氯米芬与他莫昔芬治疗多囊卵巢综合征合并不孕患者对其性激素水平和妊娠率的影响
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摘要
目的:探析氯米芬与他莫昔芬治疗多囊卵巢综合征(PCOS)合并不孕患者对其性激素水平和妊娠率的影响。方法:选取本院2015年7月-2017年7月收治的多囊卵巢综合征不孕患者106例,按照随机数字表法将患者分为观察组和对照组,各53例。观察组采取他莫昔芬治疗,对照组给予氯米芬治疗,均持续治疗3个疗程(21 d/疗程)。记录两组达到hCG时间、hCG日卵泡直径;监测滤泡期、排卵期与黄体期不同时间子宫内膜厚度与性激素指标,观察排卵情况,评估两组妊娠率与流产率。结果:两组达到hCG时间、hCG日卵泡直径比较,差异均无统计学意义(P>0.05)。两组滤泡期T、E2、P、LH以及排卵期、黄体期LH、T指标比较,差异均无统计学意义(P>0.05);观察组E2、P在排卵期与黄体期均明显低于对照组(P<0.05)。观察组排卵期、黄体期子宫内膜厚度均明显较对照组厚(P<0.05)。两组排卵率比较,差异无统计学意义(P>0.05);观察组妊娠率明显高于对照组,早期流产率、用药不良反应发生率均明显低于对照组(P<0.05)。结论:氯米芬与他莫昔芬治疗PCOS不孕者均有良好促排卵效果,但氯米芬对性激素影响较大,影响子宫内膜厚度,妊娠率较低,他莫昔芬对性激素影响较轻微,可提高妊娠率,促进孕囊、胚胎发育,减少早期流产率。
Objective:To explore the effect of Clomiphene and Tamoxifen on sex hormone level and pregnancy rate in infertility patients with polycystic ovary syndrome(PCOS).Method:106 infertility patients with polycystic ovary syndrome admitted to our hospital from July 2015 to July 2017 were selected,according to the random number table method,the patients were divided into observation group and control group,53 cases in each group.The observation group was treated with Tamoxifen,while the control group was treated with Clomiphene for 3 consecutive courses(21 d/course).The two groups reached hCG time and follicular diameter on hCG day were recorded.Endometrial thickness and sex hormone indexes at different time of follicular phase,ovulation phase and luteal phase were monitored,ovulation was observed,and pregnancy rate and abortion rate of the two groups were evaluated.Result:There were no significant differences in follicular diameter between the two groups when reaching hCG and on hCG day(P>0.05).There were no statistically significant differences in T,E2,P,LH of follicular period and LH and T in ovulatory period,corpus luteum period between the two groups(P>0.05).E2 and P in ovulation and luteal phase in the observation group were significantly lower than those in the control group(P<0.05).The thickness of endometrium in the observation group during ovulation and luteal phase were significantly thicker than those in the control group(P<0.05).There was no significant difference in ovulation rate between the two groups(P>0.05).The pregnancy rate in the observation group was significantly higher than that in the control group,the rate of early abortion and adverse drug reaction were significantly lower than those in the control group(P<0.05).Conclusion:Both Clomiphene and Tamoxifen have good ovulation promoting effect in the treatment of PCOS infertility,but Clomiphene has a greater effect on sex hormone,endometrial thickness and low pregnancy rate,and Tamoxifen has a slight effect on sex hormone,which can improve pregnancy rate,promote embryo development in pregnancy sac and reduce early abortion rate.
Objective:To explore the effect of Clomiphene and Tamoxifen on sex hormone level and pregnancy rate in infertility patients with polycystic ovary syndrome(PCOS).Method:106 infertility patients with polycystic ovary syndrome admitted to our hospital from July 2015 to July 2017 were selected,according to the random number table method,the patients were divided into observation group and control group,53 cases in each group.The observation group was treated with Tamoxifen,while the control group was treated with Clomiphene for 3 consecutive courses(21 d/course).The two groups reached hCG time and follicular diameter on hCG day were recorded.Endometrial thickness and sex hormone indexes at different time of follicular phase,ovulation phase and luteal phase were monitored,ovulation was observed,and pregnancy rate and abortion rate of the two groups were evaluated.Result:There were no significant differences in follicular diameter between the two groups when reaching hCG and on hCG day(P>0.05).There were no statistically significant differences in T,E2,P,LH of follicular period and LH and T in ovulatory period,corpus luteum period between the two groups(P>0.05).E2 and P in ovulation and luteal phase in the observation group were significantly lower than those in the control group(P<0.05).The thickness of endometrium in the observation group during ovulation and luteal phase were significantly thicker than those in the control group(P<0.05).There was no significant difference in ovulation rate between the two groups(P>0.05).The pregnancy rate in the observation group was significantly higher than that in the control group,the rate of early abortion and adverse drug reaction were significantly lower than those in the control group(P<0.05).Conclusion:Both Clomiphene and Tamoxifen have good ovulation promoting effect in the treatment of PCOS infertility,but Clomiphene has a greater effect on sex hormone,endometrial thickness and low pregnancy rate,and Tamoxifen has a slight effect on sex hormone,which can improve pregnancy rate,promote embryo development in pregnancy sac and reduce early abortion rate.
