地屈孕酮片联合阿司匹林肠溶片治疗多囊卵巢综合征的临床研究
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摘要
目的观察地屈孕酮片联合阿司匹林肠溶片对多囊卵巢综合征患者促排卵及胰岛素分泌和脂肪因子水平的影响。方法将130例多囊卵巢综合征患者随机分为对照组67例和试验组63例。对照组给予地屈孕酮片10 mg,连续服药21 d;试验组在对照组的基础上给予阿司匹林,每次50 mg,每天2次,至排卵当日。比较2组患者的临床疗效、血清促卵泡刺激素(FSH)、促黄体生成素(LH)及睾酮(T)水平、卵泡发育情况、空腹胰岛素(FINS)、胰岛素抵抗(HOMA-IR)指数、瘦素、体重指数、腰臀比,随访1年记录入组患者妊娠情况。结果治疗后,对照组和试验组的总有效率分别为73. 13%(49例/67例),92. 16%(58例/63例),差异有统计学意义(P <0. 05)。治疗后,对照组FSH、LH、T、FINS、HOMA-IR、瘦素、体重指数、腰臀比分别为(6. 86±0. 78) U·L~(-1),(9. 27±1. 05)U·L~(-1),(61. 15±6. 29) nmol·L~(-1),(17. 53±1. 93) m U·L~(-1),5. 47±0. 64,(11. 24±1. 21)μg·L~(-1),(24. 47±1. 66) kg·m~(-2),0. 97±0. 04;试验组分别为(6. 47±0. 75) U·L~(-1),(7. 49±0. 71) U·L~(-1),(47. 87±5. 44) nmol·L~(-1),(14. 07±1. 60) m U·L~(-1),4. 42±0. 48,(9. 27±0. 95)μg·L~(-1),(23. 06±1. 24)kg·m~(-2),0. 94±0. 03,差异均有统计学意义(均P <0. 05)。治疗后,试验组和对照组优势卵泡占比分别为85. 71%,59. 70%,优势卵泡的单卵泡分别为69. 84%,25. 37%,双卵泡分别为34. 33%,15. 87%,差异均有统计学意义(均P <0. 05)。试验组患者妊娠率高于对照组(57. 14%vs 35. 82%,P <0. 05),早期流产率低于对照组(3. 10%vs 17. 91%,P <0. 05)。结论地屈孕酮片联合阿司匹林肠溶片可提高单卵泡的发生概率,促进排卵,提高妊娠率,并且能够改善胰岛功能,降低脂肪因子水平。
Objective To observe the effects of dextroprogesterone tablets combined with aspirin enteric-coated tablets on ovulation induction,insulin secretion and adipokine levels in patients with polycystic ovary syndrome. Methods A total of 130 patients with polycystic ovary syndrome were randomly divided into control group( 67 cases) and treatment group( 63 cases). Control group was given dextroprogesterone tablets 10 mg for 21 d,and treatment group was given aspirin 50 mg twice a day until ovulation day,on the basis of control group. The clinical efficacy,serum follicle stimulating hormone( FSH),luteinizing hormone( LH),testosterone( T),follicular development,fasting insulin( FINS),homeostasis model assessment-insulin resistance( HOMA-IR) index,leptin,body mass index,waist-hip ratio were compared between the two groups. The pregnancy status of the two groups was recorded after 1 year follow-up. Results After treatment,the total effective rates of control group and treatment group were 73. 13%( 49 cases/67 cases) and 92. 16%( 58 cases/63 cases),with significant difference( P < 0. 05). After treatment,the FSH,LH,T,FINS,HOMA-IR,leptin,body mass index and waist-hip ratio in control group were( 6. 86 ± 0. 78) U · L~(-1),( 9. 27 ± 1. 05) U·L~(-1),( 61. 15 ± 6. 29) nmol·L~(-1),( 17. 53 ± 1. 93)m U·L~(-1),5. 47 ± 0. 64,( 11. 24 ± 1. 21) μg·L~(-1),( 24. 47 ± 1. 66) kg·m~(-2),0. 97 ± 0. 04,all had significant difference with those in treatment group,which were( 6. 47 ± 0. 75) U·L~(-1),( 7. 49 ± 0. 71) U·L~(-1),( 47. 87 ± 5. 44)nmol·L~(-1),( 14. 07 ± 1. 60) m U · L~(-1),4. 42 ± 0. 48,( 9. 27 ± 0. 95) μg · L~(-1),( 23. 06 ± 1. 24) kg · m~(-2),0. 94 ± 0. 03( all P < 0. 05). After treatment,the proportion of dominant follicles in treatment group and control group were 85. 71%,59. 70%,the single follicles of the dominant follicles were 69. 84%,25. 37%,double follicles were34. 33%,15. 87%,all with significant differences( all P < 0. 05). The pregnancy rate of treatment group was higher than that of control group( 57. 14% vs 35. 82%,P < 0. 05),and the early abortion rate was lower than that of control group( 3. 10% vs 17. 91%,P < 0. 05). Conclusion Didroxyprogesterone tablets combined with aspirin enteric-coated tablets can increase the incidence of single follicle,promote ovulation,increase pregnancy rate,and improve islet function,reduce the level of fat factor.
