氯米芬联合低分子肝素钙治疗多囊卵巢综合征不孕症的临床疗效观察
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摘要
目的探讨氯米芬联合低分子肝素钙治疗多囊卵巢综合征(PCOS)不孕症患者的临床效果。方法收集2016年9月至2018年4月于青岛大学附属妇女儿童医院就诊105例PCOS不孕症患者作为研究对象,随机分为观察组57例、对照组48例,对照组采用氯米芬促排卵治疗,观察组采用氯米芬联合低分子肝素钙促排卵治疗,比较两组患者子宫内膜容受性改变、妊娠率及不良反应的发生率。结果观察组排卵日子宫内膜厚度、血流指数(FI)增加,子宫内膜螺旋动脉血流阻力指数(RI)及搏动指数(PI)降低,妊娠率优于对照组,差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论氯米芬联合低分子肝素钙治疗多囊卵巢综合征不孕症可提高治疗有效率,且安全、可靠,值得临床推广应用。
Objective To discuss the clinical effects of clomiphene citrate combined with low molecular weight heparin calcium in the treatment of patients with polycystic ovarian syndrome(PCOS)infertility. Methods A total of 105 patients with PCOS infertility who were admitted to the Outpatient Department of Women and Children's Hospital of Qingdao University from September 2016 to April 2018 were taken as research subjects.They were randomly divided into observation group(57 cases)and control group(48 cases).The control group received clomiphene citrate for ovulation treatment,the observation group was given clomiphene citrate combined with low molecular weight heparin calcium for ovulation treatment,and the endometrial receptivity changes,pregnancy rate and the incidence of adverse reactions of patients were compared between the two groups.Results In the observation group,the endometrial thickness,blood flow index(FI),endometrial spiral arterial blood flow resistance index(RI)and pulsatility index(PI)decreased,and the pregnancy rate was better than that in the control group;the difference was statistically significan(t P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Clomiphene citrate combined with low molecular weight heparin calcium in the treatment of polycystic ovary syndrome infertility can improve the treatment efficiency,and is safe and reliable.It is worthy of clinical promotion.
Objective To discuss the clinical effects of clomiphene citrate combined with low molecular weight heparin calcium in the treatment of patients with polycystic ovarian syndrome(PCOS)infertility. Methods A total of 105 patients with PCOS infertility who were admitted to the Outpatient Department of Women and Children's Hospital of Qingdao University from September 2016 to April 2018 were taken as research subjects.They were randomly divided into observation group(57 cases)and control group(48 cases).The control group received clomiphene citrate for ovulation treatment,the observation group was given clomiphene citrate combined with low molecular weight heparin calcium for ovulation treatment,and the endometrial receptivity changes,pregnancy rate and the incidence of adverse reactions of patients were compared between the two groups.Results In the observation group,the endometrial thickness,blood flow index(FI),endometrial spiral arterial blood flow resistance index(RI)and pulsatility index(PI)decreased,and the pregnancy rate was better than that in the control group;the difference was statistically significan(t P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Clomiphene citrate combined with low molecular weight heparin calcium in the treatment of polycystic ovary syndrome infertility can improve the treatment efficiency,and is safe and reliable.It is worthy of clinical promotion.
引文
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[7]Chen C,Yan Q,Liu K,et al.Endometrial receptivity markers in mice stimulated with Raloxifene versus Clomiphene Citrate and natural cycles[J].Reprod Sci,2016,23(6):748-755.
[8]Bonhoff A,Nether D,Johaunisson E,et al.Morphometric characteristics of endometrial biopsies after diffent types of ovarian stimulation for the infertility treatment[J].Fertil Steril,1993,59:560-566.
[9]Fluhr H,Spratte J,Ehrhardt J,et al.Heparin and low-molecularweight heparins modulate the decidualization of human endometrial stromal cells[J].Fertil Steril,2010,93(8):2581-2587.
