他莫昔芬对氯米芬抵抗的多囊卵巢综合征促排卵作用研究

目的 探讨氯米芬（CC）联合他莫昔芬（tamoxifen）对CC抵抗的多囊卵巢综合征（PCOS）患者的促排卵效果.方法 将100例CC抵抗患者随机分为治疗组（A组）和对照组（B组）.A组患者在月经第3～7天口服CG 100 mg/d,同时在月经周期的第3～7天口服他莫昔芬40 mg/d;B组CC的应用同A组.月经第8 d开始监测卵泡发育情况.当有1个卵泡直径≥18 rmm或2个卵泡直径≥17 mm时,肌注hCG1 0 000 IU,36 h后性生活.观察两组注射hCG日成熟卵泡数和子宫内膜厚度、促排卵天数、月经周期第22天孕酮水平、排卵率和妊娠率.结果 A组注射hCG日的成熟卵泡数、子宫内膜厚度、月经第21 d血清中孕酮水平以及排卵率和妊娠率与B组相比差异均有统计学意义（P＜0.05～P＜0.01）;促排卵天数组间无统计学意义（P＞0.05）.结论 对CC抵抗的PCOS患者,他莫昔芬可以促进排卵,改善CC对子宫内膜的抗雌激素效应,增加子宫内膜厚度,提高排卵率和妊娠率.

Investigation on the effect of promoting ovulation of tamoxifen in clomiphene resistant polycysitic ovary Syndrome

Objective To explore the effect of domoxifen combined with tamoxifen on ovulation in clomiphene-resistant patients with polycystic ovary syndrome. Methods 100 patients who was resistant to CG were randomly divided into two groups:the treatment group (group A) and control group (group B). Oral dosing CC 100mg/d to the patients of group A in the first 3th to 7th days of menses,at the same time,oral dosing tamoxifen 40mg/d in the first 3th to 7th days of menstrual cycle. The dose of CC to group B was same as group A. Beginning to monitor the case of follicular growth during the 8th day of menses. When a ovarian follicle' s diameter beyond 18mm or 2 ovarian follicle' s diameter beyond 17mm, intramuscular injection hCG 10 000IU, sexing after 36 hours later. Observing the two groups of the mature ovarian number,the endometrial thickness, the days of promoting ovulation ,the level of progesterone in serum about the 22th day of menstrual cycle, ovulation rate and pregnancy rate, after injecting hCG.Results The day after injecting hCG, the mature ovarian follicle number,the endometrial thickness, the level of progesterone in serum about the 22th day of menstrual cycle,ovulation rate and pregnancy rate,group A was significantly different from group B( P ＜0.05 ～ P ＜0. 01 ) ,the days of promoting ovulation have no statistically significant differences between the groups (P ＞ 0. 05). Conclusion In the clomiphene-resistant patients with polycystic ovary syndrome,tamoxifen could promote ovulation,improve the effect of CC on the uterus' s anti-estrogen,increase endometrial thickness, elevate ovulation rate and pregnancy rate.