Anovulation yog ib qho ntawm cov ua rau infertility.Polycystic zes qe menyuam syndrome (PCOS) yog ib qho mob anovulatory ntau tshaj plaws.Rau peb qhov kev paub, insulin kuj tseem cuam tshuam nrog PCOS.Yog li ntawd, hauv cov neeg mob PCO, cov tshuaj insulin-rhiab heev xws li pioglitazone. tuaj yeem siv los txhawb ovulation.
Rau caum-ib tus neeg mob nrog PCOS tau suav nrog hauv txoj kev tshawb fawb raws li kev suav nrog / cais tawm tom qab tau txais kev pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees ntawm Medical University of Mashhad.Cov neeg mob tau muab faib ua ob pawg.Cov thawj pab pawg tau noj 30 milligrams (mg) ntawm pioglitazone txhua hnub pib rau hnub thib ob ntawm lawv lub sijhawm coj khaub ncaws. Qhov thib ob tau txais cov placebo.150 mg ntawmclomiphene citratetau muab tshuaj los ntawm hnub 3 mus rau hnub 7 ntawm kev coj khaub ncaws. Vaginal ultrasonography tau ua rau txhua tus poj niam, thiab nyob rau hauv cov ntaub ntawv ntawm cov follicles paub tab, intrauterine insemination tau ua tom qab txhaj tshuaj ntawm tib neeg chorionic gonadotropin.Ovarian stimulation thiab cev xeeb tub tus nqi tau muab piv rau txhua pab pawg.
Tsis muaj qhov sib txawv ntawm cov pab pawg ntawm cov yam ntxwv ntawm cov pej xeem thiab hom kev xeeb tub. Lub cev qhov ntsuas siab siab dua hauv pawg pioglitazone (28.3 ± 3.8 vs 26.2 ± 3.5, P tus nqi = 0.047).Follicle loj tsis txawv ntawm pawg (2.2. ± 1.4 vs 1.3 ± 1.1, P tus nqi = 0.742) Tus nqi cev xeeb tub [4 (12.9%) vs 4 (13.3%), P tus nqi = 1] tsis txawv ntawm pawg.
Txawm hais tias muaj pes tsawg tus follicles hauv pawg pioglitazone, peb txoj kev tshawb fawb pom tsis muaj qhov sib txawv ntawm kev txhawb nqa ntawm zes qe menyuam thiab kev xeeb tub.
Infertility cuam tshuam txog 10-15% ntawm cov khub niam txiv.30% ntawm poj niam muaj menyuam tsis taus yog vim ovulation tsis ua haujlwm [1] .Polycystic ovary syndrome (PCOS) yog qhov pom tseeb tshaj plaws thiab feem ntau cuam tshuam nrog cov kab mob ovulatory mob ntev [2].Thaum siv cov European. Society for Human Reproduction thiab Embryology thiab American Society for Reproductive Medicine (ESHRE/ASRM) diagnostic cov txheej xwm, qhov prevalence ntawm PCOS yog kwv yees li 15-20% [3].
Cov qib lipoprotein txawv txav yog ib yam ntawm cov neeg mob PCOS, nrog nce tag nrho cov roj cholesterol (Chol), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), thiab apoptotic AI [4], 5,6]. Qhov kev hloov pauv tseem ceeb tshaj plaws hauv lipids tau tshaj tawm yog qhov txo qis hauv HDL.Hyperinsulinemia thiab insulin tsis kam (IR) feem ntau tshwm sim hauv PCOS.Mustafa li al.Hais txog 46% ntawm cov poj niam Egyptian nrog PCOS tau pom tias muaj IR [4, 7].Insulin cuam tshuam. steroidogenesis nyob rau hauv zes qe menyuam ywj pheej ntawm gonadotropin secretion I PCOS [1] .Insulin receptors thiab insulin-zoo li kev loj hlob factor-1 (IGF-I) muaj nyob rau hauv zes qe menyuam stromal cells [5].Kev txo qis autophosphorylation, ib qho teeb meem tshwj xeeb cuam tshuam nrog insulin receptor- Kev kho kom haum xeeb, kuaj pom hauv 50% ntawm cov poj niam nrog PCOS [3].
