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目的:探讨经阴道补充雌激素对促排卵期薄型子宫内膜的影响。方法:将经B超监测有排卵发生但子宫内膜厚度<7 mm的不孕患者随机分为对照组(CC组)和治疗组,治疗组又分成补佳乐组(CC+口服补佳乐)、芬吗通组(CC+芬吗通雌二醇片阴道用药)、联合用药组(CC+口服补佳乐及芬吗通雌二醇片阴道用药),观察内膜厚度增幅、类型、用药48 h后血雌激素浓度及妊娠率。结果:共纳入患者110例,对照组20例,治疗组90例,其中补佳乐组28例,芬吗通组28例,联合用药组34例。治疗组患者用药前、后子宫内膜增幅分别为2.3±0.3 mm、2.1±0.2 mm、2.9±0.2 mm;A型内膜比例分别为53.57%、46.43%、67.64%;用药48 h后血雌激素浓度分别为1 141.5±246.4 pmol/L、1 220.3±247.7 pmol/L、1 746.8±247.3 pmol/L;妊娠率分别为14.29%、17.86%、26.47%,均大于对照组,差异有统计学意义(P<0.05)。用药48 h后直径>15 mm的卵泡个数分别为1.1±0.5、1.2±0.5、1.2±0.5、1.1±0.5,对照组与治疗组间无统计学差异(P>0.05)。联合用药组子宫内膜厚度、A型内膜比例、用药48 h后血雌激素浓度、妊娠率均大于补佳乐组和芬吗通组,差异有统计学意义(P<0.05)。结论:经阴道补充雌激素可一定程度上提高血雌激素浓度,改变子宫内膜容受性,有助于胚胎着床,提高妊娠率,从而改善妊娠结局。
Objective: To investigate the effect of transvaginal estrogen supplementation on thin endometrium during ovulation induction. Methods: The infertile patients who had ovulation occurred but whose endometrial thickness was less than 7 mm by B-ultrasound were randomly divided into control group (CC group) and treatment group. The treatment group was further divided into naloxone group (CC + oral nadir) (CC + Fenheng Tong estradiol tablets vaginal medication), combination group (CC + oral Bujia Le and fentanypin estradiol tablets vaginal medication), to observe the thickness of the intima, type, medication 48 h Post-estrogen concentration and pregnancy rate. Results: A total of 110 patients were enrolled in this study. Twenty patients in the control group and 90 patients in the treatment group were treated with nadrogol group (28 cases), fentanyl group (28 cases) and combination group (34 cases). In the treatment group, the increase of endometrium before and after treatment were 2.3 ± 0.3 mm, 2.1 ± 0.2 mm and 2.9 ± 0.2 mm, respectively. The ratio of type A endometrium was 53.57%, 46.43% and 67.64% The hormone concentrations were 1 141.5 ± 246.4 pmol / L, 1 220.3 ± 247.7 pmol / L and 1 746.8 ± 247.3 pmol / L, respectively. The pregnancy rates were 14.29%, 17.86% and 26.47% respectively, both of which were significantly higher than those of the control group Significance (P <0.05). The number of follicles with diameters> 15 mm after 48 h treatment were 1.1 ± 0.5, 1.2 ± 0.5, 1.2 ± 0.5 and 1.1 ± 0.5, respectively. There was no significant difference between the control group and the treatment group (P> 0.05). The thickness of endometrium and ratio of type A endometrium in combination group were higher than those in nociferine group and fentanyl group after 48 h, and the difference was statistically significant (P <0.05). Conclusion: Transvaginal estrogen administration can increase blood estrogen concentration to a certain extent, change endometrial receptivity, help embryo implantation, improve pregnancy rate and improve pregnancy outcome.