Clinical observation of letrozole combined with methylprednisolone in the treatment of infertile patients with polycystic ovary syndrome resistant to clomiphene

LIU Shan; GUO Jing; CUI Yalin; CHENG Yayu; DUAN Wei

doi:10.6039/j.issn.1001-0408.2024.09.16

您当前的位置：

首页 >

文章列表页 >

Clinical observation of letrozole combined with methylprednisolone in the treatment of infertile patients with polycystic ovary syndrome resistant to clomiphene

更新时间：2025-09-25

- Clinical observation of letrozole combined with methylprednisolone in the treatment of infertile patients with polycystic ovary syndrome resistant to clomiphene
- ZHONGGUO YAOFANG Vol. 35, Issue 9, Pages: 1118-1122(2024)
- 作者机构：
  
  1.青岛市中心医院检验科，山东青岛　266042
  2.青岛市中心医院妇科，山东青岛　266042
  3.滨州医学院附属医院妇科，山东滨州　256600
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2024.09.16
  CLC： R969;R984
- Received：26 October 2023，
  
  Revised：2024-04-15，
  
  Accepted：15 April 2024，
  
  Published：15 May 2024
- 稿件说明：
移动端阅览
刘珊,郭婧,崔雅琳,等.来曲唑联合甲泼尼龙治疗克罗米芬抵抗的多囊卵巢综合征不孕患者的临床观察[J].中国药房,2024,35(09):1118-1122.

LIU Shan,GUO Jing,CUI Yalin,et al.Clinical observation of letrozole combined with methylprednisolone in the treatment of infertile patients with polycystic ovary syndrome resistant to clomiphene[J].ZHONGGUO YAOFANG,2024,35(09):1118-1122.
刘珊,郭婧,崔雅琳,等.来曲唑联合甲泼尼龙治疗克罗米芬抵抗的多囊卵巢综合征不孕患者的临床观察[J].中国药房,2024,35(09):1118-1122. DOI： 10.6039/j.issn.1001-0408.2024.09.16.

LIU Shan,GUO Jing,CUI Yalin,et al.Clinical observation of letrozole combined with methylprednisolone in the treatment of infertile patients with polycystic ovary syndrome resistant to clomiphene[J].ZHONGGUO YAOFANG,2024,35(09):1118-1122. DOI： 10.6039/j.issn.1001-0408.2024.09.16.

摘要

目的

探讨来曲唑联合甲泼尼龙对克罗米芬抵抗的多囊卵巢综合征不孕患者临床结局、卵巢储备功能、血清性激素和安全性的影响。

方法

回顾性分析青岛市中心医院妇科2021年2月至2022年1月收治的78例克罗米芬抵抗的多囊卵巢综合征不孕患者的临床资料，根据治疗方法不同分为对照组（42例）和观察组（36例）。对照组患者在月经周期第5～9天口服来曲唑5 mg/d，顿服，并采用阴道B超监测子宫内膜和卵泡发育情况、以戊酸雌二醇纠正子宫内膜厚度、以绒促性素诱发排卵等措施促进受孕。观察组患者在对照组治疗基础上，于自然月经或者撤退性出血第3天开始口服甲泼尼龙，4 mg/d，顿服。2组均治疗6个月经周期。比较2组患者排卵和1年内妊娠情况，血清性激素[雌二醇（E2）、黄体生成素（LH）、卵泡刺激素（FSH）、睾酮]、抗米勒管激素（AMH）水平，排卵指标（卵泡生长时间、排卵数量和优势卵泡数量）以及不良反应发生情况。

结果

治疗后，观察组患者的生化妊娠率（72.22%）和临床妊娠率（47.22%）均显著高于对照组（47.62%、19.05%），血清E2、LH、FSH、睾酮和AMH水平均显著低于对照组，卵泡生长时间显著短于对照组，排卵数量和优势卵泡数量均显著多于对照组（

＜0.05）。观察组和对照组患者的排卵率（94.44% vs. 83.33%）和不良反应总发生率（8.33% vs. 9.52%）比较，差异均无统计学意义（

＞0.05）。

结论

来曲唑联合甲泼尼龙相比单用来曲唑能够显著提高克罗米芬抵抗的多囊卵巢综合征不孕患者的妊娠率，调节其性激素水平，改善其卵巢储备功能，且安全性良好。

Abstract

OBJECTIVE

To explore the effects of letrozole combined with methylprednisolone on clinical outcomes， ovarian reserve function， serum sex hormones， and safety in infertile patients with polycystic ovary syndrome resistant to clomiphene.