Cov piam thaj tsis txawv txav ua rau cov metabolism hauv lub cev ua kom hnyav dua;Kev poob phaus tuaj yeem txo qis hyperandrogenism thiab rov ua haujlwm ntawm ovulatory [7].Cov poj niam rog rog nrog insulin tsis kam, calorie txwv, thiab poob phaus txo qhov hnyav ntawm insulin tsis kam. Ntawm qhov tod tes, qhov txo qis hauv insulin concentration txo cov androgen ntau lawm [8].
Hnub no,clomiphene citrateyog qhov kev pom zoo kho mob rau ovulation induction rau cov poj niam nrog PCOS.Insulin tsis kam yog cuam tshuam nrog polycystic zes qe menyuam syndrome, yog li cov tshuaj uas ua rau kom cov tshuaj insulin rhiab heev, xws li metformin thiab beta-thiazolidinediones, raug txiav txim siab hauv kev kho mob ntawm cov neeg mob no. Kev kho mob ntawm insulin. Kev tiv thaiv tuaj yeem ua rau ovulation, tshwj xeeb tshaj yog nyob rau hauv cov poj niam rog rog uas muaj qib siab ntawm insulin tsis kam [9].
Insulin resistance implies ib tug txo cov piam thaj rau insulin, ua raws li hyperinsulinemia, uas ua rau kom siab triglycerides, txo HDL-cholesterol, qabzib intolerance, thiab plawv plawv [10].Pioglitazone, siv los kho hom 2 mob ntshav qab zib, ncaj qha cuam tshuam rau peripheral insulin rhiab heev. Hauv qee qhov kev tshawb fawb tsis ntev los no, pioglitazone tau pom tias yuav txo qis cov ntshav hauv lub zes qe menyuam stromal.Nws tuaj yeem pab txhim kho lub zes qe menyuam thiab hauv vitro fertilization (IVF) cov txiaj ntsig hauv PCOS cov neeg mob.Coffler qhia tias pioglitazone tuaj yeem ua rau ovulation hauv cov neeg mob hyperinsulinum [11] .
Txog niaj hnub no, tsis muaj kev tshawb fawb tau tshuaj xyuas cov txiaj ntsig ntawm pioglitazone ntawm kev xeeb tub hauv peb cov neeg mob.Yog li ntawd, peb xav tias pioglitazone ua cov tshuaj tua kab mob insulin tuaj yeem txhim kho ovulation thiab cev xeeb tub tus nqi hauv cov neeg mob PCOS.Qhov kev tshawb fawb no tsom siv pioglitazone rau kev xeeb tub, suav nrog tshuaj thiab kev kuaj mob cev xeeb tub, thiab tus naj npawb ntawm cov follicles loj hauv cov poj niam cev xeeb tub nrog PCOS.
Mashhad Medical University tau saib xyuas qhov kev sim tshuaj ntsuam xyuas qhov ntsuas no los ntawm 2014 txog 2017 thiab siv cov qauv uas tsis yog qhov tshwm sim los nrhiav 61 tus neeg mob PCOS uas tau raug xa mus rau Milad Infertility Center rau kev kho mob ntxiv lawm tshob.The ethics committee ntawm Mashhad Medical University pom zoo moratorium ntawm "Lub Peb Hlis 15, 2014" thiab sau ntawv tso cai tau txais los ntawm txhua tus neeg koom.
Cov txheej txheem suav nrog yog cov poj niam cev xeeb tub hnub nyoog 18-38 xyoo nrog ib txwm hysterosalpingography thiab spermogram.Qhov kev kuaj mob ntawm polycystic zes qe menyuam yog ua raws li AES cov qauv (Androgen Excess Society 2006) raws li cov txheej txheem saum toj no: (1) hirsutism lossis hyperandrogenic cov tsos mob.(2 ) Ovarian dysfunction yog oligomenorrhea, los yog polycystic zes qe menyuam yog kuaj tau raws li lub ncauj tsev menyuam lace-zoo li los ntawm ultrasound;(3) Kev nce qib ntawm cov kab mob hauv nruab nrab xws li qog ntawm zes qe menyuam thiab qog adrenal thiab pituitary adenomas.Polycystic ovary syndrome yog kuaj tau yog tias lub voj voog ntawm lub cev yog oligomenorrhoea, lossis yog tias tus naj npawb ntawm peripheral follicles hauv lub zes qe menyuam yog 2-9 hli ntau dua 9 ntawm Ferriman-Gallway nplai.
