来曲唑联合GnRH -a治疗用于PCOS患者的研究

摘要

目的 探讨来曲唑(LE)以及促性腺激素释放激素激动剂( GnRH -a)用于多囊卵巢综合征(PCOS)患者的治疗效果.方法 50例不孕症常规检查确诊为PCOS并接受促排卵及官腔内人工授精(IUI)的不孕患者,随机分为来曲唑组(24例):口服LE；HMG组(26例):注射HMG.两组分别于月经周期第3～7天每天口服来曲唑5.0mg或HMG75IU肌内注射,分别监测月经周期第10天子宫内膜厚度,直径≥10mm卵泡个数,记录GnRH -a注射日子宫内膜的厚度、形态,直径≥16mm卵泡(成熟卵泡)个数,直径≥14卵泡(优势卵泡)个数,血清黄体生成素(LH)、雌激素(E2)、睾酮(T)水平,分别统计排卵率及妊娠率,多胎率,卵巢过度刺激综合征(0HSS)发生率.结果 与HMG组相比,来曲唑组月经周期第10天子宫内膜厚度薄(P＝0.00)；GnRH-a注射日血清中E2水平低(P＝0.00),T水平高(P＝0.004),优势卵泡数少(P＝0.02),OHSS发生率低(P＝0.04),但临床妊娠率无明显差异(P＝0.78)且多胎率低(P＝0.02).结论 对PCOS患者,用LE或HMG促排卵,临床妊娠率无差异,用LE联合GnRH -a治疗可以降低HCG日血清中雌激素水平,减少OHSS的发生率,以及多胎率,可望成为一线促排卵药.%Objective To explore the effect of letrozole(LE) and GnRH - a on ovulation induction in the patients with polycystic ovay syndrome( PCOS). Methods SO patients were divided into two groups, group LE( 24 cases) took LE and Croup HMG( 26 cases) took HMG. The endometrial thickness,average dominant follicle numbers and levels of the E2 ,T,LH were evaluated on HCC day and the pregnancy rates,OHSS rates as well. Results Patients took HMC had more average dominant follicle numbers and endometrial thickness after five days treatment than that of took LE (P <0.05) ,and also had the higher level of the E2 on hCC day and the OHSS rates(P <0. 05). No significant difference was found in the number of mature follicles and endometrial thickness on HCG day, and clinical pregnancy rate ( P >0.05 ). Conclusion Letrozole is expected as a first - line drug to induce ovulation.