来曲唑和HMG在克罗米芬抵抗的多囊卵巢综合征患者中诱发排卵的效果

Efficacy of Letrozole and Human Menopausal Gonadotropin for Ovulation Induction in Clomiphene Resisance Polycystic Ovary Syndrome Patients

关键词:  芳香化酶抑制剂  促性腺激素  多囊卵巢综合征  克罗米芬抵抗  诱发排卵

Key words:  aromatase inhibitor  gonadotropin  polycystic ovary syndrome  clomiphene resisance  ovulation induction

摘要:

目的 比较来曲唑和人绝经期促性腺激素(HMG)治疗克罗米芬(CC)抵抗的多囊卵巢综合征(PCOS)患者的效果。方法 把克罗米芬抵抗的PCOS不孕症患者93例随机分为2组：来曲唑组49例，HMG组44例。来曲唑组从月经结束第3天至第7天(d 3-7)给予来曲唑5 mg·d^-1口服，共5 d；HMG组d 3-7给予HMG 75 U·d^-1肌注。所有患者当超声监测到至少有1个成熟卵泡平均直径≥18 mm时，肌内注射HCG 10 000 U诱发排卵。阴道B超监测卵泡发育和子宫内膜厚度。结果 2组有排卵周期数差异无统计学意义(78.91% vs 82.14%，P>0.05)；HMG组≥2个成熟卵泡周期数高于来曲唑组(P<0.01)。2组周期妊娠率(23.44% vs 24.11%，P>0.05)和流产率(6.67% vs 11.11%，P>0.05)差异无统计学意义。来曲唑组没有多胎妊娠，HMG组有5例多胎妊娠(18.52%，5/27)。HCG注射日子宫内膜厚度2组差异无统计学意义[(9.88±1.96)mm vs (10.47±1.62)mm，P>0.05]；来曲唑组血清雌二醇(E2)低于HMG组[(261.43±199.35)pg·mL^-1 vs (408.74±297.48)pg·mL^-1，P<0.01]；卵巢囊肿发生率低于HMG组(P<0.05)。来曲唑组无卵巢过度刺激综合征发生；HMG组卵巢过度刺激综合征发生率3.57%。结论 来曲唑诱发排卵可以获得与促性腺激素相似的排卵率和妊娠率，而降低了与治疗相关的风险，可以作为克罗米芬抵抗的多囊卵巢综合征患者有效的诱发排卵选择。

Abstract:

OBJECTIVE To compare the efficacy of letrozole and human menopausal gonadotropin for treatment of clomiphene resisance polycystic ovary syndrome patients. METHODS 93 clomiphene resisance polycystic ovary syndrome patients conducted in the study were randomly divided into letrozole group(n=49) and HMG group(n=44). Patients in letrozole group received letrozole at 5 mg·d^-1 for 5 days on cycle days three to seven. Human menopausal gonadotropin 75 U·d^-1 was administered for 5 days starting from the third day of menstrual cycle in HMG group. Sonography was done for all patients, When mature follicle reached≥18 mm in diameter, HCG in a dose of 10 000 U was given. Transvaginal ultrasonography was performed for follicular diameter tracking and measurement of endometrial thickness. RESULTS The number of ovalution cycles was no significant difference in two group(78.91% vs 82.14%,P>0.05); The cycle number of ≥2 mature follicles was higher in HMG group than that in letrozole group(P<0.01). There were no significant differences comparing with cycle pregnancy rate(23.44% vs 24.11%, P>0.05) or miscarriage rate(6.67% vs 11.11%, P>0.05) in two groups. No multiple pregnancy was occurred in letrozole group, and 5 multiple pregnancy(18.52%, 5/27) in HMG group. On the day of HCG administration, endometrial thickness[(9.88±1.96)mm vs (10.47±1.62)mm, P>0.05] was similar in two group. Serum levels of E2 and rates of ovarian cyst were significantly lower in letrozole group than those in HMG group. No ovarian hyperstimulation syndrome(OHSS) was occurred in letrozole group, rate of OHSS was 3.57% in HMG group. CONCLUSION There was no significant difference in either the ovulation rate or the pregnancy rate in clomiphene resisance polycystic ovary syndrome patients treated with letrozole or gonadotropin, but letrozole decreased the risk associated with treatment. Letrozole was an effective ovulation inducing agent.