目的 探討來曲唑序貫治療來曲唑促排卵失敗多囊卵巢綜合征的臨床療效。方法 選取2016年12月-2018年3月在天津醫(yī)科大學(xué)第二醫(yī)院計劃生育科就診的來曲唑促排卵失敗的178例多囊卵巢綜合征患者為研究對象，共234個促排周期。按照隨機(jī)數(shù)字表將發(fā)生來曲唑促排卵失敗的178例多囊卵巢綜合征患者隨機(jī)分為來曲唑序貫來曲唑組（62例，共87個周期）、來曲唑序貫氯米芬組（59例，共75個周期）和來曲唑序貫?zāi)虼傩运亟M（57例，共72個周期）。3組患者均在月經(jīng)第5天口服來曲唑片5 mg/次，1次/d，停藥第3天監(jiān)測卵泡，卵泡直徑≤ 10 mm的患者用藥。來曲唑序貫來曲唑組患者口服來曲唑片，5 mg/次，1次/d，連續(xù)5 d，停藥后第1天行陰道超聲檢查。來曲唑序貫氯米芬組患者口服枸櫞酸氯米芬片，100 mg/d，連續(xù)5 d，停藥后第1天行陰道超聲檢查。來曲唑序貫?zāi)虼傩运亟M患者肌內(nèi)注射注射用尿促性素，75 U/d，根據(jù)卵泡反應(yīng)調(diào)整劑量，直到出現(xiàn)優(yōu)勢卵泡。比較3組患者的單卵泡率、排卵率、周期取消率和失敗率；人絨毛膜促性腺激素日子宮內(nèi)膜的厚度和類型；臨床妊娠率、早期胚胎丟失率、多胎妊娠率和卵巢過度刺激綜合征發(fā)生率；促排方案中序貫用藥的時間、費(fèi)用和患者對促排卵方案的滿意度。結(jié)果 治療后，來曲唑序貫來曲唑組、來曲唑序貫氯米芬組的單卵泡發(fā)育率顯著高于來曲唑序貫?zāi)虼傩运亟M，且來曲唑序貫來曲唑組的單卵泡發(fā)育率顯著高于來曲唑序貫氯米芬組，3組間差異均有統(tǒng)計學(xué)意義（P<0.05）。治療后，來曲唑序貫來曲唑組、來曲唑序貫?zāi)虼傩运亟M的排卵率均高于來曲唑序貫氯米芬組，差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，來曲唑序貫來曲唑組、來曲唑序貫氯米芬組的周期取消率顯著低于來曲唑序貫?zāi)虼傩运亟M，且來曲唑序貫來曲唑組的周期取消率顯著低于來曲唑序貫氯米芬組，3組間差異均有統(tǒng)計學(xué)意義（P<0.05）。治療后，來曲唑序貫來曲唑組、來曲唑序貫?zāi)虼傩运亟M子宮內(nèi)膜厚度明顯厚于來曲唑序貫氯米芬組（P<0.05）。治療后，來曲唑序貫來曲唑組、來曲唑序貫氯米芬組的多胎妊娠率顯著低于來曲唑序貫?zāi)虼傩运亟M，且來曲唑序貫來曲唑組的多胎妊娠率顯著低于來曲唑序貫氯米芬組，3組間差異均有統(tǒng)計學(xué)意義（P<0.05）。治療后，來曲唑序貫來曲唑組、來曲唑序貫氯米芬組的卵巢過度刺激綜合征發(fā)生率低于來曲唑序貫?zāi)虼傩运亟M，差異有統(tǒng)計學(xué)意義（P<0.05）。來曲唑序貫來曲唑組、來曲唑序貫氯米芬組明顯短于來曲唑序貫?zāi)虼傩运亟M的用藥時間（P<0.05）。來曲唑序貫?zāi)虼傩运亟M的總費(fèi)用顯著高于來曲唑序貫氯米芬組、來曲唑序貫來曲唑組?；颊邔砬蛐蜇瀬砬蚪M、來曲唑序貫氯米芬組的促排卵方案滿意度高。結(jié)論 來曲唑序貫來曲唑方案具有較高的排卵率、妊娠率，同時多胎妊娠率、卵巢過度刺激綜合征風(fēng)險最低，不但減少了肌內(nèi)注射尿促性素多卵泡發(fā)育的風(fēng)險，而且方案更加簡單方便，節(jié)省患者的時間和花費(fèi)，是一種既經(jīng)濟(jì)有效又安全省時的促排卵方案，非常適合全科醫(yī)生在基層醫(yī)療機(jī)構(gòu)中推廣應(yīng)用。

Objective To evaluate the clinical effect of letrozole sequential therapy in treatment of polycystic ovary syndrome due to letrozole induced ovulation failure. Methods Patients (178 cases) with polycystic ovary syndrome due to letrozole induced ovulation failure in the Second Hospital of Tianjin Medical University from December 2016 to March 2018 were randomly divided into letrozole sequential letrozole group (62 cases, 87 cycles), letrozole sequential clomiphene group (59 cases, 75 cycles), and letrozole sequential gonadotropin group (57 cases, 72 cycles). All the three groups were po administered with Letrozol Tablets on the fifth day of menstruation, 5 mg/time, once daily. And the follicles were monitored on the third day after drug withdrawal, if the follicle diameter of the patient was less than or equal to 10 mm, and medication was given. Patients in letrozole sequential letrozole group were po administered with Letrozol Tablets, 5 mg/time, once daily, continuous treatment for 5 d, and vaginal ultrasound examination was performed on the first day after drug withdrawal. Patients in letrozole sequential clomiphene group were treated with clomiphene citrate tablets, 100 mg/d, continuous treatment for 5 d, and vaginal ultrasound examination was performed on the first day after drug withdrawal. Patients in letrozole sequential gonadotropin group were iv administered with Menotrophins for injection, 75 U/d, and the dosage was adjusted according to the follicular response until dominant follicles appeared. The follicular development, the cycle cancellation rate and failure rate, the endometrial thickness and type on human chorionic gonadotropin day, the pregnancy outcome, the clinical pregnancy rate, the early embryo loss