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来曲唑联合甲泼尼龙治疗克罗米芬抵抗的多囊卵巢综合征不孕患者的临床观察
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| 篇名： | 来曲唑联合甲泼尼龙治疗克罗米芬抵抗的多囊卵巢综合征不孕患者的临床观察 |
| TITLE： | Clinical observation of letrozole combined with methylprednisolone in the treatment of infertile patients with polycystic ovary syndrome resistant to clomiphene |
| 摘要： | 目的 探讨来曲唑联合甲泼尼龙对克罗米芬抵抗的多囊卵巢综合征不孕患者临床结局、卵巢储备功能、血清性激素和安全性的影响。方法回顾性分析青岛市中心医院妇科2021年2月至2022年1月收治的78例克罗米芬抵抗的多囊卵巢综合征不孕患者的临床资料，根据治疗方法不同分为对照组（42例）和观察组（36例）。对照组患者在月经周期第5～9天口服来曲唑5mg/d，顿服，并采用阴道B超监测子宫内膜和卵泡发育情况、以戊酸雌二醇纠正子宫内膜厚度、以绒促性素诱发排卵等措施促进受孕。观察组患者在对照组治疗基础上，于自然月经或者撤退性出血第3天开始口服甲泼尼龙，4mg/d，顿服。2组均治疗6个月经周期。比较2组患者排卵和1年内妊娠情况，血清性激素[雌二醇（E2）、黄体生成素（LH）、卵泡刺激素（FSH）、睾酮]、抗米勒管激素（AMH）水平，排卵指标（卵泡生长时间、排卵数量和优势卵泡数量）以及不良反应发生情况。结果治疗后，观察组患者的生化妊娠率（72.22%）和临床妊娠率（47.22%）均显著高于对照组（47.62%、19.05%），血清E2、LH、FSH、睾酮和AMH水平均显著低于对照组，卵泡生长时间显著短于对照组，排卵数量和优势卵泡数量均显著多于对照组（P＜0.05）。观察组和对照组患者的排卵率（94.44%vs.83.33%）和不良反应总发生率（8.33%vs.9.52%）比较，差异均无统计学意义（P＞0.05）。结论来曲唑联合甲泼尼龙相比单用来曲唑能够显著提高克罗米芬抵抗的多囊卵巢综合征不孕患者的妊娠率，调节其性激素水平，改善其卵巢储备功能，且安全性良好。 |
| ABSTRACT： | OBJECTIVE To explore the effects of letrozole combined with methylprednisolone on clinical outcomes， ovarian reserve function， serum sex hormones， and safety in infertile patients with polycystic ovary syndrome resistant to clomiphene. METHODS The clinical data of 78 infertile patients with polycystic ovary syndrome resistant to clomiphene in the Department of Gynecology of Qingdao Central Hospital from February 2021 to January 2022 was analyzed retrospectively， and all patients were divided into control group （42 cases） and observation group （36 cases） based on the treatment methods. The control group took letrozole 5 mg/d orally on the 5th to 9th day of the menstrual cycle. Vaginal ultrasound was used to monitor the development of the endometrium and follicles； estradiol valerate was used to correct endometrial thickness， and measures such as inducing ovulation with follicle-stimulating hormone were taken to promote pregnancy. On the basis of treatment in the control group， the observation group began taking methylprednisolone orally at a dose of 4 mg/d starting from the third day of natural menstruation or withdrawal bleeding. Both groups were treated for 6 menstrual cycles. The ovulation and pregnancy within one year， serum levels of sex hormones [estradiol （E2）， luteinizing hormone （LH）， follicle-stimulating hormone （FSH）， testosterone] and anti-Müllerian hormone （AMH）， ovulation indicators （follicle growth time， the number of ovulations， and the number of dominant follicles）， and the occurrence of adverse drug reactions were compared between the two groups. RESULTS After treatment， the biochemical pregnancy rate （72.22%） and clinical pregnancy rate （47.22%） of the observation group were significantly higher than those of control group （47.62%， 19.05%）； the serum levels of E2， LH， FSH， testosterone and AMH were significantly lower than the control group； the follicle growth time was significantly shorter than the control group； the number of ovulation and dominant follicles were significantly higher than the control group （P＜0.05）. There was no statistically significant difference in ovulation rate （94.44% vs. 83.33%） and total incidence of adverse drug reactions （8.33% vs. 9.52%） between the observation group and the control group （P＞0.05）. CONCLUSIONS Compared with letrozole alone， the combination of letrozole and methylprednisolone can significantly improve the pregnancy rate， the sex hormone levels and ovarian reserve function in infertile patients with polycystic ovary syndrome resistant to clomiphene， with high safety profiles. |
| 期刊： | 2024年第35卷第09期 |
| 作者： | 刘珊；郭婧；崔雅琳；程亚玉；段伟 |
| AUTHORS： | LIU Shan，GUO Jing，CUI Yalin，CHENG Yayu，DUAN Wei |
| 关键字： | 来曲唑；甲泼尼龙；多囊卵巢综合征；不孕；克罗米芬抵抗；卵巢储备功能；性激素；促排卵 |
| KEYWORDS： | letrozole； methylprednisolone； polycystic ovarian syndrome； infertility； clomiphene resistance； ovarian reserve |
| 阅读数： | 32 次 |
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