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目的比较来曲唑(LE)、克罗米芬(CC)、人绝经期促性腺激素(HMG)3种药物相互联合使用的疗效与安全性,探索CC抵抗及LE无反应的多囊卵巢综合征(PCOS)患者更佳的促排卵方案。方法将CC抵抗及LE无反应的209例(周期)PCOS患者,随机分入CC+HMG组59周期,LE+HMG组72周期,LE+CC组78周期,LE+CC组中无反应者54周期立即转入LE+CC+HMG组,观察4组间绒毛膜促性腺激素(HCG)注射日,最大卵泡平均直径(MFD)、子宫内膜厚度、>1.4cm卵泡数、血清雌二醇(E2)水平,以及促排天数、HMG用量、排卵数、临床妊娠率、生化妊娠率、早期流产率、双胎率、异位妊娠率等。结果LE+CC组排卵率最低(30.77%),但>1.4cm卵泡数、排卵数和促排天数最少,HCG注射日E2水平最低(P<0.05),余3组排卵率差异无统计学意义(P>0.05);LE+CC+HMG组HMG用量以及HCG注射日E2水平最高(P<0.05);仅CC+HMG组出现异位妊娠,共3周期(P<0.05)。4组HCG日子宫内膜厚度、MFD、临床妊娠率、生化妊娠率、早期流产率以及双胎率差异无统计学意义(P>0.05),均未发生中-重度卵巢过度刺激综合征(OHSS)及卵泡未破裂黄素化(LUF)。结论对CC抵抗及LE无反应的PCOS患者,LE+CC联合促排卵方案,仍有30.77%的排卵率,尤其适合OHSS高危人群。而LE+CC与LE+CC+HMG的总体排卵率92.31%,明显高于传统联合促排卵方案LE+HMG与CC+HMG,同时降低了OHSS及多胎妊娠的风险。
Objective To compare the efficacy and safety of three drugs, letrozole (LE), clomiphene citrate (CC) and human menopausal gonadotropin (HMG), to explore the relationship between CC resistance and LE nonresponse in patients with polycystic ovary syndrome PCOS) patients with better ovulation program. Methods A total of 209 patients (cycles) with PCOS and LE without reaction were randomly divided into 59 cycles of CC + HMG, 72 cycles of LE + HMG, 78 cycles of LE + CC and 54 of LE + CC Cycle immediately transferred to the LE + CC + HMG group, observe the 4 groups of human chorionic gonadotropin (HCG) injection day, the average diameter of the largest follicles (MFD), endometrial thickness,> 1.4cm follicles, serum estradiol E2) levels, as well as the number of days of promoting metabolism, the amount of HMG, the number of ovulation, the clinical pregnancy rate, the biochemical pregnancy rate, the early miscarriage rate, the twins rate and the ectopic pregnancy rate. Results The ovulation rate in LE + CC group was the lowest (30.77%), but the number of follicles> 1.4cm was the least, while the number of ovulation and the number of promoting row was the lowest in LE + CC group (P <0.05) (P> 0.05). The amount of HMG in LE + CC + HMG group and the E2 level on the day of HCG injection were the highest (P <0.05). Only ectopic pregnancy occurred in CC + HMG group for 3 cycles (P <0.05). There was no significant difference in endometrial thickness, MFD, clinical pregnancy rate, biochemical pregnancy rate, early miscarriage rate and twins rate among the 4 groups on HCG day (P> 0.05), and no OHSS ) And unruptured luteinized follicle (LUF). Conclusions There is still an ovulation rate of 30.77% in the combined ovulation induction program of LE + CC in PCOS patients who do not respond to CC resistance and LE, especially for those at high risk of OHSS. The overall ovulation rate of LE + CC and LE + CC + HMG was 92.31%, which was significantly higher than that of LE + HMG and CC + HMG combined with traditional ovulation induction therapy, and reduced the risk of OHSS and multiple pregnancy.