>0.05).Conclusion:In the treatment of obese PCOS patients with infertility,both 5mg/d and 7.5mg/d letrozole treatment can effectively promote follicle maturation,increase estrogen levels,improve ovarian ultrasonography and ovulation conditions,and promote ovulation.