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中国临床药理学与治疗学 ›› 2006, Vol. 11 ›› Issue (11): 1279-1284.

• 研究原著 • 上一篇    下一篇

来曲唑治疗排卵异常的临床疗效评价

黎平, 阮晓红, 郭江华, 陈晓燕, 邓爱民   

  1. 广东省江门市中心医院生殖医学中心, 江门 529070, 广东
  • 收稿日期:2006-06-06 修回日期:2006-11-05 出版日期:2006-11-26 发布日期:2020-11-06
  • 作者简介:黎平, 女, 学士, 副主任医师, 从事不孕不育专科工作。Tel:13924686369  E-mail:doctorliping@126.com

Analysis on therapeutic effect of letrozole on abnormal ovulation

LI Ping, RUAN Xiao-hong, GUO Jiang-hua, CHEN Xiao-yan, DENG Ai-min   

  1. Generation Center, Jiangmen Center Hospital , Jiangmen 529070, Guangdong, China
  • Received:2006-06-06 Revised:2006-11-05 Online:2006-11-26 Published:2020-11-06

摘要: 目的 观察、比较来曲唑( letrozole , LE) 治疗各种排卵异常的疗效, 以探讨其适应症及不良反应等。方法 选取排卵异常患者313 例, 观察871 个治疗周期, 按排卵异常类型分成4 组:除多囊卵巢综合征(polycystic ovarian syndrome, PCOS) 外的无排卵组( A组) 、PCOS 组( B 组) 、小卵泡排卵组( C 组) 、未破裂卵泡黄素化综合征( luteinized unruptured follicle syndrome, LUFS) 组( D 组) 。4 组均自月经d 5 起, 口服LE 2.5 mg q.d.×5, 后酌情或加用人绝经促性腺激素( human menopausal gonadotropin,HMG) 。当优势卵泡平均直径(MFD) ≥18 mm, 或尿黄体生成素( luteinizing hormone, LH) 测定( +) , 肌注人绒毛膜促性腺激素( human chorionic gonadotropin, HCG) 10000 IU 。比较4 组的排卵率、妊娠率、流产率等。结果 4 种排卵异常中, 仅B 组有因无优势卵泡发育或有卵巢过度刺激综合征( ovarian hyperstimulation syndrome,OHSS) 危险而取消周期者;单用LE 的优势卵泡出现率:B 组明显低于另3 组;HCG 肌注日最大卵泡平均直径( middle follicle dominant, MFD):C 组明显低于另3 组;HCG ( human chorionic gonadotropin) 肌注日MFD ≥15 mm 卵泡个数:B 组明显高于另3 组;排卵率:A 、C 组明显高于B 、D 组;妊娠率C 组最低;早期流产率C 组最高, 其次为B 组;PCOS 患者刺激卵泡前的窦卵泡数≤8 个 侧者较≥9 个/侧者取消周期率、HCG 肌注日MFD ≥15 mm 卵泡个数低而单用LE的优势卵泡出现率、排卵率高;刺激卵泡日数:≤6 d者无妊娠, 7 ~ 13 d 者较≥14 d 者妊娠率高而早期流产率低;不良反应:全部患者均诉月经经期延长,仅有7 个周期有患者诉服LE 期间轻微胃肠道反应。结论 LE 对除PCOS 外的无排卵、PCOS 、LUFS 均有疗效, 对小卵泡排卵者的卵泡发育无明显改善;刺激卵泡前窦卵泡数目可预测PCOS 患者对LE 的敏感;刺激卵泡日数7 ~ 13 d 疗效最佳;服用LE 不良反应少。

关键词: 来曲唑, 排卵异常, 多囊卵巢综合征, 未破裂卵泡黄素化综合征

Abstract: AIM: To investigate and compare the therapeutic effect of letrozole on abnormal ovulation, and to investigate its indication and side effect.METHODS: 313 cases of abnormal ovulation who were treated for 871 treatment cycles were divided into 4 groups:anovulia without PCOS grouP( A) , PCOS grouP( B) , ovule ovulation( C) and LUFS ( D).They took letrozole 2.5 mg q.d.×5 d from menstruation stage 5th day and added HMG later.They were injected HCG 1 000 IU when average diameter of dominant follicle ≥18 μm or LH( +) in urine.The ovulation rates, pregnancy rates and abortion rates were compared among 4 groups.RESULTS: There were several cycles canceled in PCOS grouP( B) because there was OHSS or no dominant follicle.Dominant follicles rates were lower in grouPB than others.MFD was shorter in grouPC than others.The amount of MFD ≥15mm was more in grouPB than others.Pregnancy rates were higher for sinus ovarian follicle ≤8/side and less for MFD ≥15 mm.Early abortion rate was the highest in grouPC.All patients had bradymenorrhea, with 7 cycles in some patients having light gastrointestinal side effect.CONCLUSION: Letrozole can treat abnormal ovulation such as anovulia without PCOS.PCOS and LUFS can not improve the follicular development of ovule ovulation.The amount of sinus ovarian follicle before stimulated follicle can predict the sensitiveness of letrozole for PCOS.The time of stimulating follicle was best for 7 -13 days.There was slight side effect for letrozole.

Key words: letrozole, abnormal ovulation, polycystic ovarian syndrome, luteinized unruptured follicle syndrome

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