Anovulation yana daya daga cikin abubuwan da ke haifar da rashin haihuwa.Polycystic ovary Syndrome (PCOS) shine mafi yawan cututtuka na anovulatory na yau da kullum. A saninmu, juriya na insulin yana da alaƙa da PCOS. Saboda haka, a cikin marasa lafiya tare da PCO, insulin-sensitizing kwayoyi irin su pioglitazone. za a iya amfani da su tada kwai.
An haɗa marasa lafiya sittin da ɗaya tare da PCOS a cikin binciken bisa ga ka'idodin haɗawa / cirewa bayan samun izini daga Kwamitin Da'a na Jami'ar Kiwon Lafiya ta Mashhad. An raba marasa lafiya zuwa ƙungiyoyi biyu. Ƙungiyar farko ta ɗauki 30 milligrams (mg) na pioglitazone kullum yana farawa daga rana ta biyu na al'adar su.Na biyu ya sami placebo.150 MG naclomiphene citratean gudanar da shi daga rana ta 3 zuwa rana ta 7 na lokacin haila. An yi amfani da ultrasonography na farji a kan dukkan mata, kuma a cikin lokuta masu girma, an yi amfani da intrauterine bayan allurar gonadotropin chorionic chorionic. An kwatanta ƙwanƙwasa ovarian da yawan ciki a kowane rukuni.
Babu bambance-bambance tsakanin kungiyoyi dangane da halaye na alƙaluma da nau'ikan rashin haihuwa. Matsakaicin nauyin jiki ya kasance mafi girma a cikin rukuni na pioglitazone (28.3 ± 3.8 vs 26.2 ± 3.5, P darajar = 0.047) . Girman follicle bai bambanta sosai tsakanin ƙungiyoyi ba (2.2). ± 1.4 vs 1.3 ± 1.1, P darajar = 0.742) . Farashin ciki [4 (12.9%) vs 4 (13.3%), P darajar = 1] bai bambanta tsakanin kungiyoyi ba.
Duk da mafi girman adadin follicles a cikin rukunin pioglitazone, bincikenmu bai nuna wani bambanci a cikin kuzarin kwai da ƙimar ciki ba.
Rashin haihuwa yana shafar kusan 10-15% na ma'aurata.30% na rashin haihuwa na mace yana faruwa ne saboda gazawar ovulation [1].Polycystic ovary syndrome (PCOS) shine cuta mafi bayyane kuma na kowa da ke hade da cututtuka na ovulatory na kullum [2].Lokacin amfani da Turai. Al'umma don haifuwa na ɗan adam da al'ummomin Amurka da al'ummar Amurka don tsarin bincike na haihuwa, ƙaddamar da PCOs kusan 15-20% [3].
Matakan lipoprotein mara kyau sune na al'ada na marasa lafiya na PCOS, tare da yawan adadin cholesterol (Chol), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), da apoptotic AI [4], 5,6. Mafi mahimmancin canji a cikin lipids da aka ruwaito shine raguwa a cikin HDL.Hyperinsulinemia da insulin juriya (IR) suna da yawa a cikin PCOS.Mustafa et al. Game da 46% na matan Masar tare da PCOS an gano cewa suna da IR [4, 7].Insulin ya rushe. steroidogenesis a cikin ovary mai zaman kansa na sirrin gonadotropin I PCOS [1] Masu karɓar insulin da insulin-kamar girma factor-1 (IGF-I) suna cikin sel stromal ovarian [5] Rage autophosphorylation, takamaiman cuta mai alaƙa da mai karɓar insulin- siginar tsaka-tsaki, ana gano shi a cikin 50% na mata masu PCOS [3].
Metabolism na glucose mara kyau yana inganta asarar nauyi sosai;asarar nauyi na iya rage hyperandrogenism da mayar da aikin ovulatory [7].Mata masu kiba tare da juriya na insulin, ƙuntataccen calorie, da asarar nauyi suna rage girman juriya na insulin.