引文
[1]李扬璐,阮祥燕,Alfred O.Mueck.多囊卵巢综合征对妊娠结局的影响研究进展[J].首都医科大学学报,2016,37(4):449-453.
[2]Li S J,Zhou D N,Li W,et al.Mental health status assessment in polycystic ovarian syndrome infertility patients:a pilot study[J].Journal of Huazhong University of Science and Technology(Medical Sciences),2017,37(5):750-754.
[3]龚衍,曾玖芝,席娜,等.氯米芬诱导多囊卵巢综合征患者排卵6个周期的临床观察[J].中国计划生育和妇产科,2016,8(9):59-62.
[4]王晶.来曲唑、他莫昔芬、氯米芬联合尿促性素治疗多囊卵巢综合征不孕的疗效比较[J].中国生育健康杂志,2014,25(4):371-373.
[5]朱亮.多囊卵巢综合征的临床诊治[M].天津:天津科学技术出版社,2012:25-27.
[6]Almasi-Hashiani A,Omani-Samani R,Sepidarkish M.Relationship of Body Mass Index with Failure Rate in Assisted Reproductive Techniques in Polycystic Ovary Syndrome Infertile Women;A Retrospective Cohort Study[J].Iranian Journal of Obstetrics Gynecology&Infertility,2016,18(175):1-6.
[7]Chen Z J,Shi Y,Sun Y,et al.Fresh versus Frozen Embryos for Infertility in the Polycystic Ovary Syndrome[J].New England Journal of Medicine,2016,375(6):523.
[8]侯莲云,闫胜英.达英-35联合二甲双胍治疗多囊卵巢综合征后促排卵效果观察[J].中国计划生育学杂志,2010,18(7):429-431.
[9]Seckin B,Pekcan M K,Bostanc?E I,et al.Comparison of pregnancy rates in PCOS patients undergoing clomiphene citrate and IUI treatment with different leading follicular sizes[J].Archives of Gynecology&Obstetrics,2016,293(4):901-906.
[10]虞如芬,蔡丽梅,吴雪清.尿促性素联合枸橼酸氯米芬对多囊卵巢综合征患者的影响[J].中国全科医学,2017,20(s1):30-33.
[11]吴军,黄华武,黄勇平,等.他莫昔芬和枸橼酸氯米芬治疗少弱精症效果比较[J].中国计划生育学杂志,2013,21(6):407-408.
[12]Sharma S,Geeta Rani B S,Bathwal S,et al.Progesterone Supplementation in PCOS Women Undergoing Clomiphene Citrate Stimulated IUI may Improve Pregnancy[J].Fertility&Sterility,2016,106(3):e260.
[13]Jiang S,Kuang Y.Clomiphene citrate is associated with favorable cycle characteristics but impaired outcomes of obese women with polycystic ovarian syndrome undergoing ovarian stimulation for in vitro fertilization[J].Medicine,2017,96(32):e7540.
[14]吉柳,武文慧,阎丽丽,等.他莫昔芬超说明书用于促排卵的分析与管理[J].中国药房,2016,27(1):124-126.
[15]薛惠文,章静波.他莫昔芬的新用途[J].基础医学与临床,2017,37(8):1174.
[16]向大清,陈玲,曾林.氯米芬与他莫昔芬治疗多囊卵巢综合征不孕患者临床疗效对比观察[J].河北医学,2016,22(2):284-287.
[17]Gayathri S R,Tripathy S,Muthulakshmi M.A comparative study of ovulation induction with clomiphene versus clomiphene and bromocriptine in follicular phase of normoprolactinemic PCOS women[J].Int J Reprod Contracept Obstet Gynecol,2017,6(8):3464.
[18]任卫娟,邵扬琴.单次大剂量雌激素在氯米芬促排卵前的应用[J].现代妇产科进展,2012,21(11):891-892.