Cov neeg mob uas muaj keeb kwm ntawm cov kab mob plawv, mob raum, mob ntshav qab zib, kab mob thyroid, thiab kab mob ntsws tsis suav nrog.
Tom qab xaiv cov neeg mob tsim nyog, lawv tau muab faib ua ob pawg los ntawm qhov yooj yim random sampling siv computer software.Cov txheej txheem lub hnab ntawv yog siv los randomly muab cov neeg mob mus kawm cov pab pawg.Qhov no, random tooj yuav muab tso rau hauv ib lub hnab ntawv kaw.Cov ntsiab lus ntawm Lub hnab ntawv tsis tuaj yeem pom los ntawm sab nraud.Pob A muaj 30 ntsiav tshuaj ntawm pioglitazone, 30 mg, thiab 15 ntsiav tshuaj ntawm clomiphene, thaum pab pawg B tau muab 30 ntsiav tshuaj ntawm placebo thiab 15 ntsiav tshuaj ntawm clomiphene. Cov neeg mob tau qhov muag tsis pom kev rau kev kho mob.
Txhua tus neeg mob tau txais transvaginal ultrasonography nyob rau hnub thib ob ntawm kev coj khaub ncaws thiab tau suav nrog hauv txoj kev tshawb no yog tias tsis muaj lub zes qe menyuam loj dua 20 hli.
Tus naj npawb ntawm nruab nrab thiab loj follicles thiab endometrial thickness tau soj ntsuam nyob rau hnub thib kaum los yog kaum ib hnub ntawm kev coj khaub ncaws.Chemical thiab soj ntsuam cev xeeb tub tus nqi raug soj ntsuam.
Thawj pab pawg tau txais 30 mg ntawm pioglitazone txhua hnub;pab pawg thib ob tau txais cov placebo pib hnub thib ob ntawm kev coj khaub ncaws.Nruab nrab hnub 3 thiab 7 ntawm kev coj khaub ncaws, ob pawg tau muab 150 mg ntawmclomiphene citrate.Transvaginal ultrasonography nyob rau hnub 10 lossis 11.Xav txog tib neeg chorionic gonadotropin (HCG) ua raws li intrauterine insemination (IUI) hauv cov poj niam uas muaj endometrial thickness ntau dua 7 hli thiab cov follicles siab dua 16 hli.
Nyob rau hauv cov ntaub ntawv ntawm 5-hnub ncua kev coj khaub ncaws, kuaj ntshav tau coj mus kuaj βHCG theem.Pioglitazone-txog cov kev mob tshwm sim thiab cov naj npawb follicle ntau dua 16 hli thiab endometrial thickness raug soj ntsuam thaum lub sij hawm txoj kev tshawb no. Thaum kawg, zes qe menyuam stimulation thiab cev xeeb tub. piv thoob cov pab pawg.
Cov qauv loj tau suav nrog siv PASS 11 software thiab qhov nruab nrab ntawm cov follicles hauv txhua pab pawg tau muab piv.Los ntawm lub neej ntawd, Hom 1 yuam kev yog 5% thiab Hom 2 yuam kev yog 20%.Peb kwv yees 22 tus neeg mob hauv ib pawg, tab sis vim muaj peev xwm. attrition, 30 tus neeg koom rau ib pab pawg tau txiav txim siab.
