综合干预后多囊卵巢综合征不孕患者应用来曲唑促排卵的临床效果

目的 探讨综合干预后采用来曲唑促排治疗多囊卵巢综合征不孕患者的临床效果。方法 选取2019年3月至2019年9月就诊于首都医科大学附属北京妇产医院内分泌科的144例多囊卵巢综合征不孕患者作为研究对象，按照组间匹配的原则分为两组，观察组96例患者在接受综合干预治疗3个月后采用来曲唑治疗，对照组48例患者直接采用来曲唑治疗。观察综合干预组患者治疗前后激素浓度变化，包括黄体生成素（luteinizing hormone，LH）、卵泡刺激素（follicle stimulating hormone，FSH）、LH/FSH、总睾酮（total testosterone，TT）、游离睾酮（free testosterone，FT）、抗苗勒管激素（anti-Müllerian hormone，AMH）及腰围，比较两组患者的排卵率。结果 两组患者治疗前不孕年限、身高、体质量、体质量指数（body mass index，BMI）、腰围、臀围、LH、FSH、AMH浓度比较差异均无统计学意义（P>0.05）；观察组患者综合干预后LH、FSH、LH/FSH、TT、FT、AMH浓度较治疗前显著降低（P<0.05），腰围较治疗前减低，但差异无统计学意义（P>0.05）；与对照组相比，观察组的排卵率明显升高，差异有统计学意义（P<0.05）。分层分析显示促排卵前BMI<24 kg/m²的患者中，观察组的排卵率高于对照组（P<0.05）；而BMI ≥ 24 kg/m²的患者中，两组的排卵率差异无统计学意义（P>0.05）。结论 综合干预后采用来曲唑治疗多囊卵巢综合征不孕患者的临床效果显著，能够改善患者的激素浓度，提高排卵率，尤其是体质量指数控制在正常或偏低的患者效果更佳。

Clinical effect of letrozole on ovulation induction in infertile patients with polycystic ovary syndrome after comprehensive intervention

Objective To investigate the clinical effect of letrozole in the treatment of infertile patients with polycystic ovary syndrome (PCOS) after comprehensive intervention. Methods A total of 144 infertile patients with PCOS who visited the Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, from March to September 2019 were divided into two groups according to the principle of matching between groups. 96 patients in the observation group were treated with letrozole after 3 months of comprehensive intervention, while 48 patients in the control group were treated with letrozole alone. The changes of hormone levels before and after treatment were observed in the comprehensive intervention group, including luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH, total testosterone (TT), free testosterone (FT), anti-Müllerian hormone (AMH), and waist circumference. The ovulation rate was compared with each other between the two groups. Results There was no significant difference in infertility years, height, body weight, body mass index (BMI), waist circumference, hip circumference, LH, FSH and AMH between the two groups before treatment (P>0.05). After comprehensive intervention, the levels of LH, FSH, LH/FSH, TT, FT and AMH in the observation group were significantly lower than those before treatment (P<0.05), except that the waist circumference was lower than that before, but without statistically significant difference (P>0.05). Compared with the control group, the ovulation rate in the observation group was significantly increased, with statistically significant difference (P<0.05). Stratified analysis showed that the ovulation rate in the observation group was higher than that in the control group (P<0.05) in the patients with BMI<24 kg/m² before ovulation induction. However, in patients with BMI ≥ 24 kg/m², there was no significant difference between the two groups (P>0.05). Conclusion The clinical effect of letrozole in the treatment of infertility patients with PCOS after comprehensive intervention is significant, which can improve the both hormone level of patients and the ovulation rate, especially in patients with normal or low BMI.