[19]赵越,阮祥燕,李扬璐,等.来曲唑联合高纯度尿促性素治疗克罗米芬耐药的多囊卵巢综合征不孕患者的临床研究[J].首都医科大学学报,2016,37(4):431-436.
[20]程玲慧,李泽莲,颜士杰,等.胰岛素抵抗对多囊卵巢综合征育龄妇女生育能力的影响[J].中国临床保健杂志,2016,19(2):163-165.
[2]Li S J,Zhou D N,Li W,et al.Mental health status assessment in polycystic ovarian syndrome infertility patients:a pilot study[J].Journal of Huazhong University of Science and Technology(Medical Sciences),2017,37(5):750-754.
[3]龚衍,曾玖芝,席娜,等.氯米芬诱导多囊卵巢综合征患者排卵6个周期的临床观察[J].中国计划生育和妇产科,2016,8(9):59-62.
[4]王晶.来曲唑、他莫昔芬、氯米芬联合尿促性素治疗多囊卵巢综合征不孕的疗效比较[J].中国生育健康杂志,2014,25(4):371-373.
[5]朱亮.多囊卵巢综合征的临床诊治[M].天津:天津科学技术出版社,2012:25-27.
[6]Almasi-Hashiani A,Omani-Samani R,Sepidarkish M.Relationship of Body Mass Index with Failure Rate in Assisted Reproductive Techniques in Polycystic Ovary Syndrome Infertile Women;A Retrospective Cohort Study[J].Iranian Journal of Obstetrics Gynecology&Infertility,2016,18(175):1-6.
[7]Chen Z J,Shi Y,Sun Y,et al.Fresh versus Frozen Embryos for Infertility in the Polycystic Ovary Syndrome[J].New England Journal of Medicine,2016,375(6):523.
[8]侯莲云,闫胜英.达英-35联合二甲双胍治疗多囊卵巢综合征后促排卵效果观察[J].中国计划生育学杂志,2010,18(7):429-431.
[9]Seckin B,Pekcan M K,Bostanc?E I,et al.Comparison of pregnancy rates in PCOS patients undergoing clomiphene citrate and IUI treatment with different leading follicular sizes[J].Archives of Gynecology&Obstetrics,2016,293(4):901-906.
[10]虞如芬,蔡丽梅,吴雪清.尿促性素联合枸橼酸氯米芬对多囊卵巢综合征患者的影响[J].中国全科医学,2017,20(s1):30-33.
[11]吴军,黄华武,黄勇平,等.他莫昔芬和枸橼酸氯米芬治疗少弱精症效果比较[J].中国计划生育学杂志,2013,21(6):407-408.
[12]Sharma S,Geeta Rani B S,Bathwal S,et al.Progesterone Supplementation in PCOS Women Undergoing Clomiphene Citrate Stimulated IUI may Improve Pregnancy[J].Fertility&Sterility,2016,106(3):e260.
[13]Jiang S,Kuang Y.Clomiphene citrate is associated with favorable cycle characteristics but impaired outcomes of obese women with polycystic ovarian syndrome undergoing ovarian stimulation for in vitro fertilization[J].Medicine,2017,96(32):e7540.
[14]吉柳,武文慧,阎丽丽,等.他莫昔芬超说明书用于促排卵的分析与管理[J].中国药房,2016,27(1):124-126.
[15]薛惠文,章静波.他莫昔芬的新用途[J].基础医学与临床,2017,37(8):1174.
[16]向大清,陈玲,曾林.氯米芬与他莫昔芬治疗多囊卵巢综合征不孕患者临床疗效对比观察[J].河北医学,2016,22(2):284-287.
[17]Gayathri S R,Tripathy S,Muthulakshmi M.A comparative study of ovulation induction with clomiphene versus clomiphene and bromocriptine in follicular phase of normoprolactinemic PCOS women[J].Int J Reprod Contracept Obstet Gynecol,2017,6(8):3464.
[18]任卫娟,邵扬琴.单次大剂量雌激素在氯米芬促排卵前的应用[J].现代妇产科进展,2012,21(11):891-892.
[19]赵越,阮祥燕,李扬璐,等.来曲唑联合高纯度尿促性素治疗克罗米芬耐药的多囊卵巢综合征不孕患者的临床研究[J].首都医科大学学报,2016,37(4):431-436.
[20]程玲慧,李泽莲,颜士杰,等.胰岛素抵抗对多囊卵巢综合征育龄妇女生育能力的影响[J].中国临床保健杂志,2016,19(2):163-165.