METHODS

The clinical data of 78 infertile patients with polycystic ovary syndrome resistant to clomiphene in the Department of Gynecology of Qingdao Central Hospital from February 2021 to January 2022 was analyzed retrospectively， and all patients were divided into control group （42 cases） and observation group （36 cases） based on the treatment methods. The control group took letrozole 5 mg/d orally on the 5th to 9th day of the menstrual cycle. Vaginal ultrasound was used to monitor the development of the endometrium and follicles； estradiol valerate was used to correct endometrial thickness， and measures such as inducing ovulation with follicle-stimulating hormone were taken to promote pregnancy. On the basis of treatment in the control group， the observation group began taking methylprednisolone orally at a dose of 4 mg/d starting from the third day of natural menstruation or withdrawal bleeding. Both groups were treated for 6 menstrual cycles. The ovulation and pregnancy within one year， serum levels of sex hormones [estradiol （E2）， luteinizing hormone （LH）， follicle-stimulating hormone （FSH）， testosterone] and anti-Müllerian hormone （AMH）， ovulation indicators （follicle growth time， the number of ovulations， and the number of dominant follicles）， and the occurrence of adverse drug reactions were compared between the two groups.

RESULTS

After treatment， the biochemical pregnancy rate （72.22%） and clinical pregnancy rate （47.22%） of the observation group were significantly higher than those of control group （47.62%， 19.05%）； the serum levels of E2， LH， FSH， testosterone and AMH were significantly lower than the control group； the follicle growth time was significantly shorter than the control group； the number of ovulation and dominant follicles were significantly higher than the control group （

＜0.05）. There was no statistically significant difference in ovulation rate （94.44% vs. 83.33%） and total incidence of adverse drug reactions （8.33% vs. 9.52%） between the observation group and the control group （

＞0.05）.

CONCLUSIONS

Compared with letrozole alone， the combination of letrozole and methylprednisolone can significantly improve the pregnancy rate， the sex hormone levels and ovarian reserve function in infertile patients with polycystic ovary syndrome resistant to clomiphene， with high safety profiles.

关键词

Keywords

references

宋小青，蔡迁，王革玲，等 . 多囊卵巢综合征患者血清FGF-21、MCP-1、AngⅡ表达与胰岛素抵抗的关系 [J ] . 中国医师杂志， 2022 ， 24 （ 5 ）： 790 - 792 .

SONG X Q ， CAI Q ， WANG G L ， et al . Relationship between serum FGF-21，MCP-1，AngⅡ expression and insulin resistance in patients with polycystic ovary syndrome [J ] . J Chin Physician ， 2022 ， 24 （ 5 ）： 790 - 792 .

李萌，阮祥燕 . 多囊卵巢综合征的诊断、治疗与管理 [J ] . 中国医刊， 2018 ， 53 （ 5 ）： 465 - 468 .

LI M ， RUAN X Y . Polycystic ovary syndrome：update on diagnosis，treatment and management [J ] . Chin J Med ， 2018 ， 53 （ 5 ）： 465 - 468 .

张倩，李力，刘倩，等 . 多囊卵巢综合征妇女克罗米芬抵抗状况研究 [J ] . 检验医学与临床， 2018 ， 15 （ 22 ）： 3398 - 3400 .

ZHANG Q ， LI L ， LIU Q ， et al . A study on the resistance of clomifene citrate capsules in women with polycystic ovarian syndrome [J ] . Lab Med Clin ， 2018 ， 15 （ 22 ）： 3398 - 3400 .

多囊卵巢综合征相关不孕治疗及生育保护共识专家组，中华预防医学会生育力保护分会生殖内分泌生育保护学组 . 多囊卵巢综合征相关不孕治疗及生育保护共识 [J ] . 生殖医学杂志， 2020 ， 29 （ 7 ）： 843 - 851 .

Consensus Expert Group on the Treatment and Reproductive Protection of Infertility Related to Polycystic Ovarian Syndrome ， Reproductive Endocrine and Reproductive Protection Group of the Fertility Protection Branch of the Chinese Society of Preventive Medicine . Consensus on the treatment and reproductive protection of infertility related to polycystic ovarian syndrome [J ] . J Reprod Med ， 2020 ， 29 （ 7 ）： 843 - 851 .

