來曲唑和氯米芬對多囊卵巢綜合征所致不孕患者子宮內膜及妊娠率的影響分析

盧貝琳 陳俊卿

【摘要】目的：考察多囊卵巢綜合征所致不孕患者使用來曲唑和氯米芬對子宮內膜及妊娠率的影響。 方法：將200例多囊卵巢綜合征所致不孕患者隨機分為研究組和對照組，每組100例。對照組患者給予氯米芬治療，研究組患者給予來曲唑治療。比較兩組患者的生殖激素水平變化、子宮內膜情況以及妊娠率。結果：研究組患者周期第8d的雌二醇水平顯著低于對照組、雄烯二酮水平顯著高于對照組（P<0.01）；hCG日的黃體生成素水平顯著高于對照組（P<0.01），雌二醇水平顯著低于對照組（P<0.01）；研究組患者排卵率和周期妊娠率顯著高于對照組（P<0.01，P<0.05）；研究組患者成熟卵泡數顯著低于對照組（P<0.01），hCG日子宮頸黏液評分、hCG日子宮內膜厚度顯著高于對照組（P<0.01）。結論：來曲唑具有促進患者排卵作用，且排卵率高于氯米芬并傾向于單卵發育，對子宮內膜影響較小。

【關鍵詞】多囊卵巢綜合征；不孕；來曲唑；氯米芬

Clinical efficacy of letrozole and clomiphene citrate on ovulation induction in the infertile women with polycystic ovary syndromeLU Beilin1， CHEN Junqing2△. 1.Department of Gynecology， Puning City Peoples Hospital， Jieyang 528000， Guangdong， China； 2.Department of Obstetrics， Puning City Peoples Hospital， Jieyang 528000， Guangdong， China

【Abstract】Objectives： To study the clinical effect of letrozole and clomiphene citrate on ovulation induction in the infertile women with polycystic ovary syndrome. Methods： A total of 200 infertile women with polycystic ovary syndrome were randomly divided into study group and control group， with 100 patients in each group. Patients in control group were treated by clomiphene citrate and patients in study group were treated by letrozole. The changes in reproductive hormone levels， endometrial and pregnancy rate were compared between two groups. Results： On the 8th day， the estradiol level in study group was significantly less than that in control group and androstenedione level was significantly higher （P<0.01）. On the HCG day， the estradiol level in study group was significantly less than that in control group and luteinizing hormone level was significantly higher （P<0.01）. The ovulation rate and pregnancy rate in study group were significantly higher than those in control group （P<0.01， P<0.05）. The number of mature follicles in study group were significantly less than that in control group （P<0.01）. The cervical mucus score at HCG and endometrial thickness in study group was significantly higher than that in control group （P<0.01）. Conclusion： Letrozole has a better clinical effect on infertile women with polycystic ovary syndrome， which can improve ovulation， reduce mature follicles and has less influence on endometrium.

【Key words】Polycystic ovary syndrome； Infertile； Letrozole； Clomiphene citrate

【中圖分類號】R711.6【文獻標志碼】A

多囊卵巢綜合征（PCOS）是一種臨床上多見的生殖內分泌疾病，50%～75%的PCOS患者因不排卵而無法生育[1，2]。對于PCOS的治療，目前仍以藥物治療為主要手段，其中氯米芬是應用最為廣泛的促排卵藥物[3]。然而，約有1/4的患者存在氯米芬抵抗，且氯米芬對于PCOS的臨床治療效果不夠理想，其對子宮內膜和宮頸黏液具有負面影響，因此雖然其具有較高的排卵率，但妊娠率較低[4]。來曲唑是一種新型的PCOS治療藥物，屬于高選擇性的芳香化酶抑制劑，已有報道其臨床應用效果良好[5]。然而，目前的報道多停留在來曲唑對PCOS患者妊娠率的影響，其對子宮內膜和患者體內激素水平的調節作用少見報道。因此，探討多囊卵巢綜合征所致不孕患者使用來曲唑和氯米芬對子宮內膜及妊娠率的影響具有重要意義。

1資料與方法

1.1一般資料

選取2013年10月至2014年10月間于本院就診的PCOS所致不孕患者200例，所有患者均符合鹿特丹標準[6]，排除男方因素、輸卵管造影確認至少一側暢通。……