Cov ntaub ntawv tau nkag mus rau hauv SPSS version 16.Thaum pib, cov yam ntxwv ntawm txhua pab pawg tau piav qhia los ntawm cov txheej txheem kev txheeb cais, suav nrog kev txhais tau tias thiab cov qauv sib txawv rau cov kev sib txawv tsis tu ncua thiab cov lej ntxiv rau ntau zaus rau categorical variables.Tom qab ntawd, los sib piv ntau qhov sib txawv ntawm ob pawg kawm, ywj siab t-tests los yog Mann-Whitney-U kev ntsuam xyuas tau siv tom qab kev ntsuam xyuas ib txwm siv lub Kolmogorov-Smirnov test.Qualitative variables tau muab piv nrog rau siv cov chi-square test.Nyob rau hauv tag nrho cov kev txheeb cais, P-values tsawg dua 0.05 tau txiav txim siab theem tseem ceeb. .
Hais txog cov txheej txheem suav nrog, 93 tus poj niam tau koom nrog hauv txoj kev tshawb no, 19 muaj cov txheej txheem cais tawm thiab 13 tus neeg tau tawm mus.Peb caug tus neeg mob tau muab cais tawm hauv pawg placebo thiab 31 hauv pab pawg cuam tshuam.Cov CONSORT algorithm tau qhia hauv daim duab 1.Cov yam ntxwv ntawm cov poj niam yog qhia nyob rau hauv Table 1.Tsis muaj qhov sib txawv ntawm cov pab pawg nyob rau hauv cov nqe lus ntawm pej xeem cov yam ntxwv thiab hom infertility.Qhov nruab nrab hnub nyoog ntawm pab pawg neeg cuam tshuam yog 28.20 ± 5.46 thiab cov pab pawg tswj yog 27.07 ± 4.18, thiab qhov sib txawv tsis yog qhov tseem ceeb ntawm kev txheeb cais. .Txawm li cas los xij, qhov ntsuas lub cev qhov ntsuas (BMI) siab dua hauv pawg pioglitazone.
Daim duab 2 qhia txog tus neeg mob qhov kev tshawb pom, xws li tus naj npawb ntawm cov follicles nruab nrab, tus naj npawb ntawm cov follicles loj, qhov siab tshaj plaws follicle loj, thiab endometrial thickness.Raws li pom nyob rau hauv Table 2, qhov loj ntawm cov follicles nyob hauv pab pawg tshwj tsis yog cov follicle. nruab nrab follicles.
Cov ntaub ntawv ntawm ovulation induction kev kho mob tshwm sim, xws li ovulation ntim, tshuaj, thiab soj ntsuam cev xeeb tub tus nqi ib lub voj voog, yog nthuav tawm nyob rau hauv Table 3.Ovarian stimulation thiab cev xeeb tub tus nqi tsis txawv ntawm pab pawg.
Cov txiaj ntsig ntawm txoj kev tshawb fawb no tau pom tias muaj qhov sib txawv tseem ceeb ntawm cov ovulation stimulation ntawm cov neeg mob kho nrog pioglitazone.Ultrasonography, ua rau hnub 10 ntawm kev coj khaub ncaws, pom tias muaj qhov nce ntxiv ntawm cov follicles hauv pawg pab cuam cuam tshuam.Peb qhov kev tshawb pom. lees paub qhov kev tshawb pom ntawm 2012 txoj kev tshawb fawb txog lub luag haujlwm ntawm pioglitazone hauv ovulation induction nyob rau hauv cov neeg mob hyperinsulinemic nrog PCOS [12].Morley thiab al.Increased ovulation kuj tau qhia nyob rau hauv PCOS cov neeg mob noj pioglitazone [13].
Tsis muaj qhov sib txawv ntawm ovulation thiab cev xeeb tub ntawm ob pawg kev tshawb fawb.Qhov no tej zaum yuav yog vim lub sij hawm ntawm pioglitazone siv ua ntej pib clomiphene.Ota pom tau tias 2008 cov txiaj ntsig tau pom tias 7 ntawm 9 tus neeg mob uas noj pioglitazone rau 12-30 lub lis piam ua ntej. clomiphene tau cev xeeb tub [14].Kim txoj kev tshawb fawb xyoo 2010 tau pom tias muaj qhov txo qis hauv cov follicles tom qab pioglitazone tau muab. Tsis tas li ntawd, hauv nws txoj kev tshawb fawb, pawg pioglitazone muaj ntau dua kev kuaj mob cev xeeb tub, tab sis qhov sib txawv no tsis yog qhov tseem ceeb.Qhov kev tshawb pom no. yog qhov sib piv rau peb cov txiaj ntsig, tab sis tuaj yeem piav qhia los ntawm cov neeg mob xaiv cov txheej txheem, suav nrog cov neeg mob uas muaj clomiphene-resistant [15].
