二甲双胍联合不同剂量克罗米芬治疗多囊卵巢综合征的效果分析
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摘要
目的探究二甲双胍联合不同剂量克罗米芬治疗多囊卵巢综合征(PCOS)不孕症患者的临床效果。方法回顾性分析襄阳市妇幼保健院2015年8月-2018年4月的PCOS不孕症患者,研究组接受二甲双胍+克罗米芬100 mg、对照组接受二甲双胍+克罗米芬50 mg促排卵。比较两组患者h CG日血清LH、E2水平、成熟卵泡数和内膜厚度,以及排卵率、临床妊娠率、早期流产率。结果研究组和对照组分别纳入218例、240例患者。两组患者h CG日血清LH、子宫内膜厚度,早期流产率差异无统计学意义(P> 0. 05)。研究组h CG日血清E2水平、成熟卵泡数、排卵率和临床妊娠率显著高于对照组,差异有统计学意义(P <0. 05)。结论二甲双胍联合克罗米芬每天100 mg比每天50 mg治疗PCOS不孕症患者显著增高h CG日E2水平、成熟卵泡数、排卵率和临床妊娠率。
Objective To explore the effect of metformin combined with different doses of clomiphene in the treatment of PCOS.Methods The data of PCOS patients from August 2015 to April 2018 in our hospital were retrospectively analyzed. Research group and control group were treated with metformin combined with clomiphene citrate 100 mg and metformin combined with clomiphene citrate50 mg,respectively. The level of serum LH and E2,mature follicles and endometrial thickness on the day of h CG administration,ovulation rate,pregnancy rate and early spontaneous abortion rate were compared between research group and control group. Results There were 218 and 240 patients in research group and control group,respectively. There were no significant difference in serum LH and endometrial thickness on the day of h CG administration and early spontaneous abortion rate( P > 0. 05). The serum E2 on the day of h CG administration,mature follicles,ovulation rate,and clinical pregnancy rate was significantly higher in research group than those in control group( P < 0. 05). Conclusion Using metformin combined with clomiphene citrate 100 mg to treat PCOS patients can significantly increase the level ofserum E2 on the day of h CG administration,mature follicles,ovulation rate,and clinical pregnancy rate.
Objective To explore the effect of metformin combined with different doses of clomiphene in the treatment of PCOS.Methods The data of PCOS patients from August 2015 to April 2018 in our hospital were retrospectively analyzed. Research group and control group were treated with metformin combined with clomiphene citrate 100 mg and metformin combined with clomiphene citrate50 mg,respectively. The level of serum LH and E2,mature follicles and endometrial thickness on the day of h CG administration,ovulation rate,pregnancy rate and early spontaneous abortion rate were compared between research group and control group. Results There were 218 and 240 patients in research group and control group,respectively. There were no significant difference in serum LH and endometrial thickness on the day of h CG administration and early spontaneous abortion rate( P > 0. 05). The serum E2 on the day of h CG administration,mature follicles,ovulation rate,and clinical pregnancy rate was significantly higher in research group than those in control group( P < 0. 05). Conclusion Using metformin combined with clomiphene citrate 100 mg to treat PCOS patients can significantly increase the level ofserum E2 on the day of h CG administration,mature follicles,ovulation rate,and clinical pregnancy rate.
引文
[1] March WA,Moore VM,Willson KJ,et al. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria[J].Human Reproduction,2010,25:544-551.
[2] Azziz R,Woods KS,Reyna R,et al. The prevalence and features of the polycystic ovary syndrome in an unselected population[J]. J Clin Endocrinol Metab,2004,89:2745-2749.
[3] Misso ML,Costello MF,Garrubba M,et al. Metformin versus clomiphene citrate for infertility in non-obese women with polycystic ovary syndrome:a systematic review and meta-analysis[J]. Hum Reprod Update,2013,19:2-11.
[4] Practice Committee of the American Society for Reproductive Medicine. Electronic address Aao, Practice Committee of the American Society for Reproductive M.Role of metformin for ovulation induction in infertile patients with polycystic ovary syndrome(PCOS):a guideline[J]. Fertil Steril,2017,108:426-441.
[5]孙培培,王桂花,高丹.二甲双胍联合克罗米芬治疗多囊卵巢综合征并不孕症的临床疗效及其对患者内分泌的影响[J].安徽医药,2018,22(3):518-522.
[6] Kar S. Anthropometric,clinical,and metabolic comparisons of the four Rotterdam PCOS phenotypes:A prospective study of PCOS women[J]. J Hum Reprod Sci,2013,6:194-200.
[7] Krzysztof C. Lewandowski AL,Katarzyna Dbrowska,Lucjusz Jakubowski,Agnieszka Gach. Familial partial lipodystrophy as differential diagnosis of polycystic ovary syndrome[J]. Endokrynologia Polska,2015,66(6):550-554.
[8] March WA,Moore VM,Willson KJ,et al. Prevalence of the Polycystic Ovary Syndrome in a Community Sample Assessed under Contrasting Diagnostic Criteria[J].Australian&New Zealand Journal of Obstetrics&Gynaecology,2010,50:16-17.
[9] Fruzzetti F,Perini D,Lazzarini V,et al. Comparison of effects of 3 mg drospirenone plus 20 mu g ethinyl estradiol alone or combined with metformin or cyproterone acetate on classic metabolic cardiovascular risk factors in nonobese women with polycystic ovary syndrome[J].Fertility and Sterility,2010,94:1793-1798.