A yau,clomiphene citrateshine shawarar da aka ba da shawarar don shigar da ovulation a cikin mata masu PCOS. juriya na insulin yana da alaƙa da alaƙa da polycystic ovary syndrome, don haka ana la'akari da magungunan da ke ƙara haɓaka mai karɓar insulin, kamar metformin da beta-thiazolidinediones a cikin jiyya na waɗannan marasa lafiya. juriya na iya haifar da ovulation, musamman a cikin mata masu kiba waɗanda ke da babban matakin juriya na insulin [9].
Juriya na insulin yana haifar da raguwar amsawar glucose ga insulin, sannan hyperinsulinemia, wanda ke haifar da haɓakar triglycerides, rage HDL-cholesterol, rashin haƙuri na glucose, da haɗarin cututtukan zuciya [10]. A wasu binciken da aka yi kwanan nan, an nuna pioglitazone don rage kwararar jini na intra-ovarian stromal. Yana iya taimakawa wajen inganta haɓakar ovarian da kuma sakamakon hadi (IVF) a cikin marasa lafiya na PCOS. .
Ya zuwa yau, babu wani binciken da ya yi nazarin tasirin pioglitazone akan haihuwa a cikin majiyyatan mu.Saboda haka, mun yi hasashe cewa pioglitazone a matsayin maganin insulin zai iya inganta yanayin kwai da ciki a cikin marasa lafiya na PCOS. Wannan binciken yana nufin amfani da pioglitazone don samun ciki mai nasara, ciki har da sinadarai da sinadarai. ciki na asibiti, da adadin manyan ƙwayoyin cuta a cikin mata marasa haihuwa tare da PCOS.
Jami'ar Kiwon Lafiya ta Mashhad ta kula da wannan binciken gwaji na asibiti bazuwar daga 2014 zuwa 2017 kuma ta yi amfani da hanyar da ba za ta yiwu ba don daukar majinyata PCOS 61 da aka tura zuwa Cibiyar Infertility ta Milad don maganin rashin haihuwa. Kwamitin da'a na Jami'ar Kiwon Lafiya ta Mashad ya amince da dakatarwar. "Maris 15, 2014" kuma an samu izini a rubuce daga dukkan mahalarta.
Ƙididdigar haɗawa sun kasance mata marasa haihuwa a cikin shekaru 18-38 tare da hysterosalpingography na al'ada da kuma spermogram. Sakamakon ganewar asali na polycystic ovary syndrome ya dogara ne akan ka'idodin AES (Androgen Excess Society 2006) bisa ga ma'auni na sama: (1) hirsutism ko hyperandrogenic bayyanar cututtuka.(2) ) Rashin aiki na Ovarian shine oligomenorrhea, ko kuma an gano kwayar cutar polycystic a matsayin bayyanar lace na mahaifa ta hanyar duban dan tayi;(3) Ci gaba da haifar da na biyu kamar ciwon daji na ovarian da adrenal da pituitary adenomas.Polycystic ovary syndrome ana gano shi idan yanayin haila ya kasance oligomenorrhoea, ko kuma idan adadin kwayoyin halitta a cikin ovary ya wuce 2-9 mm fiye da 9 akan Ferriman-Gallway sikelin.
Marasa lafiya tare da tarihin cututtukan cututtukan zuciya na zuciya, cututtukan koda na yau da kullun, ciwon sukari, cututtukan thyroid, da cututtukan huhu an cire su.
Bayan zabar marasa lafiya da suka cancanta, an raba su zuwa rukuni biyu ta hanyar samfurin bazuwar sauƙi ta amfani da software na kwamfuta.An yi amfani da hanyar ambulaf don sanya marasa lafiya zuwa ƙungiyoyin ba da gangan. ba za a iya ganin ambulaf daga waje ba.Group A ya ƙunshi allunan 30 na pioglitazone, 30 MG, da 15 allunan clomiphene, yayin da aka sanya rukunin B tare da allunan 30 na placebo da 15 allunan clomiphene. Marasa lafiya sun makantar da magani da aka ba su.
