二甲双胍联合氯米芬对多囊卵巢综合征患者的促排卵疗效观察

目的 探讨二甲双胍联合氯米芬在多囊卵巢综合征（PCOS）患者中的促排卵治疗效果. 方法 46例PCOS不孕症患者中对照组27例单用氯米芬促排卵治疗,试验组19例用二甲双胍联合氯米芬促排卵.对照组从月经周期第5天开始口服氯米芬,每次50 mg,1次/d,连服5 d,共3个周期.试验组先口服二甲双胍,每次500 mg,3次/d,连服3个月,随后从月经周期或撤退性出血的或撤退性出血的第5天开始加用氯米芬,用法同对照组.监测各组患者治疗前后生殖激素水平,阴道B型超声监测卵泡发育.分析各组排卵率和妊娠率. 结果 对照组治疗前后比较,各项生殖激素变化差异均无统计学意义（P＞0.05）;试验组治疗后睾酮、LH/FSH比值分别为[（0.54±0.28）μg/L、（1.27±0.32）],较治疗前[（1.02±0.86）μg/L、（1.93±0.72）]明显下降,差异有统计学意义（P＜0.05）;试验组妊娠12例（63.2%）,优于对照组的7例（25.9%）,差异有统计学意义（P＜0.05）. 结论 二甲双胍能改善PCOS患者高雄激素状态,提高PCOS患者对氯米芬的敏感性;二甲双胍和氯米芬联用能获得更高的排卵率和妊娠率.

Efficacy of metformin and clomiphene citrate combination for ovulation induction in PCOS patients

Objective To study the efficacy of ovulation induction in Polycystic ovary syndrome(PCOS)patients who receive a combination of metformin and clomiphene citrate(CC). Methods Totally 46 PCOS patients were conducted in the study.The control group had 27 patients receiving only CC at a dose of 50 mg from day 5 of the menstrual cycle until day 9 for a total of five days for three menstrual cycles.The test group had 19 patients receiving 500 mg three times a day of metformin continuously from the first cycle for six months or until pregnancy was confirmed.CC was started as that of the control group from the third cycle.Follicular growth was monitored by transvaginal ultrasound and plasma hormone concentrations were measured.The ovulation and pregnancy rates were evaluated in each group. Results After CC treatment in the control group,the plasma hormone concentration had not a significantly reduction compared with that before treatment(P ＞ 0.05).In the test group,the plasma concentrations of T and LH/FSH ratio showed a significantly reduction after treatment(P ＜0.05);the ovulation and pregnancy rates after treatment were significantly higher in the test group in comparison with those in control group(P ＜ 0.05). Conclusion Metformin can improve elevated androgen levels and CC sensitivity in PCOS patients.