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目的比较来曲唑和人绝经期促性腺激素(HMG)治疗克罗米芬(CC)抵抗的多囊卵巢综合征(PCOS)患者的效果。方法把克罗米芬抵抗的PCOS不孕症患者93例随机分为2组:来曲唑组49例,HMG组44例。来曲唑组从月经结束第3天至第7天(d 3-7)给予来曲唑5 mg.d 1口服,共5 d;HMG组d 3-7给予HMG 75 U.d 1肌注。所有患者当超声监测到至少有1个成熟卵泡平均直径≥18 mm时,肌内注射HCG 10 000 U诱发排卵。阴道B超监测卵泡发育和子宫内膜厚度。结果 2组有排卵周期数差异无统计学意义(78.91%vs 82.14%,P>0.05);HMG组≥2个成熟卵泡周期数高于来曲唑组(P<0.01)。2组周期妊娠率(23.44%vs 24.11%,P>0.05)和流产率(6.67%vs 11.11%,P>0.05)差异无统计学意义。来曲唑组没有多胎妊娠,HMG组有5例多胎妊娠(18.52%,5/27)。HCG注射日子宫内膜厚度2组差异无统计学意义[(9.88±1.96)mm vs(10.47±1.62)mm,P>0.05];来曲唑组血清雌二醇(E2)低于HMG组[(261.43±199.35)pg.mL 1vs(408.74±297.48)pg.mL 1,P<0.01];卵巢囊肿发生率低于HMG组(P<0.05)。来曲唑组无卵巢过度刺激综合征发生;HMG组卵巢过度刺激综合征发生率3.57%。结论来曲唑诱发排卵可以获得与促性腺激素相似的排卵率和妊娠率,而降低了与治疗相关的风险,可以作为克罗米芬抵抗的多囊卵巢综合征患者有效的诱发排卵选择。
Objective To compare the efficacy of letrozole and human menopausal gonadotropin (HMG) in the treatment of clomiphene citrate (CC) -resistant patients with polycystic ovary syndrome (PCOS). Methods Ninety-nine patients with PCOS infertility resistant to clomiphene were randomly divided into two groups: 49 in letrozole group and 44 in HMG group. Letrozole was given orally at 5 mg.d 1 for 5 days from the third day of menstruation to the seventh day (d 3-7), and HMG 75 U.d 1 was injected intramuscularly in dams 3-7 of HMG group. All patients underwent an intramuscular injection of 10 000 U of HCG to induce ovulation when the mean diameter of at least one mature follicle was ≥18 mm monitored by ultrasound. Vaginal B-monitoring of follicular development and endometrial thickness. Results There were no significant differences in the number of ovulation cycles between the two groups (78.91% vs 82.14%, P> 0.05). The number of mature follicles in two HMG groups was higher than that in letrozole group (P <0.01). There was no significant difference in pregnancy rate (23.44% vs 24.11%, P> 0.05) and abortion rate (6.67% vs 11.11%, P> 0.05) between the two groups. There was no multiple pregnancy in the letrozole group and 5 multiple pregnancies in the HMG group (18.52%, 5/27). There was no significant difference in endometrial thickness between the HCG injection group and the HMG group [(9.88 ± 1.96) mm vs (10.47 ± 1.62) mm, P> 0.05] (261.43 ± 199.35) pg.mL 1vs (408.74 ± 297.48) pg.mL 1, P <0.01]. The incidence of ovarian cyst was lower than that of HMG group (P <0.05). Ovarian hyperstimulation syndrome occurred in letrozole group; the incidence of ovarian hyperstimulation syndrome in HMG group was 3.57%. Conclusion Letrozole induced ovulation can be similar to gonadotropin ovulation and pregnancy rates, and reduce the risk associated with treatment, can be used as clomiphene citrate resistance in patients with ovarian induction induced ovulation effectively.