山东大学学报(医学版) ›› 2017, Vol. 55 ›› Issue (5): 81-85.doi: 10.6040/j.issn.1671-7554.0.2016.1676
张素萍1,2,王泽1,周亚丽3, 李敬1,路西兰4,柏宏伟4,石玉华1
ZHANG Suping1,2, WANG Ze1, ZHOU Yali3, LI Jing1, LU Xilan4, BAI Hongwei4, SHI Yuhua1
摘要: 目的 比较不同体质量指数(BMI)的多囊卵巢综合征(PCOS)患者使用来曲唑促排卵的临床效果。 方法 将2014年1月至2015年12月于山东大学附属生殖医院就诊的153例有生育要求的PCOS患者作为研究对象,根据BMI将患者分为肥胖型组71例和非肥胖型组82例。在患者月经第2~4天开始给予来曲唑5 mg,次/d×5 d促排卵监测并指导同房;比较两组间的促排卵效果。 结果 肥胖型组的血糖、胰岛素、甘油三酯、高密度脂蛋白及总胆固醇水平高于非肥胖型组(P=0.020, <0.001, 0.002, <0.001, 0.028),而给予绒促性素(HCG)日雌二醇水平低于非肥胖型组,差异均有统计学意义(P=0.026)。两组患者的优势卵泡数、排卵率、HCG日子宫内膜厚度和促黄体生成素、孕酮等激素水平、妊娠率、流产率及活产率等的比较差异均无统计学意义(P>0.05)。 结论 不同BMI的PCOS患者可选用来曲唑促排卵,其可提高周期排卵率及妊娠率,肥胖型PCOS患者临床效果与非肥胖型患者相似。
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| [1] Norman RJ, Dewailly D, Legro RS, et al. Polycystic ovary syndrome[J]. Lancet, 2007, 370(9588): 685-697. [2] Richard S, Robert G, Michael P, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome[J]. The New England, 2014, 371(2): 119-129. [3] Roque M, Tostes AC, Valle M, et al. Letrozole versus clomiphene citrate in polycystic ovary syndrome: systematic review and meta-analysis[J]. Gynecol Endocrinol, 2015, 31(12): 917-921. [4] 丁楠, 王芳, 简启亮, 等. 不同剂量来曲唑对多囊卵巢综合征患者疗效的 Meta 分析[J]. 生殖与避孕, 2015, 35(9): 626-633. DING Nan, WANG Fang, JIAN Qiliang, et al. A Meta-analysis of two different dosages of letrozole in women with polycystic ovary syndrome[J]. Reproduction & Contraception, 2015, 35(9): 626-633. [5] 多囊卵巢综合征诊断中华人民共和国卫生行业标准[J]. 中华妇产科杂志, 2012, 47(1): 74-75. [6] Stocco C. Aromatase expression in the ovary: hormonal and molecule regulation[J]. Steroids, 2008, 73(5): 473-487. [7] Hickey TE, Marrocco DL, Gilchrist RB, et al. Interactions between androgen and growth factors in granulosa cell subtypes of porcine antral follicles[J]. Biol Reprod, 2004, 71(1): 45-52. [8] 栾素娴, 马华刚, 孙银婷. 来曲唑促排卵对性激素水平的影响[J]. 生殖医学杂志, 2015, 24(2): 111-114. LUAN Suxian, MA Huagang, SUN Yinting. Impact of letrozole on sex hormone levels in ovulation induction[J]. Journal of Reproductive Medicine, 2015, 24(2): 111-114. [9] McKnight KK, Nodler JL, Cooper JJ Jr, et al. Body mass index-associated differences in response to ovulation induction with letrozole[J]. Fertil Steril, 2011, 96(5): 1206-1208. [10] 李晓芳, 孙宝治. 来曲唑对肥胖和非肥胖型PCOS病人促排卵的影响[J]. 青岛大学医学院学报, 2011, 47(6): 491-495. LI Xiaofang, SUN Baozhi. The effect of letrozole on ovarian stimulation in patients with obese or non-obese polycystic ovarian syndrome[J]. Acta Aacademiae Medicinae Qingdao Universitatis, 2011, 47(6): 491-495. [11] Elnashar A, Fouad H, Eldosoky M, et al. Letrozole induction of ovulation in women with clomiphene citratere-sistant polycystic ovary syndrome may not depend on the period of infertility, the body mass index, or the luteinizing hormone/follicle-stimulating hormone ratio[J]. Fertil Steril, 2006, 85(2): 511-513. [12] Xu XH, Shi YH, Cui YQ, et al. Endocrine and metabolic characteristics of polycystic ovary syndrome in Chinese women with different phenotypes[J]. Clinical Endocrinology(Oxford), 2012, 76(3): 425-430. [13] Nahid L, Sirous K. Comparison of the effects of letrozole and clomiphene citrate for ovulation induction in infertile women with polycystic ovary syndrome[J]. Minerva ginecologica, 2012, 64(3): 253-258. [14] 卢贝琳, 陈俊卿. 来曲唑和氯米芬对多囊卵巢综合征所致不孕患者子宫内膜及妊娠率的影响分析[J]. 中国性科学, 2016, 25(4): 126-128. LU Beilin, CHEN Junqing. Clinical efficacy of letrozole and clomiphene citrate on ovulation induction in the infertile women with polycystic ovary syndrome[J]. Chinese Journal of Human Sexuality, 2016, 25(4): 126-128. [15] Casper RF, Mitwally MF. A historical perspective of aromatase inhibitors for ovulation induction[J]. Fertility Sterility, 2012, 98(6): 1352-1355. [16] Pritts EA. Letrozole for ovulation induction and controlled ovarian hyperstimulation[J]. Curr Opin Obstet Gynecol, 2010, 22(4): 289-294. [17] Rahmani E, Ahmadi S, Motamed N, et al. Dosage optimization for letrozole treatment in clomiphene-resistant patients with polycystic ovary syndrome a prospective interventional study[J]. Obstet Gynecol Int, 2012, 758508. doi: 10.1155/2012/758508. Epub 2012 Jan 16. [18] Lim SS, Davies MJ, Norman RJ, et al. Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis[J]. Hum Reprod Update, 2012, 18(6): 618-637. [19] Legro RS, Arslanian SA, Ehrmann DA, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline[J]. J Clin Endocrinol Metab, 2013, 98(12): 4565-4592. [20] Panidis D, Farmakiotis D, Rousso D, et al. Obesity, weight loss, and the polycystic ovary syndrome: effect of treatment with diet and orlistat for 24 weeks on insulin resistance and androgen levels[J]. Fertil Steril, 2008, 89(4): 899-906. [21] Milone M, De Placido G, Musella M, et al. Incidence of successful pregnancy after weight loss interventions in infertile women: a systematic review and meta-analysis of the literature[J]. Obes Surg, 2016, 26(2): 443-451. [22] Moran L, Tsagareli V, Norman R. Diet and IVF pilot study: short-term weight loss improves pregnancy rates in overweight/obese women undertaking IVF[J]. Aust N Z J Obstet Gynaecol, 2011, 51(5): 455-459. |
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