Objective To observe the effects of dextroprogesterone tablets combined with aspirin enteric-coated tablets on ovulation induction,insulin secretion and adipokine levels in patients with polycystic ovary syndrome. Methods A total of 130 patients with polycystic ovary syndrome were randomly divided into control group( 67 cases) and treatment group( 63 cases). Control group was given dextroprogesterone tablets 10 mg for 21 d,and treatment group was given aspirin 50 mg twice a day until ovulation day,on the basis of control group. The clinical efficacy,serum follicle stimulating hormone( FSH),luteinizing hormone( LH),testosterone( T),follicular development,fasting insulin( FINS),homeostasis model assessment-insulin resistance( HOMA-IR) index,leptin,body mass index,waist-hip ratio were compared between the two groups. The pregnancy status of the two groups was recorded after 1 year follow-up. Results After treatment,the total effective rates of control group and treatment group were 73. 13%( 49 cases/67 cases) and 92. 16%( 58 cases/63 cases),with significant difference( P < 0. 05). After treatment,the FSH,LH,T,FINS,HOMA-IR,leptin,body mass index and waist-hip ratio in control group were( 6. 86 ± 0. 78) U · L~(-1),( 9. 27 ± 1. 05) U·L~(-1),( 61. 15 ± 6. 29) nmol·L~(-1),( 17. 53 ± 1. 93)m U·L~(-1),5. 47 ± 0. 64,( 11. 24 ± 1. 21) μg·L~(-1),( 24. 47 ± 1. 66) kg·m~(-2),0. 97 ± 0. 04,all had significant difference with those in treatment group,which were( 6. 47 ± 0. 75) U·L~(-1),( 7. 49 ± 0. 71) U·L~(-1),( 47. 87 ± 5. 44)nmol·L~(-1),( 14. 07 ± 1. 60) m U · L~(-1),4. 42 ± 0. 48,( 9. 27 ± 0. 95) μg · L~(-1),( 23. 06 ± 1. 24) kg · m~(-2),0. 94 ± 0. 03( all P < 0. 05). After treatment,the proportion of dominant follicles in treatment group and control group were 85. 71%,59. 70%,the single follicles of the dominant follicles were 69. 84%,25. 37%,double follicles were34. 33%,15. 87%,all with significant differences( all P < 0. 05). The pregnancy rate of treatment group was higher than that of control group( 57. 14% vs 35. 82%,P < 0. 05),and the early abortion rate was lower than that of control group( 3. 10% vs 17. 91%,P < 0. 05). Conclusion Didroxyprogesterone tablets combined with aspirin enteric-coated tablets can increase the incidence of single follicle,promote ovulation,increase pregnancy rate,and improve islet function,reduce the level of fat factor.
引文
[1]朱晓秋.多囊卵巢综合征临床特征分析[J].中国实用医药,2017,12(3):77-78.
[2]吴燕祯,苏蓉卿,禤少芬,等.初诊多囊卵巢综合征与胰岛素抵抗、肥胖和性激素的关联性研究[J].中国妇幼保健,2017,32(17):4034-4038.
[3]钟卓慧.多囊卵巢综合征孕妇产科并发症及其危险因素分析[J].中国计划生育和妇产科,2017,9(12):9-12.
[4]李美芝,李蓉.多囊卵巢综合征诊断的金标准:鹿特丹标准?[J].中国实用妇科与产科杂志,2007,23(9):657-659.
[5]刘彩杰,冯艳红.经阴道三维超声在多囊卵巢综合征超声评价中的价值研究[J].实用妇产科杂志,2014,30(1):36-38.
[6]李美芝.多囊卵巢综合征的诊断与治疗[J].中华妇产科杂志,2002,37(7):444-446.
[7] YU H F,CHEN H S,RAO D P,et al. Association between polycystic ovary syndrome and the risk of pregnancy complications:A PRISMA-compliant systematic review and meta-analysis[J].Medicine,2016,95(51):4863.
