标题：来曲唑联合HMG治疗不同体质量指数PCOS不孕患者的促排卵效果及妊娠结局分析

      作者：张婷，李颖，王佩红，赵莉，蒋秋丽，陈钢，马丹，苗群英    汉中市中心医院妇科，陕西 汉中 723000

      卷次： 2019年30卷15期

      【摘要】 目的 分析不同体质量指数(BMI)多囊卵巢综合征(PCOS)不孕患者应用来曲唑(LE)联合人绝经期促性腺激素(HMG)治疗的促排卵效果及妊娠结局。方法 回顾性分析2016年10月至2019年1月在汉中市中心医院妇科治疗的300例PCOS不孕患者的诊疗情况，按照BMI将其分为体质量过低组72例、正常体质量组75例、超重组74例和肥胖组79例。检测所有患者的激素水平后，应用来曲唑联合HMG促进排卵，比较四组患者的激素水平、排卵率及妊娠结局。结果 四组患者的雌二醇(E2)值比较差异无统计学意义(P>0.05)；BMI指数越大，睾酮(T)值越大，超重组和肥胖组的T值为(0.73±0.42) ng/mL和(0.88±0.51) ng/mL，明显高于正常体质量组的(0.45±0.21) ng/mL，差异均具有统计学意义(P<0.05)；BMI指数越大，卵泡刺激素/黄体生成素(LH/FSH)值越小，超重组和肥胖组的LH/FSH值为1.14±0.58和1.12±0.62，明显低于正常体质量组的1.37±0.80，差异具有统计学意义(P<0.05)，体质量过低组患者的T值和LH/FSH值分别为(0.44±0.18) ng/mL和1.62±0.93，与正常体质量组比较差异均无统计学意义(P>0.05)；四组患者的排卵率比较差异无统计学意义(P>0.05)；超重组和肥胖组的临床妊娠率分别为 9.46%和 8.46%，明显低于正常体质量组的21.33%；超重组和肥胖组的流产率为5.41%和6.33%，明显高于正常体质量组的0；超重组和肥胖组的生化妊娠率为6.76%和6.33%，明显高于正常体质量组的0，差异均具有统计学意义(P<0.05)；体质量过低组的临床妊娠率、流产率和生化妊娠率分别为 11.11%、1.39%和 2.78%，与正常体质量组比较差异均无统计学意义(P>0.05)。结论 不同BMI的PCOS不孕患者进行来曲唑联合HMG促排后的效果和妊娠结局不同，BMI指数越高，睾酮水平越高，临床妊娠率越低，流产率和生化妊娠率越高。低体质量的妊娠结局在本次研究中并未得出有影响的结论，可能是由于样本数量不够，有待进一步研究确定。
      【关键词】 多囊卵巢综合征；人绝经期促性腺激素；来曲唑；体质量指数；排卵；妊娠
      【中图分类号】 R711.75 【文献标识码】 A 【文章编号】 1003—6350（2019）15—1950—04

Effect of letrozole combined with human menopausal gonadotropin on ovulation induction and pregnancyoutcome in infertile patients of polycystic ovary syndrome with different body mass index.
ZHANG Ting, LI Ying,WANG Pei-hong, ZHAO Li, JIANG Qiu-li, CHEN Gang, MA Dan, MIAO Qun-ying. Department of Gynecology, HanzhongCentral Hospital, Hanzhong 723000, Shaanxi, CHINA
【Abstract】 Objective To analyze the effect of letrozole (LE) combined with human menopausal gonadotropin(HMG) on ovulation induction and pregnancy outcome in infertile women of polycystic ovary syndrome (PCOS) withdifferent body mass index (BMI). Methods A total of 300 infertile patients of PCOS treated in Department of Gynecol-ogy, Hanzhong Central Hospital from October 2016 to January 2019 were selected and divided, according to BMI, intolow body mass group (72 cases), normal body mass group (75 cases), overweight group (74 cases), and obesity group(79 cases). After testing the hormone levels of all patients, letrozole combined with HMG was used to promote ovula-tion. The hormone levels, ovulation rate, and pregnancy outcomes of the four groups were compared. Results Therewas no significant difference in estradiol (E2) between the four groups (P>0.05). The larger the BMI index, the greaterthe testosterone (T) value. The T value of the overweight group and obesity group were (0.73±0.42) ng/mL and (0.88±0.51) ng/mL, significantly higher than (0.45±0.21) ng/mL in normal body mass group (P<0.05). The larger the BMI in-dex, the smaller the value of follicle stimulating hormone/luteinizing hormone (LH/FSH). The LH/FSH values of theoverweight group and obesity group were 1.14±0.58 and 1.12±0.62, which were significantly lower than 1.37±0.80 ofnormal body mass group (P<0.05). The T and LH/FSH values of the overweight group were (0.44 ± 0.18) ng/mL and1.62±0.93, which showed no statistically significant difference with those in normal body mass group (P>0.05). Therewas no significant difference in ovulation rate among the four groups (P>0.05). The clinical pregnancy rates of the over-weight group and obesity group were 9.46% and 8.46%, which were significantly lower than 21.33% of normal bodymass group; the abortion rates were 5.41% and 6.33% , which were significantly higher than 0 of normal body massgroup; the biochemical pregnancy rates were 6.76% and 6.33%, significantly higher than 0 of normal body mass group;all the differences were statistically significant (P<0.05). There were no significant differences in clinical pregnancy rate,abortion rate, and biochemical pregnancy rate between the low body mass group (11.11%, 1.39%, 2.78%, respectively)and the normal body mass group (P>0.05). Conclusion The effect and pregnancy outcome are different in infertile pa-