克罗米酚对不孕症患者子宫内膜发育及性激素水平的影响

目的:观察服用克罗米酚(clomiphene citrate,CC)后不孕妇女子宫内膜发育、子宫血流和雌激素、孕激素水平,探讨克罗米酚引起不孕妇女高排卵率、低妊娠率的原因。方法:20例不孕症妇女于月经周期第5～9天服用克罗米酚100 mg/d(CC组),于排卵前1 d和排卵后10 d检测子宫动脉血流阻力指数(RI)、子宫内膜厚度及血雌激素(E2)和孕激素(P)水平,并于排卵后10 d刮取子宫内膜检测子宫内膜腺腔面积、腺腔周长、间质面积及腺/间比值;免疫组化检测子宫内膜雌激素受体ER和孕激素受体PR的表达。另选20例不孕症患者作为对照。结果:与对照组比较,CC组妇女子宫动脉血流RI及血E2和P水平显著升高(P<0.01),子宫内膜明显变薄(P<0.05);子宫内膜腺腔面积、腺腔周长、间质面积及腺/间比值、ER、PR的表达明显低于对照组(P<0.01)。结论:克罗米酚促排卵时导致子宫内膜发育不良可能是其高排卵率、低妊娠率的原因之一。

Influence of Clomiphene Citrate on Development of Endometrium and Sexual Hormone Levels in Patients with Infertility

Objective To investigate the influence of clomiphene citrate(CC) on the endometrial development,uterine blood flow,estrogen and progestogen levels in female with inferility after administration,as well to explore the possible reason of that CC inducing high ovulation but low pregnancy rate.Methods CC were given in 20 inferility female with dose of 100 mg/d from 5th to 9th day of menstrual cycle,and another 20 cases with inferility were selected as control group.The uterine blood flow resistant index(RI),the thickness of endometrium,and levels of E2 and P were determined at the day before ovulation and 10 days after ovulation,respectively.The endometrium was scraped at 10 days after ovulation for measuring the area,perimeter of gland cavities,the area of stroma,the ratio of gland to stroma.The expression of estrogen receptors(ER) and progestogen receptors(PR) in endometrium were assessed by immunohistochemistry.Results Compared to control group,the RI of blood flow in uterine arteries,the levels of blood E2 and P were significantly increased(P<0.01),while the thickness of endometrium was significantly decreased(P<0.05),the area and perimeter of gland cavities,the ratio of gland to stroma,the expression of ER and PR were obviously decreased(P<0.01) in CC group.Conclusion The administration of clomiphene citrate in stimulating ovulation could cause the dysplasia of endometria,which may account for its high ovulation but low pregnancy rate partially.