N-乙酰半胱氨酸联合他莫昔芬治疗氯米芬抵抗多囊卵巢综合征的效果
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摘要
目的探讨N-乙酰半胱氨酸联合他莫昔芬治疗氯米芬抵抗多囊卵巢综合征的效果评价及对促排卵和性激素的影响。方法选取2015年9月～2017年10月4家医院妇科门诊就诊的110例多囊卵巢综合征患者,将其随机分为观察组和对照组,每组55例。对照组采用他莫昔芬治疗,观察组采用N-乙酰半胱氨酸联合他莫昔芬治疗。比较两组患者临床疗效、临床症状、雌激素水平、排卵和妊娠情况、胰岛素抵抗指标及不良反应发生情况。结果观察组的总有效率高于对照组(90.9%vs 72.7%,P<0.05);观察组多毛评分和卵巢体积均低于对照组,子宫内膜厚度和宫颈黏液评分高于对照组(P<0.05);观察组血清黄体生成素、睾酮、雌二醇低于对照组(P<0.05),而促卵泡激素差异无统计学意义(P>0.05);观察组排卵率、成熟卵泡数及妊娠率均高于对照组,早期流产率低于对照组(P<0.05);观察组FBG、FINs、HOMA-IR、HOMA-β低于对照组(P<0.05);两组患者不良反应发生率差异无统计学意义(P>0.05)。结论 N-乙酰半胱氨酸联合他莫昔芬治疗可有效改善氯米芬抵抗多囊卵巢综合征患者的胰岛素抵抗和高雄激素血症症状,促进排卵和妊娠。
Objective To investigate the effect evaluation of N-acetylcysteine combined with tamoxifen for the treatment of clomiphene resistant polycystic ovary syndrome evaluation and its effect on ovulation and sex hormone. Methods A total of110 patients with PCOS were selected from September 2015 to October 2017 in our hospital. All patients were randomly divided into the observation group and the control group, with 55 cases in each group. The control group was treated with tamoxifen, and the observation group was treated with N-acetylcysteine combined with tamoxifen. The clinical efficacy,clinical symptoms, estrogen levels, ovulation and pregnancy, insulin resistance index and adverse reactions were compared between the two groups. Results The total effective rate of the observation group was significantly higher than that of the control group(90.9% vs 72.7%, P<0.05). The scores of hirsutism and ovary in the observation group were significantly lower than those in the control group. The endometrial thickness and cervical mucus score were significantly higher in the observation group than the control group(P<0.05). The levels of LH, T and E2 in the observation group were significantly lower than those in the control group(P<0.05), while there was no significant difference of FSH(P>0.05). The ovulation rate, the number of mature follicles and the pregnancy rate of the observation group were significantly higher than those of the control group. The rate of early abortion was significantly lower than that of the control group(P<0.05). The levels of FBG, FINs,HOMA-IR and HOMA-β in the observation group were significantly lower than those in the control group(P<0.05). There was no significant difference of the incidence of adverse reactions between the two groups(P>0.05). Conclusion N-acetylcysteine combined with tamoxifen therapy can effectively improve the clomiphene resistant polycystic ovary syndrome patients with insulin resistance and Kaohsiung hormones symptoms, promote ovulation and pregnancy.
Objective To investigate the effect evaluation of N-acetylcysteine combined with tamoxifen for the treatment of clomiphene resistant polycystic ovary syndrome evaluation and its effect on ovulation and sex hormone. Methods A total of110 patients with PCOS were selected from September 2015 to October 2017 in our hospital. All patients were randomly divided into the observation group and the control group, with 55 cases in each group. The control group was treated with tamoxifen, and the observation group was treated with N-acetylcysteine combined with tamoxifen. The clinical efficacy,clinical symptoms, estrogen levels, ovulation and pregnancy, insulin resistance index and adverse reactions were compared between the two groups. Results The total effective rate of the observation group was significantly higher than that of the control group(90.9% vs 72.7%, P<0.05). The scores of hirsutism and ovary in the observation group were significantly lower than those in the control group. The endometrial thickness and cervical mucus score were significantly higher in the observation group than the control group(P<0.05). The levels of LH, T and E2 in the observation group were significantly lower than those in the control group(P<0.05), while there was no significant difference of FSH(P>0.05). The ovulation rate, the number of mature follicles and the pregnancy rate of the observation group were significantly higher than those of the control group. The rate of early abortion was significantly lower than that of the control group(P<0.05). The levels of FBG, FINs,HOMA-IR and HOMA-β in the observation group were significantly lower than those in the control group(P<0.05). There was no significant difference of the incidence of adverse reactions between the two groups(P>0.05). Conclusion N-acetylcysteine combined with tamoxifen therapy can effectively improve the clomiphene resistant polycystic ovary syndrome patients with insulin resistance and Kaohsiung hormones symptoms, promote ovulation and pregnancy.
