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目的比较多囊卵巢综合征(PCOS)不孕患者经纠正内分泌代谢紊乱后应用3种不同促排卵药物的效果及对子宫内膜的影响。方法选择2009年3月至2010年1月中山大学孙逸仙纪念医院妇产科生殖中心128例PCOS不孕患者,于本院行第1次促排卵,有高雄激素或胰岛素抵抗者经预处理至少3个月。随机分为3组,来曲唑44个周期、他莫昔芬40个周期和氯米芬44个周期。结果月经第10天的子宫内膜厚度,他莫昔芬组[(6.4±1.2)mm]高于来曲唑组[(5.4±1.7)mm]和氯米芬组[(5.4±1.3)mm](P=0.01);HCG日血雌二醇(E2)水平,来曲唑组[(838.6±678.2)pmol/L]低于他莫昔芬组[(2629.2±1931.5)pmol/L]和氯米芬组[(1971.2±1222.8)pmol/L](P<0.001);3组间加用尿促性腺激素(HMG)周期数,HCG日子宫内膜厚度、血黄体生成素及孕酮、直径≥18mm成熟卵泡数,妊娠率和早期流产率,差异无统计学意义(P>0.05);HCG日子宫内膜的厚度与注射HCG的月经周期日及月经第10天的子宫内膜厚度呈正相关(P<0.05),与药物的种类及HCG日血E2水平等无显著相关(P>0.05)。结论 PCOS患者经纠正内分泌代谢紊乱后,来曲唑及他莫昔芬在促排卵效果及改善子宫内膜厚度方面并不优于氯米芬。
Objective To compare the effects of three different ovulation-promoting drugs and their effects on the endometrium after correction of endocrine and metabolic disorders in patients with polycystic ovary syndrome (PCOS) infertility. Methods From March 2009 to January 2010 Sun Yat-sen Memorial Hospital of Sun Yat-sen Memorial Hospital Obstetrics and Gynecology Reproductive Center 128 cases of PCOS infertility in our hospital line ovulation, hyperandrogenism or insulin resistance by pretreatment at least 3 Months. Randomly divided into 3 groups, letrozole 44 cycles, tamoxifen 40 cycles and clomiphene 44 cycles. Results The thickness of endometrium on the 10th day of menstruation was significantly higher in the tamoxifen group ([5.4 ± 1.3] mm vs [5.4 ± 1.7 mm] in the letrozole group and (5.4 ± 1.3) mm in the clomiphene citrate group (P <0.01). The level of estradiol (E2) in HCG group was lower than that in tamoxifen group [(838.6 ± 678.2) pmol / L and (1971.2 ± 1222.8) pmol / L] (P <0.001). The number of cycles of urinary gonadotropin (HMG), thickness of endometrium on HCG day, serum progesterone and progesterone, There was no significant difference in the number of mature follicles with diameter≥18mm, pregnancy rate and early miscarriage rate (P> 0.05). The thickness of endometrium on HCG day was the same as the menstrual cycle day of HCG injection and endometrial thickness on the 10th day of menstruation (P <0.05), but not with the type of drugs and E2 level of HCG day (P> 0.05). CONCLUSION Letrozole and tamoxifen are not superior to clomiphene in promoting ovulation and improving endometrial thickness after correcting endocrine and metabolic disorders in patients with PCOS.