目的 研究氯米芬与来曲唑对多囊卵巢综合征(polycystic ovarian syndrome, PCOS)促排卵患者子宫动脉及内膜下血流的影响,为提高患者疗效提供依据.方法 回顾性分析2014年9月至2016年8月在西安交通大学第一附属医院妇产科就诊的PCOS排卵障碍患者198例的临床资料,根据促排卵方案不同分为氯米芬组(CC组,102例)、来曲唑组(LE组,96例),比较两组患者促排卵后子宫动脉及内膜下血流、促排卵率和妊娠率等.结果 ①两组患者促排卵后子宫动脉搏动指数(PI)、阻力指数(RI)的差异均无统计学意义(t值0.302～1.644,P均>0.05),LE组子宫内膜生长速度显著优于CC组(t值3.750～9.573,P均<0.05),两组患者内膜下血流PI无统计学差异(t值0.153～1.042,P均>0.05),但LE组促排卵后月经第17、19、20天内膜下RI显著低于CC组(t值分别为2.809、4.776、5.231,P均<0.05);②比较两组促排卵成功患者相关数据发现,LE组注射hCG日、排卵后5～6d子宫内膜厚度均显著高于CC组(t值分别为4.839、4.438,P均<0.05),且子宫内膜形态显著优于CC组(χ2=12.674,P<0.05),两组排卵日、平均优势卵泡直径、优势卵泡数、排卵数、注射hCG日及排卵后5～6d血清雌二醇、孕酮水平比较均无统计学差异(t值0.402～1.234,P均>0.05);③CC组促排卵成功率为63.73％,LE组促排卵成功率为59.38％,两组比较无统计学差异(χ2=0.396,P>0.05),LE组生化妊娠率和临床妊娠率分别为33.33％、27.08％,显著高于CC组的20.59％、14.71％(χ2=4.098、4.614,P均<0.05);④两组促排卵成功患者注射hCG日、排卵后5～6d子宫动脉PI、RI两组比较均无统计学差异(t=0.435、0.324、0.564、0.879,P均>0.05),且两组子宫内膜下PI亦无统计学差异(t=0.442、0.490,P均>0.05),但子宫内膜下LE组RI均显著低于CC组(t=3.097、4.036,P均<0.05).结论 来曲唑用于PCOS患者促排卵能显著改善子宫内膜形态和厚度,使内膜血供增加,容受性好,进而提高妊娠率.%Objective To study the effects of clomiphene citrate and letrozole on uterine artery and subendometrial blood flow in patients with polycystic ovarian syndrome (PCOS) and ovulation induction so as to improve the curative effect.Methods Clinical data of 198 patients diagnosed with ovulatory disorder PCOS in Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xi`an Jiaotong University, from September 2014 to October 2016 were retrospectively analyzed.Patients were divided into CC group (102 cases) and LE group (96 cases) according to stimulated ovulation plan.The uterine artery and subendometrial blood flow, stimulated ovulation rate and pregnancy rate were compared between the two groups.Results ① There was no significant difference in PI and RI of uterine artery after stimulated ovulation between the two groups (t=0.302-1.644, all P>0.05);the endometrial growth was significantly faster in LE group than in CC group (t=3.750-9.573, all P<0.05).There was no significant difference in subendometrial PI after stimulated ovulation betweenthe two groups (t=0.153-1.042, all P>0.05), but RI was significantly lower in LE group than in CC group (t=2.809, 4.776, and 5.231, all P<0.05).② Comparison of the data of patients with successfully stimulated ovulation between the two groups showed that endometrial thickness was significantly superior in LE group to that in CC group on the day of hCG injection and 5～6 days after ovulation (t=4.839, 4.438, all P<0.05), and the morphology of endometrium was also better than that in CC group (χ2=12.674, P<0.05).There was no significant difference in ovulation date, average diameter of dominant follicle, number of dominant follicles, number of ovulations, serum E2 and P levels on hCG injection day and 5～6 days after ovulation between the two groups (t=0.402-1.234, all P>0.05).③ There was no significant difference in the successfully stimulated ovulation rate between CC group (63.73％) and LE group (59.38％)(χ2=0.396, P>0.05).The biochemical pregnancy rate and clinical pregnancy rate in LE group were 33.33％ and 27.08％, which were significantly higher than those of CC group(20.59％,14.71％)(χ2=4.098, 4.614, all P<0.05).④ There was no significant difference in PI and RI of uterine artery on the day of hCG injection and 5～6 days after ovulation of patients with successfully stimulated ovulation between the two groups (t=0.435, 0.324, 0.564, and 0.879, all P>0.05), and there was no significant difference in PI of subendometrial blood flow between the two groups (t=0.442, 0.490, all P>0.05), but PI of subendometrial blood flow in LE group was significantly higher than that in CC group (t=3.097, 4.036, P<0.05).Conclusion Letrozole used to stimulate ovulation in patients with PCOS could significantly improve endometrial morphology and thickness, which could increase the blood supply and receptiveness of endometrium, thus increasing pregnancy rate.
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