氯米芬与来曲唑对PCOS促排卵患者子宫动脉及内膜下血流的影响

发布时间：2018-03-28 21:07

本文选题：氯米芬　切入点：来曲唑　出处：《西安交通大学学报(医学版)》2017年05期

【摘要】：目的研究氯米芬与来曲唑对多囊卵巢综合征(polycystic ovarian syndrome,PCOS)促排卵患者子宫动脉及内膜下血流的影响,为提高患者疗效提供依据。方法回顾性分析2014年9月至2016年8月在西安交通大学第一附属医院妇产科就诊的PCOS排卵障碍患者198例的临床资料,根据促排卵方案不同分为氯米芬组(CC组,102例)、来曲唑组(LE组,96例),比较两组患者促排卵后子宫动脉及内膜下血流、促排卵率和妊娠率等。结果 (1)两组患者促排卵后子宫动脉搏动指数(PI)、阻力指数(RI)的差异均无统计学意义(t值0.302~1.644,P均0.05),LE组子宫内膜生长速度显著优于CC组(t值3.750~9.573,P均0.05),两组患者内膜下血流PI无统计学差异(t值0.153~1.042,P均0.05),但LE组促排卵后月经第17、19、20天内膜下RI显著低于CC组(t值分别为2.809、4.776、5.231,P均0.05);(2)比较两组促排卵成功患者相关数据发现,LE组注射hCG日、排卵后5~6d子宫内膜厚度均显著高于CC组(t值分别为4.839、4.438,P均0.05),且子宫内膜形态显著优于CC组(χ~2=12.674,P0.05),两组排卵日、平均优势卵泡直径、优势卵泡数、排卵数、注射hCG日及排卵后5~6d血清雌二醇、孕酮水平比较均无统计学差异(t值0.402~1.234,P均0.05);(3)CC组促排卵成功率为63.73%,LE组促排卵成功率为59.38%,两组比较无统计学差异(χ~2=0.396,P0.05),LE组生化妊娠率和临床妊娠率分别为33.33%、27.08%,显著高于CC组的20.59%、14.71%(χ~2=4.098、4.614,P均0.05);(4)两组促排卵成功患者注射hCG日、排卵后5~6d子宫动脉PI、RI两组比较均无统计学差异(t=0.435、0.324、0.564、0.879,P均0.05),且两组子宫内膜下PI亦无统计学差异(t=0.442、0.490,P均0.05),但子宫内膜下LE组RI均显著低于CC组(t=3.097、4.036,P均0.05)。结论来曲唑用于PCOS患者促排卵能显著改善子宫内膜形态和厚度,使内膜血供增加,容受性好,进而提高妊娠率。
[Abstract]:Objective to study the effects of clomiphene and letrozole on uterine artery and subendometrial blood flow in patients with polycystic ovarian syndrome (PCOS). Methods from September 2014 to August 2016, 198 patients with PCOS ovulation disorder who were admitted to gynecology and obstetrics department of the first affiliated Hospital of Xi'an Jiaotong University were analyzed retrospectively. According to the different ovulation promotion schemes, 102 patients in CC group and 96 patients in letrozole group were divided into two groups. The uterine artery and subendometrial blood flow after ovulation stimulation were compared between the two groups. Results there was no significant difference in uterine artery pulsatility index (Pi) and resistance index (RI) between the two groups. There was no significant difference in endometrial growth rate between the two groups (t = 0.302 ~ 1.644g, P = 0.05LE, P = 3.7509.573P). There was no significant difference in Pi between the two groups. There was no significant difference in Pi between the two groups. However, the RI of subintimal blood flow was significantly lower in le group than that in CC group on day 17, 1920 after ovulation stimulation. The data of patients with successful ovulation promotion were found to be significantly lower than those of CC group (P = 0.052P = 2.809 卤4.776N 5.231g, P = 0.052respectively). The endometrial thickness was significantly higher than that in CC group (P = 4.839, P = 4.438N, P < 0.05), and the endometrial morphology was significantly better than that in CC group (蠂 ~ (2) 2) 12.674 (P 0.05). The mean dominant follicle diameter, the number of dominant follicles, and the number of ovulation in the two groups were significantly higher than those in CC group on the 6th day after ovulation. Serum estradiol was injected on the day of hCG and 5 days after ovulation. There was no significant difference in progesterone levels between the two groups (P = 0.402 卤1.234p = 0.05). The success rate of ovulation promotion in CC group was 63.73g / L = 59.38, respectively. There was no significant difference between the two groups (蠂 ~ (2) 0.396N P 0.05LE group's biochemical pregnancy rate and clinical pregnancy rate were 33.333n 27.08, respectively, significantly higher than those in CC group. 20.59: 14.71% (蠂 ~ (2 / 2) 4.098 ~ 4.614). The two groups of patients with successful ovulation promotion were injected with hCG on the day of ovulatory stimulation. There was no statistical difference between the two groups in uterine artery Pi RI on the 6th day after ovulation. There was no statistical difference between the two groups. Conclusion the subendometrial Pi of the two groups is not significantly different from that of the control group (P < 0.05), but the RI of the subendometrial le group is significantly lower than that of the CC group (P < 0.05). Conclusion Letrazole is used in PCOS patients with no significant difference (P < 0.05), but the RI in the subendometrial le group is significantly lower than that in the CC group (P < 0.05). Ovulatory stimulation can significantly improve the endometrial shape and thickness. The blood supply of endometrium is increased, the receptivity is good, and the pregnancy rate is increased.
【作者单位】：西安交通大学第一附属医院妇产科;
【分类号】：R711.75

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