Duk marasa lafiya sun yi amfani da ultrasonography transvaginal a rana ta biyu na haila kuma an haɗa su a cikin binciken idan babu cysts na ovarian wanda ya fi girma fiye da 20 mm.
An ƙididdige adadin matsakaici da manyan follicles da kauri na endometrial a rana ta goma ko sha ɗaya na haila. An ƙididdige ƙimar ciki na kimiyya da asibiti.
Ƙungiyar farko ta karbi 30 MG na pioglitazone kowace rana;Kashi na biyu sun sami placebo tun daga rana ta biyu na al'ada. Tsakanin kwanaki 3 zuwa 7 na al'ada, an ba wa ƙungiyoyin biyu 150 MG.clomiphene citrate.Transvaginal ultrasonography on day 10 or 11. Yi la'akari da chorionic gonadotropin (HCG) wanda ke biye da intrauterine insemination (IUI) a cikin mata masu kauri na endometrial fiye da 7 mm da follicles fiye da 16 mm.
A cikin yanayin jinkiri na kwanaki 5 a cikin haila, an dauki samfurori na jini don tantance matakan βHCG. Abubuwan da ke da alaka da Pioglitazone da lambobin follicle fiye da 16 mm da kauri na endometrial an kiyasta a yayin binciken. idan aka kwatanta a fadin kungiyoyi.
An ƙididdige girman samfurin ta amfani da software na PASS 11 kuma an kwatanta ma'anar adadin follicles a cikin kowace ƙungiya. atrition, 30 mahalarta kowane rukuni da aka yi la'akari.
An shigar da bayanai a cikin nau'in SPSS na 16. Da farko, an kwatanta halayen kowane rukuni ta hanyoyin ƙididdiga masu kwatanta, ciki har da ma'ana da ma'auni na ma'auni don ci gaba da canji da lambobi tare da mitoci don ma'auni. T-tests masu zaman kansu ko gwajin Mann-Whitney-U an yi amfani da su bayan an yi la'akari da al'ada ta amfani da gwajin Kolmogorov-Smirnov. An kwatanta ma'auni masu mahimmanci ta amfani da gwajin chi-square. A cikin duk kididdiga, P-darajar kasa da 0.05 an yi la'akari da matakan mahimmanci. .
Game da ka'idojin haɗakarwa, mata 93 sun shiga cikin binciken, 19 suna da ka'idojin cirewa kuma 13 sun fita daga cikin. wanda aka nuna a cikin Table 1.Ba a sami bambance-bambance tsakanin kungiyoyi dangane da halaye na alƙaluma da nau'in rashin haihuwa ba.Matsakaicin shekarun ƙungiyar masu shiga tsakani shine 28.20 ± 5.46 kuma na ƙungiyar kulawa shine 27.07 ± 4.18, kuma bambancin ba shi da mahimmanci. .Duk da haka, ma'aunin jiki (BMI) ya kasance mafi girma a cikin rukunin pioglitazone.
Table 2 yana taƙaita abubuwan da aka gano na sonographic na majiyyaci, kamar adadin matsakaicin matsakaicin matsakaici, adadin manyan ƙwayoyin cuta, matsakaicin matsakaicin girman, da kauri na endometrial. Kamar yadda aka nuna a cikin Table 2, girman girman ya kasance a cikin rukuni sai dai matsakaici-sized follicles.
Bayani game da sakamakon shigar da kwayar cutar ovulation, kamar ƙarar ovulation, sinadaran, da kuma yawan ciki na asibiti a kowane zagaye, an gabatar da su a cikin Tebu 3. Ƙwararrun ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ma
Sakamakon wannan binciken ya nuna cewa akwai bambanci mai yawa a cikin adadin abubuwan motsa jiki na ovulation a tsakanin marasa lafiya da aka bi da su tare da pioglitazone.Ultrasonography, wanda aka yi a ranar 10 na haila, ya nuna karuwa mai yawa a cikin ma'auni na follicles a cikin rukunin shiga tsakani.Bincikenmu. tabbatar da binciken binciken 2012 game da rawar pioglitazone a cikin shigar da kwayar halitta a cikin marasa lafiya na hyperinsulinemic tare da PCOS [12].