何珊，刘大艳，宁艳，等 . 不同剂量来曲唑联合低剂量HMG治疗多囊卵巢综合征不孕患者的临床效果 [J ] . 中国医药导报， 2022 ， 19 （ 6 ）： 93 - 97 .

HE S ， LIU D Y ， NING Y ， et al . Clinical effect of different doses of letrozole combined with low-dose HMG on infertile patients with polycystic ovary syndrome [J ] . China Med Her ， 2022 ， 19 （ 6 ）： 93 - 97 .

何顺昱，杨栋霞 . 甲泼尼龙辅助治疗子宫内膜异位症合并反复早期自然流产效果及对可溶性类FMS酪氨酸激酶-1、血管内皮生长因子及C反应蛋白水平的影响 [J ] . 世界临床药物， 2022 ， 43 （ 12 ）： 1586 - 1591 .

HE S Y ， YANG D X . Effects of methylprednisolone in adjuvant treatment of endometriosis complicated with recurrent early spontaneous abortion and its effects on levels of soluble FMS-like tyrosine kinase-1，vascular endothelial growth factor and C reactive protein [J ] . World Clin Drug ， 2022 ， 43 （ 12 ）： 1586 - 1591 .

袁俊亮，王双坤，郭晓娟，等 . 卵巢过度刺激综合征合并系统性红斑狼疮、甲状腺功能减退引起的静脉窦血栓一例 [J ] . 中华医学杂志， 2015 ， 95 （ 28 ）： 2322 - 2323 .

YUAN J L ， WANG S K ， GUO X J ， et al . A case of venous sinus thrombosis caused by ovarian hyperstimulation syndrome complicated with systemic lupus erythematosus and hypothyroidism [J ] . Natl Med J China ， 2015 ， 95 （ 28 ）： 2322 - 2323 .

石彩歌 . 甲泼尼龙治疗克罗米芬耐药多囊卵巢综合征的效果观察 [J ] . 中国医药指南， 2013 ， 11 （ 15 ）： 28 - 29 .

SHI C G . Clinical effect of treatment with methylprednisolone on chloramiphene resistant polycystic ovarian syndrome [J ] . Guide China Med ， 2013 ， 11 （ 15 ）： 28 - 29 .

GREENWOOD E A ， PASCH L A ， CEDARS M I ， et al . Insulin resistance is associated with depression risk in polycystic ovary syndrome [J ] . Fertil Steril ， 2018 ， 110 （ 1 ）： 27 - 34 .

National Cancer Institute . Common terminology criteria for adverse events （CTCAE），version 4.0 [EB/OL ] . （ 2010-06-14 ）[ 2023-07-27 ] . https：//ctep.cancer.gov/protocol- Development/electronic_applications/ctc.htm#ctc_40 https://ctep.cancer.gov/protocol-Development/electronic_applications/ctc.htm#ctc_40 .

LIU Z M ， SONG Y ， XU Y F ， et al . The comparison of the effectiveness and safety of drospirone ethinyl estradiol and ethinyl estradiol cyproterone in the treatment of polycystic ovarian syndrome：a protocol for systematic review and meta-analysis [J ] . Medicine ， 2020 ， 99 （ 51 ）： E23811 .

白芳，王芬，王黎黎，等 . 养精种玉汤加味治疗肾虚肝郁型多囊卵巢综合征不孕症的临床疗效及对患者下丘脑-垂体-肾上腺轴功能和卵巢动脉血流动力学的影响 [J ] . 河北中医， 2022 ， 44 （ 4 ）： 590 - 594 .

BAI F ， WANG F ， WANG L L ， et al . Clinical efficacy of modified Yangjing zhongyu decoction for polycystic ova- rian syndrome patients with infertility （kidney liver depression type） and how to impact on hypothalamic-pituitary-adrenal axis function and hemodynamics of ovarian artery [J ] . Hebei J Tradit Chin Med ， 2022 ， 44 （ 4 ）： 590 - 594 .

TRUMMER C ， SCHWETZ V ， KOLLMANN M ， et al . Effects of vitamin D supplementation on metabolic and endocrine parameters in PCOS：a randomized-controlled trial [J ] . Eur J Nutr ， 2019 ， 58 （ 5 ）： 2019 - 2028 .

WU X K ， STENER-VICTORIN E ， KUANG H Y ， et al . Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome：a randomized clinical trial [J ] . JAMA ， 2017 ， 317 （ 24 ）： 2502 - 2514 .

