克罗米芬联合炔雌醇环丙孕酮治疗多囊卵巢综合征的效果及对BiP、CTGF的影响
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摘要
目的分析克罗米芬联合炔雌醇环丙孕酮治疗多囊卵巢综合征的效果及对内质网分子伴侣免疫球蛋白结合蛋白(BiP)和结缔组织生长因子(CTGF)的影响。方法选择2015年2月-2016年3月于我院接受治疗的多囊卵巢综合征患者74例,按照随机分配原则将其分为对照组和观察组,各37例。其中,对照组患者给予克罗米芬治疗,观察组在其基础上给予炔雌醇环丙孕酮。对两组患者血清性激素水平、Bi P、CTGF表达水平以及卵巢功能和妊娠情况进行评估。结果连续3个疗程治疗结束后,相比对照组,观察组FSH水平显著升高(P<0.05),血清LH、T水平显著降低(P<0.05)。两组HCG日内膜厚度、卵泡成熟时间无明显差异(P>0.05);相比对照组,观察组HCG日优势卵泡个数、2年内妊娠率均显著提高(P<0.05)。治疗后观察组血清CTGF及BiP表达水平较对照组显著降低(P<0.05)。结论克罗米芬联合炔雌醇环丙孕酮可有效治疗多囊卵巢综合征,提高患者妊娠率,降低患者Bi P和CTGF的表达水平。
Objective To analyze the therapeutic effect of clomiphene combined with ethinylestradiol and cycloprogesterone against polycystic ovary syndrome( PCOS) and its influence on immunoglobulin binding protein(BiP) and connective tissue growth factor(CTGF). Methods Seventy-four patients with polycystic ovary syndrome who were treated in our hospital between February 2015 and March 2016 were randomly divided into the control group and observation group,with 37 cases in each group.The patients in the control group were treated with clomiphene,while those in the observation group were additionally treated with ethinylestradiol and cycloprogesterone. Serum levels of sex hormones,Bi P and CTGF,ovarian function and pregnancy were evaluated in both groups.Results After three consecutive courses of treatment,the level of FSH in the observation group increased significantly(P<0.05) compared with the control group,but the levels of serum LH and T decreased significantly(P<0.05). There was no significant difference in the daily intimal thickness of HCG or follicular maturation time between the two groups(P>0.05). Compared with the control group,the number of dominant follicles on HCG day and the pregnancy rate within two years in the observation group were significantly increased(P<0.05). After treatment,the levels of serum CTGF and Bi P in the observation group were significantly lower than those in the control group(P<0.05). Conclusion Clomiphene combined with ethinylestradiol and cycloproterone can effectively treat polycystic ovary syndrome,improve pregnancy rates and reduce the expressions of Bi P and CTGF in patients with polycystic ovary syndrome.
Objective To analyze the therapeutic effect of clomiphene combined with ethinylestradiol and cycloprogesterone against polycystic ovary syndrome( PCOS) and its influence on immunoglobulin binding protein(BiP) and connective tissue growth factor(CTGF). Methods Seventy-four patients with polycystic ovary syndrome who were treated in our hospital between February 2015 and March 2016 were randomly divided into the control group and observation group,with 37 cases in each group.The patients in the control group were treated with clomiphene,while those in the observation group were additionally treated with ethinylestradiol and cycloprogesterone. Serum levels of sex hormones,Bi P and CTGF,ovarian function and pregnancy were evaluated in both groups.Results After three consecutive courses of treatment,the level of FSH in the observation group increased significantly(P<0.05) compared with the control group,but the levels of serum LH and T decreased significantly(P<0.05). There was no significant difference in the daily intimal thickness of HCG or follicular maturation time between the two groups(P>0.05). Compared with the control group,the number of dominant follicles on HCG day and the pregnancy rate within two years in the observation group were significantly increased(P<0.05). After treatment,the levels of serum CTGF and Bi P in the observation group were significantly lower than those in the control group(P<0.05). Conclusion Clomiphene combined with ethinylestradiol and cycloproterone can effectively treat polycystic ovary syndrome,improve pregnancy rates and reduce the expressions of Bi P and CTGF in patients with polycystic ovary syndrome.
引文
[1]刘桢,梁瑞宁,李佩双.多囊卵巢综合征代谢异常特点及中医认识[J].中国中医基础医学杂志,2017,23(5):654.
[2]张翌蕾,潘文,汪永娟.多囊卵巢综合征病因病机中西医研究进展[J].中国中医基础医学杂志,2016,22(7):1004.
[3]曹云霞,唐静文.多囊卵巢综合征患者胰岛素抵抗和高胰岛素血症的诊治[J].中国实用妇科与产科杂志,2013,29(11):864.
[4]洪宇,刘雯,赵晓苗,等.多囊卵巢综合征患者的血脂代谢异常及与胰岛素抵抗的关系分析[J].实用妇产科杂志,2012,28(3):230.
[5]陆新虹,杨海燕,罗佐杰,等.不同胰岛素抵抗状态下多囊卵巢综合征患者内分泌指标与卵巢超声特征的相关性研究[J].中国糖尿病杂志,2015,23(1):40.
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[7]郑思远,张莹,龙涛,等.不同胰岛素抵抗及肥胖水平对多囊卵巢综合征患者高雄激素血症特征的影响[J].广东医学,2017,38(3):406.
