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应用复方醋酸环丙孕酮治疗多囊卵巢综合征及合并耐氯菧酚不育的探讨 |
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were determined before, 2～3 cycles and 4～6 cycles after treatment. After stopping the drug, CC or human menopausal gonadotropin were re-administered in 12 patients (22 cycles) and 5 cases (6 cycles) respectively for induction of ovulation. Results All patients had regular uterine bleeding during CPA Co therapy. Acne improved in 8 cases. Hirsute score didn t decrease significantly. Serum LH, FSH, E2, A, T, Ds concentrations decreased significantly (P<0.05～0.01), while SHBG levels increased by 5.1 times after treatment. Meanwhile, bilateral ovarian volumes shrunk and follicle numbers decreased significantly (P<0.05～0.01). Serum insulin levels did not change significantly. As to the lipid profile, the most striking change was55.1% increase of HDL-C and 23.0% decrease of LDL-C, although TG also increased by 36.2%. 58.6% of patients had mild and transient adverse effects. Serum alanine transaminase increased in 3 cases. After stopping treatment, CC induced 5.3% (by cases) or 45.4% (by cycles) ovulation rate and 2 pregnancies achieved in 12 CC resistant patients. Conclusion CPA Co has antiandrogenic effects on PCOS patients clinically, biochemically and in ovarian morphology. Pretreatment of CPA Co may play a role in improving the outcome of ovulation induction in CC resistant cases.
【Key words】 Polycystic ovary syndrome Infertility, female Cyproterone acetate Clomiphene
多囊卵巢综合征（PCOS）是最常见的妇科内分泌疾病。可引起月经紊乱、无排卵性不育、多毛、痤疮等，并可增加动脉硬化型血脂异常、糖尿病、子宫内膜癌和乳腺癌的患病风险［1］。PCOS所致无排卵性不育，氯菧酚（CC）治疗妊娠率仅约30％［2］。绝经期促性腺激素（hMG）或促卵泡激素（FSH）因多卵泡发育而终止治疗者约28％，卵巢过度刺激综合征(OHSS)发生率23％［2］，处理上对医生是个挑战。本研究采用前瞻开放性自身对照方法，评估复方醋酸环丙孕酮(复方CPA)治疗PCOS的临床疗效、疗程及安全性，探索停药后改善促排卵疗效的可行性。
资料和方法
一、研究对象
1997年3至7月随意选择在我院妇科内分泌门诊就诊的PCOS患者29例，平均年龄(28.2±4.5)岁(20～35岁)。临床表现为稀发月经14例、闭经10例、功能失调性子宫出血4例、无排卵月经1例，不育16例，多毛［Ferriman-Gallwey (F-G)评分>4分］16例、痤疮8例、肥胖17例，稀发排卵3例、无排卵26例。PCOS诊断标准见参考文献［2］，其中根据临床、生化、超声检查诊断者22例（75.7%)，根据临床、生化检查诊断者25例(86.2%)，根据临床、超声检查者26例(89.7%)。雄烯二上一页 [1] [2] [3] 下一页
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