引文
[1]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):371-3.
[2]席稳燕,张欣,韩红芳,等.来曲唑或氯米芬联合人绝经期促性腺激素用于PCOS妇女促排卵疗效的比较[J].生殖医学杂志,2015,24(11):890-4.
[3]Visvanathan K,Hurley P,Bantug E,et al.Use of pharmacologic interventions for breast cancer risk reduction:American society of clinical oncology clinical practice guideline[J].J Clin Oncol,2013,31(23):2942-55.
[4]徐悠然,唐惠林,翟所迪.N-乙酰半胱氨酸辅助治疗多囊卵巢综合征所致不孕症的有效性:meta分析[J].中国临床药学杂志,2013,27(5):280-6.
[5]王洋,陆超亦,钱云,等.N-乙酰半胱氨酸在多囊卵巢综合征中的应用研究进展[J].国际生殖健康/计划生育杂志,2018,37(4):312-6.
[6]高红彥,任翔.N-乙酰半胱氨酸治疗氯米芬抵抗多囊卵巢综合征的效果评价[J].中国社区医师,2015;34(3):24-5.
[7]陈美玲.氯米芬与他莫昔芬对多囊卵巢综合征不孕的临床疗效[J].北方药学,2017,14(1):96-7.
[8]Roterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group.Revised 2003 consensus on diagnostic cirteria and long-term health risks related to polyeystic ovary syndrome(PCOS)[J].Hum Reprod,2004,19(1):41-7.
[9]Ferriman DM,Gallwey JD.Clinical assessment of body hair growth in women[J].J Clin Endocrinol,1961,21(12):1440-7.
[10]曹缵孙.宫颈粘液评分在监测排卵中的价值[J].中国实用妇科与产科杂志,1995,11(5):261-3.
[11]王爱华,唐惠林,冯欣.他莫昔芬治疗多囊卵巢综合征疗效的系统评价[J].中国药房,2013,24(4):359-62.
[12]黎兴利,李维玲,张西艺,等.氯米芬对多囊卵巢综合征患者卵巢血流的影响[J].中国性科学,2017,26(1):45-8.
[13]丁瑜莉,王海霞,俞腾飞.他莫昔芬临床应用研究进展[J].国际药学研究杂志,2016,43(2):275-9.
[14]Jack C,Ivana S,Simon C,et al.Tamoxifen foo prevention of breast cancer:extended long term follow-up of the IBIS-I breast cancer prevention trial[J].Lancet Oncol,2015,16(14):71171-4.
[15]王科,李荣山.N-乙酰半胱氨酸研究进展[J].国际移植与血液净化杂志,2016,14(1):11-4.
[16]焦静楠.N-乙酰半胱氨酸治疗氯米芬抵抗多囊卵巢综合征的临床疗效分析[J].世界最新医学信息文摘,2016,16(51):328-32.
[17]关亮.N-乙酰半胱氨酸治疗氯米芬抵抗多囊卵巢综合征促排卵治疗的有效性和安全性[J].中国社区医师,2015,31(29):65-7.
[18]李予,杨冬梓,阿比德.来曲唑、他莫昔芬和氯米芬治疗多囊卵巢综合征不孕疗效比较[J].中国实用妇科与产科杂志,2011,27(8):606-8.
[19]康燕.多囊卵巢综合征不孕患者氯米芬与他莫昔芬治疗对性激素和妊娠的影响[J].中国计划生育学杂志,2018,26(10):50-4.
[20]向大清,陈玲,曾林.氯米芬与他莫昔芬治疗多囊卵巢综合症不孕患者临床疗效对比观察[J].河北医学,2016,22(2):284-7.
[21]李晓诗,吕青,陈洁,等.他莫昔芬的药理作用机制及其对卵巢功能的影响[J].中国普外基础与临床杂志,2015,22(11):1397-404.
[22]陈虹.胰岛素抵抗与高雄激素[J].国际儿科学杂志,2018,45(8):615-9.
[23]Cuzick J,Sestak I,Cawthorn S,et al.Tamoxifen for prevention of breast cancer:extended long-term follow-up of the IBIS-I breast cancer prevention trial[J].Lancet Oncol,2015,16(1):67-75.
