CAJ | 학술논문

目的：探讨不同剂量来曲唑联合促性腺激素对多囊卵巢综合征（PCOS）促排卵效果及对相关激素水平的影响。方法选择2012年6月至2014年6月进行救治的 PCOS 患者110例，按照数字表法随机平均分为观察组和对照组，每组各55例。两组患者均于黄体酮撤药性出血后的第3天或者在月经周期的第3天开始给予不同剂量来曲唑，其中观察组剂量为每天5.0 mg，对照组剂量为每天2.5 mg，持续用药5天。于停止用药后的第3天（即月经周期的第10天）开始进行阴道超声监测，当检测到卵泡开始发育即给予患者肌内注射促性腺激素（HMG），每天150 IU。比较两组患者的周期妊娠率，HCG 期间优势卵泡（≥16 mm）的个数、黄体生成素（LH）峰值期间子宫内膜的厚度以及来曲唑达到峰值时静脉抽血查相关激素的水平，其中包括睾酮（T），雌二醇（E2），LH，卵泡刺激素（FSH）。结果①治疗4周后，治疗后观察组周期妊娠率为27.27%明显高于对照组5.45%，差异有统计学意义（ P ﹤0.05）；②与对照组相比，治疗后观察组患者 HCG 期间优势卵泡较多，LH 峰值期间子宫内膜较薄，差异均有统计学意义（ P ﹤0.05）；③与对照组相比，治疗后观察组患者 T 较高，LH、FSH 均较低，差异均有统计学意义（ P ﹤0.05）。结论大剂量的来曲唑联合 HMG 应用于 P-COS 患者，能够促进优势卵泡的发育，提高周期妊娠率，安全可靠。
목적：탐토불동제량래곡서연합촉성선격소대다낭란소종합정（PCOS）촉배란효과급대상관격소수평적영향。방법선택2012년6월지2014년6월진행구치적 PCOS 환자110례，안조수자표법수궤평균분위관찰조화대조조，매조각55례。량조환자균우황체동철약성출혈후적제3천혹자재월경주기적제3천개시급여불동제량래곡서，기중관찰조제량위매천5.0 mg，대조조제량위매천2.5 mg，지속용약5천。우정지용약후적제3천（즉월경주기적제10천）개시진행음도초성감측，당검측도란포개시발육즉급여환자기내주사촉성선격소（HMG），매천150 IU。비교량조환자적주기임신솔，HCG 기간우세란포（≥16 mm）적개수、황체생성소（LH）봉치기간자궁내막적후도이급래곡서체도봉치시정맥추혈사상관격소적수평，기중포괄고동（T），자이순（E2），LH，란포자격소（FSH）。결과①치료4주후，치료후관찰조주기임신솔위27.27%명현고우대조조5.45%，차이유통계학의의（ P ﹤0.05）；②여대조조상비，치료후관찰조환자 HCG 기간우세란포교다，LH 봉치기간자궁내막교박，차이균유통계학의의（ P ﹤0.05）；③여대조조상비，치료후관찰조환자 T 교고，LH、FSH 균교저，차이균유통계학의의（ P ﹤0.05）。결론대제량적래곡서연합 HMG 응용우 P-COS 환자，능구촉진우세란포적발육，제고주기임신솔，안전가고。
Objective To explore the effect of different doses of letrozole(LE)combined with gonadotropin(HMG)for promoting ovula-tion in polycystic ovary syndrome(PCOS)and its influence on levels of related hormones. Methods 110 cases of patients with polycystic ovary syndrome in June 2012 to June 2014 were divided into observation group and control group with 55 cases in each group according to the number of list method,the two groups of patients were given different doses letrozole after 3 days in the progesterone withdrawal bleeding or in the 3 day of menstrual cycle,the daily dose of the observation group was 5 mg,the control group was 2. 5 mg,with 5 days of continuous use,at the 3 days after stopping treatment(the menstrual cycle of tenth days)to give vaginal ultrasound monitoring,when the follicle began development to give intramus-cular injection of gonadotropin,150 IU per day,the period pregnancy rate,the number of the dominant follicle(≥ 16 mm)during HCG,the en-dometrial thickness during the peak value of LH,the related hormone levels in venous blood at the peak of letrozole in hematuria,including testos-terone(testosyerone,T),estradiol(estrogen,E2),luteinizing hormone(Luteinzing,LH),follicle stimulating hormone(follicle stimulatinghor-mone,SH). Results ①The cycle pregnancy rate of the observation group after treatment was 27. 27% ,higher than 5. 45% of the control group, the difference was statistically significant( P ﹤ 0. 05);②The number of the dominant follicle( ≥ 16 mm)of the observation group during HCG after the treatment was significantly higher than of the control group;the endometrial thickness during the peak of LH in observation group was sig-nificantly lower than of the control group,with no significant differences( P ﹤ 0. 05);③Testosterone(T)in the observation group after treatment was significantly higher than of the control group;the estradiol(E2)in observation group was significantly lower than of the control group;the lu-teinizing hormone(LH)of the observation group was significantly lower than of the control group;follicle stimulating hormone(FSH)of the obser-vation group significantly lower than of the control group,with no significant differences( P ﹤ 0. 05). Conclusion Large dose of letrozole com-bined with gonadotropin using in patients with polycystic ovary syndrome can promote follicular development,improve the pregnancy rate,which is safe and reliable that is worthy of clinical application.