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目的评价来曲唑联合炔雌醇环丙孕酮片、二甲双胍治疗耐克罗米芬(CC)性多囊卵巢综合征(PCOS)患者的有效性和安全性,探索来曲唑促排卵效果的最佳方案和最佳剂量。方法选取300例PCOS患者,分为对照组和促排卵组。对照组患者规律服用炔雌醇环丙孕酮片及二甲双胍,促排卵组在基础治疗上服用不同浓度的来曲唑(2.5,5,7.5,20 mg)。检测服药前、服药4周及8周血清生殖激素,空腹血糖,空腹胰岛素,体质量指数(BMI),盆腔超声相的变化,以及排卵率、排卵周期率、妊娠率和妊娠周期率。结果和对照组相比,来曲唑促排卵治疗后促黄体生成素(LH)、睾酮(T)、催乳素(PRL)、BMI水平明显减低,而性激素结合球蛋白(SHBG)明显升高(P<0.05);子宫体积明显增加,子宫内膜厚度减少,双测卵巢体积及卵泡直径均减少,卵泡数也减少(P<0.05);排卵率、排卵周期率、妊娠率和妊娠周期率明显升高(P<0.05)。而且,随着来曲唑浓度的升高(2.5,5,7.5,20 mg),血清生殖激素,空腹血糖,空腹胰岛素,BMI,盆腔超声相的变化,以及排卵率、排卵周期率、妊娠率和妊娠周期率改善更明显。结论来曲唑联合炔雌醇环丙孕酮片、二甲双胍治疗耐克罗米芬性PCOS患者,可使血清生殖激素、空腹血糖、空腹胰岛素、卵巢形态、子宫内膜及BMI得到明显改善,并提高耐克罗米芬性PCOS患者对克罗米芬促排卵的敏感性。
Objective To evaluate the effectiveness and safety of letrozole combined with ethinylestradiol and cyproterone tablets and metformin in the treatment of patients with noctuifen-induced polycystic ovary syndrome (PCOS) and to explore the best way to promote the ovulation of letrozole And the best dose. Methods 300 PCOS patients were selected and divided into control group and ovulation induction group. Patients in the control group were given ethinyl estradiol cyproterone tablets and metformin regularly. The ovulation induction group took letrozole (2.5, 5, 7.5 and 20 mg) at different concentrations on the basis of treatment. The changes of serum reproductive hormones, fasting blood glucose, fasting insulin, body mass index (BMI) and pelvic ultrasonography, ovulation rate, ovulation cycle rate, pregnancy rate and pregnancy rate before and 4 and 8 weeks after medication were measured. Results Compared with the control group, the levels of LH, T, PRL and BMI were significantly decreased and the levels of sex hormone binding globulin (SHBG) were significantly increased (P <0.05). The volume of uterus and the thickness of the endometrium were decreased. The ovary volume and the diameter of the follicles were both reduced and the number of follicles were also decreased (P <0.05). The ovulation rate, ovulation rate, pregnancy rate and pregnancy rate were significantly higher Increased (P <0.05). Moreover, with the increase of letrozole concentration (2.5, 5, 7.5, 20 mg), serum reproductive hormones, fasting blood glucose, fasting insulin, BMI, changes of pelvic ultrasonography and ovulation rate, ovulation cycle rate, pregnancy rate And the improvement of pregnancy rate is more obvious. Conclusion Letrozole combined with ethinylestradiol and cyproterone tablets and metformin in the treatment of patients with PCOS in nocomelin group can significantly improve serum reproductive hormones, fasting blood glucose, fasting insulin, ovarian morphology, endometrium and BMI, Sensitivities of clomiphene to ovulation induction in patients with PCOS.