[8]李艳.来曲唑与枸橼酸氯米芬胶囊用于不同年龄段经典型多囊卵巢综合征患者促排卵的疗效分析[J].中国药物与临床,2017,17(1):103-105.
[9] CASSAR S,MISSO M L,HOPKINS W G,et al. Insulin resistance in polycystic ovary syndrome:a systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies[J]. Hum Reprod,2016,31(11):2619-2631.
[10] HARRIS H R,JORDAN S,RISCH H,et al. Abstract 2293:Oligomenorrhea,polycystic ovary syndrome,and risk of ovarian cancer histotypes,evidence from the ovarian cancer association consortium[J]. Cancer Res,2017,77(13 Suppl.):S2293-S2293.
[11] SCHINDLER A E. Present and future aspects of dydrogesterone in prevention or treatment of pregnancy disorders:an outlook[J].Horm Mol Biol Clin Investig,2016,27(2):49-53.
[12]王美仙,张扬,谈海英,等.地屈孕酮在促排卵周期宫腔内人工授精黄体支持中的应用[J].生殖医学杂志,2017,26(2):143-147.
[13]常惠,孙林,邵小光,等.地屈孕酮预处理及黄体支持对PCOS患者促排卵结局的影响[J].生殖医学杂志,2017,26(2):138-142.
[14]王统菲,贺立颖,康晓敏,等.阿司匹林对早期复发性流产患者子宫血液动力学的作用[J].上海交通大学学报(医学版),2017,37(4):518-522.
[15]刘娟,温春燕,张唯一.促排卵期间小剂量阿司匹林对子宫内膜发育的影响[J].武警医学,2016,27(3):237-239.
[2]吴燕祯,苏蓉卿,禤少芬,等.初诊多囊卵巢综合征与胰岛素抵抗、肥胖和性激素的关联性研究[J].中国妇幼保健,2017,32(17):4034-4038.
[3]钟卓慧.多囊卵巢综合征孕妇产科并发症及其危险因素分析[J].中国计划生育和妇产科,2017,9(12):9-12.
[4]李美芝,李蓉.多囊卵巢综合征诊断的金标准:鹿特丹标准?[J].中国实用妇科与产科杂志,2007,23(9):657-659.
[5]刘彩杰,冯艳红.经阴道三维超声在多囊卵巢综合征超声评价中的价值研究[J].实用妇产科杂志,2014,30(1):36-38.
[6]李美芝.多囊卵巢综合征的诊断与治疗[J].中华妇产科杂志,2002,37(7):444-446.
[7] YU H F,CHEN H S,RAO D P,et al. Association between polycystic ovary syndrome and the risk of pregnancy complications:A PRISMA-compliant systematic review and meta-analysis[J].Medicine,2016,95(51):4863.
[8]李艳.来曲唑与枸橼酸氯米芬胶囊用于不同年龄段经典型多囊卵巢综合征患者促排卵的疗效分析[J].中国药物与临床,2017,17(1):103-105.
[9] CASSAR S,MISSO M L,HOPKINS W G,et al. Insulin resistance in polycystic ovary syndrome:a systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies[J]. Hum Reprod,2016,31(11):2619-2631.
[10] HARRIS H R,JORDAN S,RISCH H,et al. Abstract 2293:Oligomenorrhea,polycystic ovary syndrome,and risk of ovarian cancer histotypes,evidence from the ovarian cancer association consortium[J]. Cancer Res,2017,77(13 Suppl.):S2293-S2293.
[11] SCHINDLER A E. Present and future aspects of dydrogesterone in prevention or treatment of pregnancy disorders:an outlook[J].Horm Mol Biol Clin Investig,2016,27(2):49-53.
[12]王美仙,张扬,谈海英,等.地屈孕酮在促排卵周期宫腔内人工授精黄体支持中的应用[J].生殖医学杂志,2017,26(2):143-147.
[13]常惠,孙林,邵小光,等.地屈孕酮预处理及黄体支持对PCOS患者促排卵结局的影响[J].生殖医学杂志,2017,26(2):138-142.
[14]王统菲,贺立颖,康晓敏,等.阿司匹林对早期复发性流产患者子宫血液动力学的作用[J].上海交通大学学报(医学版),2017,37(4):518-522.
[15]刘娟,温春燕,张唯一.促排卵期间小剂量阿司匹林对子宫内膜发育的影响[J].武警医学,2016,27(3):237-239.