来曲唑联合GnRH—a治疗用于PCOS患者的研究

目的探讨来曲唑（LE）以及促性腺激素释放激素激动剂（GnRH—a）用于多囊卵巢综合征（PCOS）患者的治疗效果。方法50例不孕症常规检查确诊为PCOS并接受促排卵及宫腔内人工授精（IUI）的不孕患者，随机分为来曲唑组（24例）：口服LE；HMG组（26例）：注射14MG。两组分别于月经周期第3～7天每天口服来曲唑5．0mg或HMG75IU肌内注射，分别监测月经周期第10天子宫内膜厚度，直径≥10mm卵泡个数，记录GnRH—a注射日子宫内膜的厚度、形态，直径≥16ram卵泡（成熟卵泡）个数，直径≥14卵泡（优势卵泡）个数，血清黄体生成素（LH）、雌激素（E：）、睾酮（T）水平，分别统计排卵率及妊娠率，多胎率，卵巢过度刺激综合征（OHSS）发生率。结果与HMG组相比，来曲唑组月经周期第10天子宫内膜厚度薄（P=0．00）；GnRH—a注射日血清中E，水平低（P=0．00），T水平高（P=0．004），优势卵泡数少（P=0．02），OHSS发生率低（P=0．04），但临床妊娠率无明显差异（P=0．78）且多胎率低（P=0．02）。结论对PCOS患者，用LE或HMG促排卵，临床妊娠率无差异，用LE联合GnRH—a治疗可以降低HCG日血清中雌激素水平，减少OHSS的发生率，以及多胎率，可望成为一线促排卵药。

Letrozole Combined with Gonadotropin Releaseing Hormone Agonist Used in Intrauterine Insemination in Patients with PCOS

Objective To explore the effect of letrozole（LE） and GnRH - a on ovulation induction in the patients with polycystic ovay syndrome （PCOS）. Methods 50 patients were divided into two groups, group LE （24 cases）took LE and Group H MG （26 cases）took HMG. The endometrial thickness,average dominant follicle numbers and levels of the EE,T,LH were evaluated on HCG day and the preg- nancy rates,OHSS rates as well. Results Patients took HMG had more average dominant follicle numbers and endometrial thickness after five days treatment than that of took LE （P 〈 0.05 ） ,and also had the higher level of the E2 on hCG day and the OHSS rates（ P 〈 0.05 ）. No significant difference was found in the number of mature follicles and endometrial thickness on HCG day,and clinical pregnancy rate （P 〉 0.05）. Conclusion Letrozole is expected as a first - line drug to induce ovulation.