[10] Brown J,Farquhar C. Clomiphene and other antioestrogens for ovulation induction in polycystic ovarian syndrome[J]. Cochrane Database Syst Rev, 2016,12:CD002249.
[11] Ghasemi M,Ashraf H,Koushyar H,et al. The cycle characteristics of clomiphene with clomiphene and menotropins in polycystic ovary syndrome and non polycystic ovary syndrome infertile patients[J]. Minerva Ginecol,2013,65:311-317.
[12] Nemati M,Nemati S,Taheri AM,et al. Comparison of metformin and N-acetyl cysteine, as an adjuvant to clomiphene citrate,in clomiphene-resistant women with polycystic ovary syndrome[J]. Journal of Gynecology Obstetrics and Human Reproduction, 2017, 46:579-585.
[13] Viollet B,Guigas B,Garcia NS,et al. Cellular and molecular mechanisms of metformin:an overview[J].Clinical Science,2012,122:253-270.
[14] Stanford JB,Martin JC,Gibson M,et al. Use of Clomiphene Citrate in the University of Utah Community Clinics[J]. Journal of Reproductive Medicine,2013,58:229-233.
[15] Lord JM,Flight IH,Norman RJ. Insulin-sensitising drugs(metformin,troglitazone,rosiglitazone,pioglitazone,D-chiro-inositol)for polycystic ovary syndrome[J]. Cochrane Database Syst Rev,2003:CD003053.
[16]吕国香.二甲双胍与克罗米芬药物治疗多囊卵巢综合征合并不孕患者的效果探究[J].实用妇科内分泌杂志,2018,5(1):112-113.
[2] Azziz R,Woods KS,Reyna R,et al. The prevalence and features of the polycystic ovary syndrome in an unselected population[J]. J Clin Endocrinol Metab,2004,89:2745-2749.
[3] Misso ML,Costello MF,Garrubba M,et al. Metformin versus clomiphene citrate for infertility in non-obese women with polycystic ovary syndrome:a systematic review and meta-analysis[J]. Hum Reprod Update,2013,19:2-11.
[4] Practice Committee of the American Society for Reproductive Medicine. Electronic address Aao, Practice Committee of the American Society for Reproductive M.Role of metformin for ovulation induction in infertile patients with polycystic ovary syndrome(PCOS):a guideline[J]. Fertil Steril,2017,108:426-441.
[5]孙培培,王桂花,高丹.二甲双胍联合克罗米芬治疗多囊卵巢综合征并不孕症的临床疗效及其对患者内分泌的影响[J].安徽医药,2018,22(3):518-522.
[6] Kar S. Anthropometric,clinical,and metabolic comparisons of the four Rotterdam PCOS phenotypes:A prospective study of PCOS women[J]. J Hum Reprod Sci,2013,6:194-200.
[7] Krzysztof C. Lewandowski AL,Katarzyna Dbrowska,Lucjusz Jakubowski,Agnieszka Gach. Familial partial lipodystrophy as differential diagnosis of polycystic ovary syndrome[J]. Endokrynologia Polska,2015,66(6):550-554.
[8] March WA,Moore VM,Willson KJ,et al. Prevalence of the Polycystic Ovary Syndrome in a Community Sample Assessed under Contrasting Diagnostic Criteria[J].Australian&New Zealand Journal of Obstetrics&Gynaecology,2010,50:16-17.
[9] Fruzzetti F,Perini D,Lazzarini V,et al. Comparison of effects of 3 mg drospirenone plus 20 mu g ethinyl estradiol alone or combined with metformin or cyproterone acetate on classic metabolic cardiovascular risk factors in nonobese women with polycystic ovary syndrome[J].Fertility and Sterility,2010,94:1793-1798.
[10] Brown J,Farquhar C. Clomiphene and other antioestrogens for ovulation induction in polycystic ovarian syndrome[J]. Cochrane Database Syst Rev, 2016,12:CD002249.
[11] Ghasemi M,Ashraf H,Koushyar H,et al. The cycle characteristics of clomiphene with clomiphene and menotropins in polycystic ovary syndrome and non polycystic ovary syndrome infertile patients[J]. Minerva Ginecol,2013,65:311-317.
[12] Nemati M,Nemati S,Taheri AM,et al. Comparison of metformin and N-acetyl cysteine, as an adjuvant to clomiphene citrate,in clomiphene-resistant women with polycystic ovary syndrome[J]. Journal of Gynecology Obstetrics and Human Reproduction, 2017, 46:579-585.
[13] Viollet B,Guigas B,Garcia NS,et al. Cellular and molecular mechanisms of metformin:an overview[J].Clinical Science,2012,122:253-270.
[14] Stanford JB,Martin JC,Gibson M,et al. Use of Clomiphene Citrate in the University of Utah Community Clinics[J]. Journal of Reproductive Medicine,2013,58:229-233.
[15] Lord JM,Flight IH,Norman RJ. Insulin-sensitising drugs(metformin,troglitazone,rosiglitazone,pioglitazone,D-chiro-inositol)for polycystic ovary syndrome[J]. Cochrane Database Syst Rev,2003:CD003053.
[16]吕国香.二甲双胍与克罗米芬药物治疗多囊卵巢综合征合并不孕患者的效果探究[J].实用妇科内分泌杂志,2018,5(1):112-113.