[10]Ivanov P,Konova E,Gecheva S,et al.Factor V Leiden in women with repeated IVF failures[J].Akush Ginekol(Sofiia),2013,52(6):11-14.
[11]Wilcox AJ,Baird DD,Weinberg CR.Time of implantation of the conceptus and loss of pregnancy[J].N Engl J Med,1999,340(23):1796-1799.
[12]Fluhr H,Carli S,Deperschmidt M,et al.Differential effects of human chorionic gonadotropin and decidualization on insulinlike growth factors-I and-II in human endometrial stromal cells[J].Fertil Steril,2008,90(4):1384-1389.
[13]Fluhr H,Spratte J,Ehrhardt J,et al.Heparin and low-molecularweight heparins modulate the decidualization of human endometrial stromal cells[J].Fertil Steril,2009,93(8):45-48.
[14]Choi Y,Kim HR,Lim EJ,et al.Integrative analyses of uterine transcriptome and micro RNAome reveal compromised LIFSTAT3signaling and progesterone response in the endometrium of patients with recurrent/repeated implantation failure(RIF)[J].PLoS One,2016,11(6):157-169.
[2]张建伟,何泓.多囊卵巢综合征导致不孕的危险因素及治疗方案探讨[J].海南医学,2014,25(15):1750-1753.
[3]Potdar N,Gelbaya TA,Konje JC,et al.Adjunct low-molecularweight heparin to improve live birth rate after recurrent implantation failure:a systematic review and meta-analysis[J].Hum Reprod Update,2013,19(6):674-684.
[4]Chang J,Azziz R,Legro R,et al.The Rotterdam ESHRE/ASRMSponsored PCOS Consensus Workshop Group(2004)revised2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome[J].Fertil Steril,2004,81(1):19-25.
[5]Boivin J,Bunting L,Collins JA,et al.International estimates of infertility prevalence and treatment-seeking:potential need and demand for infertility medical care[J].Hum Reprod,2007,22(10):2800.
[6]Timeva T,Shterev A,Kyurkchiev S.Recurrent implantation failure:the role of the endometrial[J].J Reprod Infertil,2014,15(4):173-183.
[7]Chen C,Yan Q,Liu K,et al.Endometrial receptivity markers in mice stimulated with Raloxifene versus Clomiphene Citrate and natural cycles[J].Reprod Sci,2016,23(6):748-755.
[8]Bonhoff A,Nether D,Johaunisson E,et al.Morphometric characteristics of endometrial biopsies after diffent types of ovarian stimulation for the infertility treatment[J].Fertil Steril,1993,59:560-566.
[9]Fluhr H,Spratte J,Ehrhardt J,et al.Heparin and low-molecularweight heparins modulate the decidualization of human endometrial stromal cells[J].Fertil Steril,2010,93(8):2581-2587.
[10]Ivanov P,Konova E,Gecheva S,et al.Factor V Leiden in women with repeated IVF failures[J].Akush Ginekol(Sofiia),2013,52(6):11-14.
[11]Wilcox AJ,Baird DD,Weinberg CR.Time of implantation of the conceptus and loss of pregnancy[J].N Engl J Med,1999,340(23):1796-1799.
[12]Fluhr H,Carli S,Deperschmidt M,et al.Differential effects of human chorionic gonadotropin and decidualization on insulinlike growth factors-I and-II in human endometrial stromal cells[J].Fertil Steril,2008,90(4):1384-1389.
[13]Fluhr H,Spratte J,Ehrhardt J,et al.Heparin and low-molecularweight heparins modulate the decidualization of human endometrial stromal cells[J].Fertil Steril,2009,93(8):45-48.
[14]Choi Y,Kim HR,Lim EJ,et al.Integrative analyses of uterine transcriptome and micro RNAome reveal compromised LIFSTAT3signaling and progesterone response in the endometrium of patients with recurrent/repeated implantation failure(RIF)[J].PLoS One,2016,11(6):157-169.