[24]王冰,李宏亮,杨文英,等.N-乙酰半胱氨酸改善高脂饲养大鼠外周胰岛素抵抗的机制[J].中国糖尿病杂志,2010,18(4):255-8.
[2]席稳燕,张欣,韩红芳,等.来曲唑或氯米芬联合人绝经期促性腺激素用于PCOS妇女促排卵疗效的比较[J].生殖医学杂志,2015,24(11):890-4.
[3]Visvanathan K,Hurley P,Bantug E,et al.Use of pharmacologic interventions for breast cancer risk reduction:American society of clinical oncology clinical practice guideline[J].J Clin Oncol,2013,31(23):2942-55.
[4]徐悠然,唐惠林,翟所迪.N-乙酰半胱氨酸辅助治疗多囊卵巢综合征所致不孕症的有效性:meta分析[J].中国临床药学杂志,2013,27(5):280-6.
[5]王洋,陆超亦,钱云,等.N-乙酰半胱氨酸在多囊卵巢综合征中的应用研究进展[J].国际生殖健康/计划生育杂志,2018,37(4):312-6.
[6]高红彥,任翔.N-乙酰半胱氨酸治疗氯米芬抵抗多囊卵巢综合征的效果评价[J].中国社区医师,2015;34(3):24-5.
[7]陈美玲.氯米芬与他莫昔芬对多囊卵巢综合征不孕的临床疗效[J].北方药学,2017,14(1):96-7.
[8]Roterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group.Revised 2003 consensus on diagnostic cirteria and long-term health risks related to polyeystic ovary syndrome(PCOS)[J].Hum Reprod,2004,19(1):41-7.
[9]Ferriman DM,Gallwey JD.Clinical assessment of body hair growth in women[J].J Clin Endocrinol,1961,21(12):1440-7.
[10]曹缵孙.宫颈粘液评分在监测排卵中的价值[J].中国实用妇科与产科杂志,1995,11(5):261-3.
[11]王爱华,唐惠林,冯欣.他莫昔芬治疗多囊卵巢综合征疗效的系统评价[J].中国药房,2013,24(4):359-62.
[12]黎兴利,李维玲,张西艺,等.氯米芬对多囊卵巢综合征患者卵巢血流的影响[J].中国性科学,2017,26(1):45-8.
[13]丁瑜莉,王海霞,俞腾飞.他莫昔芬临床应用研究进展[J].国际药学研究杂志,2016,43(2):275-9.
[14]Jack C,Ivana S,Simon C,et al.Tamoxifen foo prevention of breast cancer:extended long term follow-up of the IBIS-I breast cancer prevention trial[J].Lancet Oncol,2015,16(14):71171-4.
[15]王科,李荣山.N-乙酰半胱氨酸研究进展[J].国际移植与血液净化杂志,2016,14(1):11-4.
[16]焦静楠.N-乙酰半胱氨酸治疗氯米芬抵抗多囊卵巢综合征的临床疗效分析[J].世界最新医学信息文摘,2016,16(51):328-32.
[17]关亮.N-乙酰半胱氨酸治疗氯米芬抵抗多囊卵巢综合征促排卵治疗的有效性和安全性[J].中国社区医师,2015,31(29):65-7.
[18]李予,杨冬梓,阿比德.来曲唑、他莫昔芬和氯米芬治疗多囊卵巢综合征不孕疗效比较[J].中国实用妇科与产科杂志,2011,27(8):606-8.
[19]康燕.多囊卵巢综合征不孕患者氯米芬与他莫昔芬治疗对性激素和妊娠的影响[J].中国计划生育学杂志,2018,26(10):50-4.
[20]向大清,陈玲,曾林.氯米芬与他莫昔芬治疗多囊卵巢综合症不孕患者临床疗效对比观察[J].河北医学,2016,22(2):284-7.
[21]李晓诗,吕青,陈洁,等.他莫昔芬的药理作用机制及其对卵巢功能的影响[J].中国普外基础与临床杂志,2015,22(11):1397-404.
[22]陈虹.胰岛素抵抗与高雄激素[J].国际儿科学杂志,2018,45(8):615-9.
[23]Cuzick J,Sestak I,Cawthorn S,et al.Tamoxifen for prevention of breast cancer:extended long-term follow-up of the IBIS-I breast cancer prevention trial[J].Lancet Oncol,2015,16(1):67-75.
[24]王冰,李宏亮,杨文英,等.N-乙酰半胱氨酸改善高脂饲养大鼠外周胰岛素抵抗的机制[J].中国糖尿病杂志,2010,18(4):255-8.