rate, the multiple pregnancy rate, the ovarian hyperstimulation syndrome incidence rate, the time and cost of sequential medication, and the satisfaction of ovulation induction program among three groups were compared. Results After treatment, the single follicle development rate of letrozole sequential letrozole group and letrozole sequential clomiphene group was significantly higher than that of letrozole sequential gonadotropin group, and the single follicle development rate of letrozole sequential letrozole group was significantly higher than that of letrozole sequential clomiphene group, and the differences among the three groups were statistically significant (P<0.05). After treatment, the ovulation rate of letrozole sequential letrozole group and letrozole sequential gonadotropin group were higher than that of letrozole sequential clomiphene group, and the difference was statistically significant (P<0.05). After treatment, the cycle cancellation rate of letrozole sequential letrozole group and letrozole sequential clomiphene group was significantly lower than that of letrozole sequential gonadotropin group, and the cycle cancellation rate of letrozole sequential letrozole group was significantly lower than that of letrozole sequential clomiphene group, and the differences among the three groups were statistically significant (P<0.05). After treatment, the endometrial thickness in letrozole sequential letrozole group and letrozole sequential gonadotropin group was significantly thicker than that of letrozole sequential clomiphene group (P<0.05). After treatment, the multiple pregnancy rate of letrozole sequential letrozole group and letrozole sequential clomiphene group was significantly lower than that of letrozole sequential gonadotropin group, and the multiple pregnancy rate of letrozole sequential letrozole group was significantly lower than that of letrozole sequential clomiphene group, and the differences among the three groups were statistically significant (P<0.05). After treatment, the incidence of ovarian hyperstimulation syndrome in letrozole sequential letrozole group and letrozole sequential clomiphene group was lower than that in letrozole sequential gonadotropin group (P<0.05). The medication time of letrozole sequential letrozole group and letrozole sequential clomiphene group were significantly shorter than letrozole sequential gonadotropin group (P<0.05). The total cost of letrozole sequential gonadotropin group was significantly higher than that of letrozole sequential clomiphene group and letrozole sequential letrozole group. Patients with letrozole sequential letrozole group and letrozole sequential clomiphene group were highly satisfied with ovulation induction. Conclusion Letrozole sequential letrozole regimen has higher ovulation rate and pregnancy rate, while the risk of multiple pregnancy rate and ovarian hyperstimulation syndrome is the lowest. It not only reduces the risk of multiple follicle development by intramuscular Menotrophins for injection, but also is more simple and convenient, saving time and cost for patients, which is an economical, effective, safe, and time-saving ovulation induction program, and it is very suitable for general practitioners to promote their application in primary medical institutions.

R984