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目的探讨来曲唑(LE)与枸椽酸克罗米芬(CC)用于多囊卵巢综合征(PCOS)患者促排卵的疗效。方法选择PCOS不孕症患者92例,随机分为两组:LE组和CC组各46例,LE组在月经第5天给予LE 2.5~5.0 mg/d×5 d,CC组在月经第5天给予CC 50~100 mg/d×5 d。当优势(最大)卵泡直径≥18 mm时,肌内注射重组绒毛膜促性腺激素(HCG)10 000 IU诱发排卵。于HCG注射日监测两组患者的血清雌二醇(E2)、血睾酮(T)、宫颈黏液评分、子宫内膜厚度,用阴道B超监测两组患者的周期排卵、单卵泡排卵及周期妊娠情况。结果 LE组患者的HCG注射日血E2水平低于CC组;HCG注射日宫颈黏液评分及子宫内膜厚度高于CC组(P均<0.01);LE组患者的单卵泡排卵率高于CC组(P<0.01);未破裂卵泡黄素化综合征(LUFS)发生率、卵巢过度刺激综合征(OHSS)发生率及妊娠中双胎率均低于CC组(P均<0.05),两组患者的HCG注射日血T水平、周期排卵率、周期妊娠率比较,差异无统计学意义(P>0.05);LE组不良反应发生率明显低于CC组(χ2=4.8421,P<0.05)。结论 LE用于PCOS促排卵治疗安全有效,与CC相比,提高了单卵泡排卵率,降低了LUFS发生率、OHSS发生率及妊娠中双胎率,不加重雄激素水平异常,对子宫内膜和宫颈黏液不良影响小,利于妊娠。
Objective To investigate the curative effect of letrozole (LE) and clomiphene citrate (CC) on ovulation induction in patients with polycystic ovary syndrome (PCOS). Methods Ninety-two infertile women with PCOS were randomly divided into two groups: 46 cases in LE group and CC group, LE 2.5-5.0 mg / d × 5 days in 5th day of menstruation, Day to give CC 50 ~ 100 mg / d × 5 d. When the dominant (largest) follicle diameter ≥ 18 mm, intramuscular injection of recombinant human chorionic gonadotropin (HCG) 10 000 IU induced ovulation. Serum estradiol (E2), blood testosterone (T), cervical mucus score and endometrial thickness were monitored on the day of HCG injection. Periodic ovulation, single ovulation and periodic pregnancy in both groups were monitored by vaginal B- Happening. Results The blood E2 level of HCG on the day of HCG injection in LE group was lower than that of CC group. The cervical mucus score and the thickness of endometrium on HCG injection day were higher than those of CC group (P <0.01). The ovulation rate of single follicle in LE group was higher than that of CC group (P <0.01). The incidence of lutealized unruptured follicle syndrome (LUFS), the incidence of ovarian hyperstimulation syndrome (OHSS) and the number of twins in pregnancy were both lower than those in CC group (all P <0.05) There was no significant difference in blood T level, periodic ovulation rate and cycle pregnancy rate on HCG injection day (P> 0.05). The incidence of adverse reactions in LE group was significantly lower than that in CC group (χ2 = 4.8421, P <0.05). Conclusions LE is safe and effective for ovulation induction therapy of PCOS. Compared with CC, LE improves the ovulation rate of single follicles, reduces the incidence of LUFS, the incidence of OHSS and the twins rate in pregnancy, and does not aggravate the abnormality of androgen. Adverse effects of cervical mucus and small, conducive to pregnancy.