维生素D辅助子宫内膜预处理联合来曲唑治疗多囊卵巢综合征的临床疗效研究

Comprehensive efficacy of vitamin D-assisted endometrial pretreatment and letrozole treatment for polycystic ovary syndrome

目的探讨维生素D辅助子宫内膜预处理联合来曲唑治疗多囊卵巢综合征(PCOS)的临床疗效。方法选取2022年1月至2023年12月周口市中医院收治的98例PCOS患者纳入研究,采用随机信封法分为对照组和观察组各49例。对照组患者给予子宫内膜预处理联合来曲唑治疗,观察组患者在对照组基础上联合维生素D治疗,一个月经周期为一个疗程,治疗3个疗程。治疗3个疗程后比较两组患者的临床疗效,以及治疗前、治疗3个疗程后的代谢指标[空腹血糖(FPG)、空腹血清胰岛素(FINS)、胰岛素抵抗指数(IR)]、血清性激素[睾酮(T)、黄体生成素(LH)、促卵泡刺激素(FSH)]和核因子κB(NF-κB)信号通路相关因子,并比较两组患者的子宫内膜厚度、子宫内膜血流灌注分型、促排卵情况和结局指标(排卵率、临床妊娠率)。结果观察组患者的治疗总有效率为89.80%,略高于对照组的79.59%,但差异无统计学意义(P>0.05);治疗3个疗程后观察组患者的FPG、FINS、IR分别为(4.70±0.54)mmol/L、(14.08±2.64)m IU/L、2.98±0.51,明显低于对照组的(5.23±0.58)mmol/L、(18.25±3.02)m IU/L、3.33±0.69,差异均有统计学意义(P<0.05);治疗3个疗程后观察组患者的T、LH分别为(1.02±0.29)ng/mL、(3.64±0.88)m IU/L,明显低于对照组的(1.26±0.35)ng/mL、(4.28±1.06)m IU/L,差异均有统计学意义(P<0.05),但两组患者的FSH比较差异无统计学意义(P>0.05);治疗3个疗程后观察组患者的IKKβ、P-IκBα分别为(42.32±4.85)pg/m^(2)、(35.48±4.26)pg/m^(2),明显低于对照组的(48.59±5.08)pg/m^(2)、(40.26±3.84)pg/m^(2),差异均有统计学意义(P<0.05);观察组患者的子宫内膜血流灌注、子宫内膜厚度及最大卵泡直径与对照组比较差异均无统计学意义(P>0.05),但观察组患者的成熟卵泡数(1.80±0.30)个,明显多于对照组的(1.36±0.35)个,差异有统计学意义(P<0.05);观察组患者的排卵率为91.84%,明显高于对照组的75.51%,差异有统计学意义(P<0.05),但观察组与对照组患者的临床妊娠率(61.22%vs 42.86%)比较差异无统计学意义(P>0.05)。结论维生素D辅助子宫内膜预处理联合来曲唑治疗PCOS能显著改善患者代谢状态,抑制NF-κB信号通路,促进卵泡成熟,提高排卵率。

Objective To explore the clinical efficacy of vitamin D-assisted endometrial pretreatment combined with letrozole in the treatment of polycystic ovary syndrome(PCOS).Methods Ninety-eight PCOS patients add mitted to Zhoukou Hospital of Traditional Chinese Medicine from January 2022 to December 2023 were selected and randomly divided into a control group and an observation group using a random envelope method,with 49 patients in each group.Patients in the control group were given endometrial pretreatment combined with letrozole treatment,while patients in the observation group were treated with vitamin D in addition to the treatment in the control group.One menstrual cycle was considered as one course of treatment,and the patients were treated for three courses.The clinical efficacy was compared between the two groups of patients after three treatment courses,as well as the metabolic indicators(fasting blood glucose,FPG;fasting serum insulin,FINS;insulin resistance index,IR),serum sex hormones(testosterone,T;luteinizing hormone,LH;follicle stimulating hormone,FSH),and NF-κB signaling pathway related factors before and after three treatment courses.The endometrial thickness,endometrial blood flow perfusion classification,ovulation induction status,and outcome indicators(ovulation rate,clinical pregnancy rate)were also compared between the two groups.Results The total effective rate of treatment in the observation group was 89.80%,slightly higher than the control group's 79.59%,but the difference was not statistically significant(P>0.05).After 3 courses of treatment,the FPG,FINS,and IR of the observation group were(4.70±0.54)mmol/L,(14.08±2.64)mIU/L,and 2.98±0.51,respectively,which were significantly lower than(5.23±0.58)mmol/L,(18.25±3.02)mIU/L,and 3.33±0.69 of the control group(P<0.05).After 3 courses of treatment,the T and LH levels of the observation group were(1.02±0.29)ng/mL and(3.64±0.88)mIU/L,respectively,which were significantly lower than(1.26±0.35)ng/mL and(4.28±1.06)mIU/L of the control group(P<0.05).However,there was no statistically significant difference in FSH levels between the two groups of patients(P>0.05).After 3 courses of treatment,the IKKβand P-IκBαlevels in the observation group were(42.32±4.85)pg/m^(2) and(35.48±4.26)pg/m^(2),respectively,which were significantly lower than(48.59±5.08)pg/m^(2) and(40.26±3.84)pg/m^(2) in the control group(P<0.05).There was no statistically significant difference in endometrial blood flow perfusion,endometrial thickness,and maximum follicle diameter between the two groups(P>0.05).However,the number of mature follicles in the observation group(1.80±0.30)was significantly higher than that in the control group(1.36±0.35),P<0.05.The ovulation rate of the observation group was 91.84%,significantly higher than the control group's 75.51%(P<0.05).However,there was no statistically significant difference in the clinical pregnancy rate between the observation group and the control group patients(61.22%vs 42.86%,P>0.05).Conclusion Vitamin D-assisted endometrial pretreatment combined with letrozole can significantly improve the metabolic status of patients with PCOS,inhibit the NF-κB signaling pathway,promote follicle maturation,and increase ovulation rate.