WANG J ， TENG F ， WU Q Y ， et al . Relationship between proinflammatory cytokines and clomiphene resistance in patients with polycystic ovary syndrome [J ] . Ann Palliat Med ， 2021 ， 10 （ 11 ）： 11884 - 11890 .

方艳，王丹琳，李肖梅，等 . 二甲双胍联合来曲唑治疗对多囊卵巢综合征不孕症患者性激素水平、促排卵及妊娠率的影响 [J ] . 解放军医药杂志， 2022 ， 34 （ 6 ）： 110 - 113 .

FANG Y ， WANG D L ， LI X M ， et al . Effects of metformin combined with letrozole on sex hormone levels，ovulation induction and pregnancy rate in infertility patients with polycystic ovary syndrome [J ] . Med Pharm J Chin People’s Liberation Army ， 2022 ， 34 （ 6 ）： 110 - 113 .

LERCHBAUM E ， THEILER-SCHWETZ V ， KOLLMANN M ， et al . Effects of vitamin D supplementation on surrogate markers of fertility in PCOS women：a randomized controlled trial [J ] . Nutrients ， 2021 ， 13 （ 2 ）： 547 .

傅娣芳，李鑫伟，王亭亭，等 . 戊酸雌二醇片结合来曲唑治疗排卵功能障碍致不孕症的疗效及对卵泡发育、排卵的影响 [J ] . 中国性科学， 2023 ， 32 （ 2 ）： 105 - 109 .

FU D F ， LI X W ， WANG T T ， et al . Effect of estradiol va- lerate tablets combined with letrozole on infertility caused by ovulation dysfunction and its effect on follicular deve- lopment and ovulation [J ] . Chin J Hum Sex ， 2023 ， 32 （ 2 ）： 105 - 109 .

MOHAMMADI YEGANEH L ， MOINI A ， SHIVA M ， et al . Methylprednisolone for prevention of ovarian hyperstimulation syndrome in patients with polycystic ovarian syndrome undergoing in vitro fertilization：a randomized controlled trial [J ] . J Obstet Gynaecol ， 2018 ， 38 （ 2 ）： 241 - 246 .

JONES G E S ， HOWARD J E ， LANGFORD H . The use of cortisone in follicular phase disturbances [J ] . Fertil Steril ， 1953 ， 4 （ 1 ）： 49 - 62 .

吴晓春 . 屈螺酮炔雌醇片联合地塞米松治疗多囊卵巢综合征临床效果分析 [J ] . 福建医药杂志， 2023 ， 45 （ 3 ）： 82 - 84 .

WU X C . Clinical analysis of drospirenone ethinylestradiol tablets combined with dexamethasone in the treatment of polycystic ovary syndrome [J ] . Fujian Med J ， 2023 ， 45 （ 3 ）： 82 - 84 .

TANRIVERDI A M ， AYDIN B ， BEBITOGLU B T ， et al . The behavioral and neurochemical effects of methylprednisolone or metyrapone in a post-traumatic stress disorder rat model [J ] . North Clin Istanb ， 2019 ， 6 （ 4 ）： 327 - 333 .

KOLAK A ， KAMIŃSKA M ， WYSOKIŃSKA E ， et al . The problem of fatigue in patients suffering from neopla- stic disease [J ] . Contemp Oncol ， 2017 ， 21 （ 2 ）： 131 - 135 .

JISKOOT G ， BENNEHEIJ S H ， BEERTHUIZEN A ， et al . A three-component cognitive behavioral lifestyle program for pre-conceptional weight-loss in women with polycy- stic ovary syndrome （PCOS）：a protocol for a randomized controlled trial [J ] . Reprod Health ， 2017 ， 14 （ 1 ）： 34 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Efficacy observation of cetrorelix combined with aspirin in preventing early-onset ovarian hyperstimulation syndrome

Related Author

ZHANG Yile

SHI Hao

BU Zhiqin

YANG Li

MENG Yanlei

ZHANG Yingying

GUO Yihong

Related Institution

Reproductive Medical Center， Reproductive and Genetic Hospital， the First Affiliated Hospital of Zhengzhou University

Address：8th Floor, Sihuan Building, No. 129 Daping Main Street, Yuzhong District, Chongqing, China Postal code：400042
Technical support is provided by Beijing Founder Electronics co., LTD 渝ICP备15012710号公网安备50010302001817
It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.

⁰