78例多囊卵巢综合征患者不同促卵排卵方案疗效研究.docVIP

78例多囊卵巢综合征患者不同促卵排卵方案疗效研究[摘要] 目的 探讨多囊卵巢综合征患者不同促排卵方案的疗效。方法 选择2007年1月1日～2008年10月30日在临沂市妇幼保健院生殖中心门诊就诊的78例多囊卵巢综合征患者,把78例患者随机分为三组:氯米芬(CC)组,尿促素(HMG)组,来曲唑(LZ)组。所有患者均于月经第5天或黄体酮撤退性出血的第5天,拟行促排卵治疗并指导同房。观察三组患者的排卵率及周期妊娠率。结果 三组的排卵率无显著性差异(P0.05);周期妊娠率:来曲组与HMG组均高于CC组(P0.05),子宫内膜厚度LZ组厚于CC组,但中、重卵巢过度刺激综合征(OHSS)发生率来曲唑组低于HMG组。结论 来曲唑用于多囊卵巢综合征的不孕症妇女,具有良好的排卵率及妊娠率,又能减少卵巢过度刺激综合征发生的风险。 [关键词] 多囊卵巢综合征;不同促排卵方案;疗效 [中图分类号] R711.75 [中图分类号] A[文章编号] 1673-9701(2009)24-32-03 Effects of Different Ovulation-inducing Treatments in Ininfertile Women with Polycystic Ovary Syndrome WU Chuanye Maternity and Child Care Hopsital of Linyi City,Shandong 276001,China [Abstract] Objective To investigate the effects of different ovulation-inducing treatments in ininfertile women with polycystic ovary syndrome(PCOS). Methods Seventy -eight cases of PCOS were analyzed in our hospital from Jan.2000 to Jan. 2006,and they were divided into three groups:CC group,HMG group and LZ group. Ovulation was induced by using 50mg/day CC administered daily from the fifth day of the mentrual cycle or 75 IU /day HMG or 5mg/day LZ. From the tenth day,Ultrasound was performed to monitor follicle development.When the diameter of the biggest follicle reached ≥18mm,10 000IU HCG was injected to trigger ovulation,and ovulation rate and pregnancy rate were observed. Results There was no significant difference in the ovulation rate of three groups(P0.05). The pregnancy rate was higher in HMG group and LZ group than that in CC group(P0.05). The thickness of endometrium in the LZ group was much thicker than that in CC group(P0.05);子宫内膜厚度:来曲组与HMG组均高于CC组(P0.05);但中、重卵巢过度刺激综合征发生率来曲唑组低于HMG组。来曲唑用于治疗多囊卵巢综合征患者是比较可行的治疗方案。见表1。 3讨论 目前,PCOS的发病机制尚不清楚,有关研究资料多来源于动物实验,多数研究认为:PCOS是代谢与内分泌紊乱的疾病,涉及内分泌、代谢、遗传、免疫等诸多因素。目前,关注的焦点是:胰岛素抵抗和高胰岛素血症与发病有密切关系,其中高胰岛素血症与高雄激素存在微妙关系,高雄激素是PCOS的最具有特征表现[2],本研究78例患者均有排卵功能障碍,临床上表现为月经稀发或闭经,高雄激素血症或高雄激素症状,其中有一部分患者表现为空腹血糖和空腹胰岛素升高,所有患者卵巢均为多囊改变。对于这些患者既往多采用氯米芬或绝经期妇女的尿促性腺激素(HMG)促排卵治疗,但氯米芬具有外周抗雌激素作用,影响了妊娠率;而HMG容易导致多个卵泡发