Babu bambance-bambance a cikin ovulation da yanayin ciki tsakanin ƙungiyoyin binciken biyu. Wannan na iya zama saboda tsawon lokacin pioglitazone da aka yi amfani da shi kafin fara clomiphene. clomiphene ya zama ciki [14] . Binciken 2010 na Kim ya nuna raguwa mai yawa a cikin adadin follicles bayan an ba da pioglitazone. Bugu da ƙari kuma, a cikin bincikensa, ƙungiyar pioglitazone ta sami mafi girma na ciki na asibiti, amma wannan bambanci ba shi da mahimmanci. ya bambanta da sakamakon mu, amma ana iya bayyana shi ta hanyar ma'aunin zaɓi na haƙuri, ciki har da marasa lafiya na clomiphene [15].
Ota ya nuna cewa pioglitazone zai iya inganta yawan ciki a cikin marasa lafiya na PCOS masu tsayayya da clomiphene da dexamethasone [14] .Da alama cewa lokuta PCOS tare da hyperandrogenemia ya kamata a zaba a hankali. Marasa lafiya a cikin shirin Ota suna da matakan hormones daban-daban, wanda zai iya rinjayar sakamakon sakamakon. Jiyya na pioglitazone. A cikin bincikenmu, matakan hormone bai bambanta sosai ba kafin da kuma bayan sa baki.
A cikin bincikenmu, babu wani bambance-bambance mai mahimmanci a cikin adadin manyan ƙananan ƙwayoyin cuta da kauri na endometrial tsakanin ƙungiyoyi masu shiga tsakani da masu kula da su.Duk da haka, an sami karuwa mai yawa a cikin ƙananan ƙananan ƙwayoyin cuta a cikin ƙungiyar masu shiga tsakani.
A cikin binciken da aka yi a yanzu, ƙungiyar masu shiga tsakani tana da BMI mafi girma, wanda ke nufin cewa wannan rukunin zai iya haifar da hyperinsulinemia kuma ya shafi sakamakon, kodayake wannan bambanci ba shi da mahimmanci a tsakanin ƙungiyoyin biyu.
Babu wani daga cikin marasa lafiyarmu da ya sami sakamako masu illa.Babu wani canje-canje masu mahimmanci a cikin gwaje-gwajen aikin hanta a lokacin binciken.
Babban ƙayyadaddun binciken mu shine cewa an tsara binciken ne a matsayin aikin sarrafawa, wanda ya haifar da bambance-bambance a cikin BMI tsakanin ƙungiyoyin biyu. Saboda haka, sakamakon zai iya rinjayar wannan bambanci. Duk da haka, babu irin wannan binciken na wannan biyu- An gudanar da tsarin maganin miyagun ƙwayoyi a cikin marasa lafiya a yankinmu. Duk da haka, saboda tasirin pioglitazone akan juriya na insulin, ya bayyana cewa yawan nasara ya karu idan marasa lafiya sun karbi pioglitazone na dogon lokaci kafin su fara cin abinci na clomiphene.Saboda haka, ana ba da shawarar ƙarin bincike don ƙayyade lokaci mafi kyau don amfani da pioglitazone.
Duk da yawan adadin follicles a cikin rukunin pioglitazone, bincikenmu bai nuna wani bambanci a cikin kuzarin ovarian da ƙimar ciki tsakanin ƙungiyoyin biyu ba.
A gaskiya ma, mun magance matsalolin musamman irin su rashin haihuwa, zubar da jini daga rashin aikin mahaifa da kuma hirsutism a baya. Yanzu muna da damar (da kuma haƙiƙa) don samar da tsoma baki don hana ko gyara wasu matsaloli na rayuwa na rashin haihuwa (wanda ya haifar da rashin haihuwa). na iya tasiri sosai ga lafiyar gaba ɗaya da inganci da yawan rayuwa).
Lokacin aikawa: Maris-30-2022