[8]裴菲,张焕焕,徐玉萍,等.BiP、CHOP和p-JNK在多囊卵巢综合征患者血白细胞中的表达[J].实用妇产科杂志,2016,32(4):314.
[9]苗竹林,韦相才,程龙球,等.TGF-β1及CTGF在PCOS大鼠的表达及罗格列酮的干预作用[J].现代妇产科进展,2010,19(9):676.
[10]聂晓伟,谈勇.PCOS发病机制及其与KIT/KITL相关性的研究进展[J].南京中医药大学学报,2011,27(4):398.
[11]胡颜霞,张展,贾莉婷.雄激素及其受体在大鼠多囊卵巢综合征发病机制中的相互作用[J].中国妇幼保健,2011,26(11):1694.
[12]金华良,王兴娟.胰岛素、瘦素、雄激素与多囊卵巢综合征发病机制研究进展[J].复旦学报(医学版),2010,37(2):236.
[13]张婧,李荔,陈文芬,等.多囊卵巢综合征发病机制研究进展[J].实用医学杂志,2014,30(2):323.
[14]林松,李云霞.达英35预处理治疗多囊卵巢综合征疗效分析[J].中国妇幼保健,2010,25(27):3943.
[15]胡波,张纪源,杨小春.二甲双胍联合克罗米芬治疗多囊卵巢综合征合并不孕的疗效分析[J].中国妇幼保健,2012,27(16):2487.
[16]SAKAI N,CHUN J,DUFFIELD J S,et al.Lysophosphatidic acid signaling through its receptor initiates profibrotic epithelial cell fibroblast communication mediated by epithelial cell derived connective tissue growth factor[J].Kidney Int,2017,91(3):628.
[17]MU S,KANG B,ZENG W,et al.MicroRNA-143-3p inhibits hyperplastic scar formation by targeting connective tissue growth factor CTGF/CCN2 via the Akt/m TORpathway[J].Mol Cell Biochem,2016,416(12):99.
[18]GAO L,CAO J T,LIANG Y,et al.Calcitriol attenuates cardiac remodeling and dysfunction in a murine model of polycystic ovary syndrome[J].Endocrine,2016,52(2):363.
[2]张翌蕾,潘文,汪永娟.多囊卵巢综合征病因病机中西医研究进展[J].中国中医基础医学杂志,2016,22(7):1004.
[3]曹云霞,唐静文.多囊卵巢综合征患者胰岛素抵抗和高胰岛素血症的诊治[J].中国实用妇科与产科杂志,2013,29(11):864.
[4]洪宇,刘雯,赵晓苗,等.多囊卵巢综合征患者的血脂代谢异常及与胰岛素抵抗的关系分析[J].实用妇产科杂志,2012,28(3):230.
[5]陆新虹,杨海燕,罗佐杰,等.不同胰岛素抵抗状态下多囊卵巢综合征患者内分泌指标与卵巢超声特征的相关性研究[J].中国糖尿病杂志,2015,23(1):40.
[6]林金芳,李昕,苏椿淋.多囊卵巢综合征患者胰岛素抵抗的诊断方法及治疗策略[J].中国实用妇科与产科杂志,2007(9):663.
[7]郑思远,张莹,龙涛,等.不同胰岛素抵抗及肥胖水平对多囊卵巢综合征患者高雄激素血症特征的影响[J].广东医学,2017,38(3):406.
[8]裴菲,张焕焕,徐玉萍,等.BiP、CHOP和p-JNK在多囊卵巢综合征患者血白细胞中的表达[J].实用妇产科杂志,2016,32(4):314.
[9]苗竹林,韦相才,程龙球,等.TGF-β1及CTGF在PCOS大鼠的表达及罗格列酮的干预作用[J].现代妇产科进展,2010,19(9):676.
[10]聂晓伟,谈勇.PCOS发病机制及其与KIT/KITL相关性的研究进展[J].南京中医药大学学报,2011,27(4):398.
[11]胡颜霞,张展,贾莉婷.雄激素及其受体在大鼠多囊卵巢综合征发病机制中的相互作用[J].中国妇幼保健,2011,26(11):1694.
[12]金华良,王兴娟.胰岛素、瘦素、雄激素与多囊卵巢综合征发病机制研究进展[J].复旦学报(医学版),2010,37(2):236.
[13]张婧,李荔,陈文芬,等.多囊卵巢综合征发病机制研究进展[J].实用医学杂志,2014,30(2):323.
[14]林松,李云霞.达英35预处理治疗多囊卵巢综合征疗效分析[J].中国妇幼保健,2010,25(27):3943.
[15]胡波,张纪源,杨小春.二甲双胍联合克罗米芬治疗多囊卵巢综合征合并不孕的疗效分析[J].中国妇幼保健,2012,27(16):2487.
[16]SAKAI N,CHUN J,DUFFIELD J S,et al.Lysophosphatidic acid signaling through its receptor initiates profibrotic epithelial cell fibroblast communication mediated by epithelial cell derived connective tissue growth factor[J].Kidney Int,2017,91(3):628.
[17]MU S,KANG B,ZENG W,et al.MicroRNA-143-3p inhibits hyperplastic scar formation by targeting connective tissue growth factor CTGF/CCN2 via the Akt/m TORpathway[J].Mol Cell Biochem,2016,416(12):99.
[18]GAO L,CAO J T,LIANG Y,et al.Calcitriol attenuates cardiac remodeling and dysfunction in a murine model of polycystic ovary syndrome[J].Endocrine,2016,52(2):363.