Ota tau pom tias pioglitazone tuaj yeem txhim kho kev xeeb tub hauv PCOS cov neeg mob tiv taus clomiphene thiab dexamethasone [14].Nws zoo li PCOS cov neeg mob hyperandrogenemia yuav tsum tau xaiv kom zoo dua. Cov neeg mob hauv qhov kev pab cuam Ota muaj ntau theem ntawm cov tshuaj hormones, uas tuaj yeem cuam tshuam cov txiaj ntsig ntawm pioglitazone kev kho mob.Nyob rau hauv peb txoj kev tshawb fawb, cov tshuaj hormones tsis txawv heev ua ntej thiab tom qab kev cuam tshuam.
Hauv peb txoj kev tshawb fawb, tsis muaj qhov sib txawv tseem ceeb ntawm cov follicles loj thiab endometrial thickness ntawm cov kev cuam tshuam thiab tswj pawg.Txawm li cas los xij, muaj qhov loj ntawm cov follicles nruab nrab hauv pawg kev cuam tshuam.
Hauv txoj kev tshawb fawb tam sim no, pab pawg cuam tshuam muaj BMI siab dua, uas txhais tau hais tias pab pawg no yuav muaj feem cuam tshuam rau hyperinsulinemia thiab cuam tshuam rau qhov tshwm sim, txawm hais tias qhov sib txawv no tsis yog qhov tseem ceeb ntawm ob pawg.
Tsis muaj leej twg ntawm peb cov neeg mob tau ntsib cov kev mob tshwm sim.Tsis muaj kev hloov pauv tseem ceeb hauv kev kuaj mob siab rau lub sijhawm kawm.
Ib qho kev txwv loj ntawm peb txoj kev tshawb fawb yog tias txoj kev tshawb fawb no tau tsim los ua ib txoj haujlwm tswj xyuas, uas ua rau muaj qhov sib txawv ntawm BMI ntawm ob pawg.Yog li ntawd, cov txiaj ntsig yuav cuam tshuam los ntawm qhov sib txawv no.Txawm li cas los xij, tsis muaj kev tshawb fawb zoo sib xws ntawm ob- Kev siv tshuaj kho mob tau ua tiav hauv cov neeg mob hauv peb cheeb tsam.Txawm li cas los xij, vim tias pioglitazone cuam tshuam rau insulin tsis kam, nws pom tias qhov kev vam meej nce ntxiv yog tias cov neeg mob tau txais pioglitazone rau lub sijhawm ntev ua ntej pib noj clomiphene.Yog li ntawd, kev tshawb fawb ntxiv tau pom zoo rau. txiav txim siab lub sijhawm zoo tshaj plaws los siv pioglitazone.
Txawm hais tias muaj pes tsawg tus follicles hauv pawg pioglitazone, peb txoj kev tshawb fawb pom tsis muaj qhov sib txawv ntawm kev txhawb nqa ntawm zes qe menyuam thiab kev xeeb tub ntawm ob pawg.
Qhov tseeb, peb tau kho cov teeb meem tshwj xeeb xws li kev xeeb tub, los ntshav los ntawm kev ua haujlwm ntawm lub tsev menyuam thiab hirsutism yav dhau los.Tam sim no peb muaj lub sijhawm (thiab muaj lub luag haujlwm tiag tiag) los muab kev cuam tshuam los tiv thaiv lossis kho qee qhov teeb meem metabolic ntawm infertility (uas yog. tuaj yeem cuam tshuam kev noj qab haus huv tag nrho nrog rau qhov zoo thiab muaj nuj nqis ntawm lub neej).
Lub sij hawm xa tuaj: Mar-30-2022