Anovulation ni imwe mu mpamvu zitera ubugumba. Indwara ya polycystic ovary syndrome (PCOS) ni indwara ikunze kugaragara ya anovulatory.Ku bumenyi bwacu, kurwanya insuline bifitanye isano rya bugufi na PCO. Kubera iyo mpamvu, ku barwayi bafite PCO, imiti ikingira insuline nka pioglitazone irashobora gukoreshwa mugukangura intanga.
Abarwayi 61 bafite PCOS bashyizwe mubushakashatsi bakurikije ibipimo byo gushyiramo / guhezwa nyuma yo kwemererwa na komite ishinzwe imyitwarire ya kaminuza yubuvuzi ya Mashhad.Abarwayi bagabanyijwemo amatsinda abiri. Itsinda rya mbere ryatwaye miligarama 30 (mg) za pioglitazone burimunsi guhera kumunsi wa kabiri wimihango yabo. Iya kabiri yakiriye umwanya wa mg 150.clomiphene citrateyatanzwe kuva kumunsi wa 3 kugeza kumunsi wa 7 wukwezi kwimihango. Ultrasonography ya Vaginal yakorewe kubagore bose, kandi mugihe habaye umusemburo ukuze, gutera intanga munda byakozwe nyuma yo gutera inshinge za chorionic gonadotropine.
Nta tandukaniro ryari hagati yitsinda ukurikije imiterere ya demokarasi nubwoko bwubugumba.Icyerekezo rusange cyinshi cyari hejuru mumatsinda ya pioglitazone (28.3 ± 3.8 vs 26.2 ± 3.5, P agaciro = 0.047) .Ubunini bwa Follicle ntibutandukanye cyane mumatsinda (2.2 ± 1.4 vs 1.3 ± 1.1, P agaciro = 0,742) .Ibipimo byo gutwita [4 (12.9%) vs 4 (13.3%), P agaciro = 1] ntabwo bitandukanye hagati yitsinda.
Nubwo umubare munini wibibyimba biri mu itsinda rya pioglitazone, ubushakashatsi bwacu bwerekanye ko nta tandukaniro riri hagati yo gutera intanga no gutwita.
Kutabyara bigira ingaruka ku 10-15% by'abashakanye.30% by'ubugumba bw'abagore biterwa no kunanirwa kwa ovulation [1] .Polycystic ovary syndrome (PCOS) ni indwara igaragara kandi ikunze kugaragara ifitanye isano n'indwara idakira ya ovulatory [2] .Iyo ukoresheje Uburayi Sosiyete ishinzwe imyororokere ya muntu na Embryology hamwe na Sosiyete y'Abanyamerika ishinzwe ubuvuzi bw'imyororokere (ESHRE / ASRM) ibipimo byo gusuzuma, ubwiyongere bwa PCOS ni 15-20% [3].
Urwego rwa lipoprotein idasanzwe rusanzwe ku barwayi ba PCOS, hamwe na cholesterol yuzuye (Chol), triglyceride (TG), lipoprotein nkeya (LDL), lipoproteine yuzuye (HDL), hamwe na AI ya apoptotique [4], 5,6]. Impinduka zikomeye muri lipide zavuzwe ni igabanuka rya HDL.Hyperinsulinemia hamwe no kurwanya insuline (IR) bikunze kugaragara muri PCOS.Mustafa nabandi.Abagore bagera kuri 46% b’abanyamisiri bafite PCOS wasangaga bafite IR [4, 7] .Insuline ihungabana. steroidogenezi muri ovary idashingiye ku gusohora kwa gonadotropine I PCOS [1] .Ibikoresho bya insuline hamwe na insuline isa na insuline-1 (IGF-I) biboneka mu ngirabuzimafatizo ya ovarian [5] .Kugabanuka kwa autophosphorylation, indwara yihariye ifitanye isano na reseptor ya insuline- ibimenyetso byabunzi, bigaragara muri 50% byabagore bafite PCOS [3].
Glucose metabolism idasanzwe itezimbere cyane kugabanya ibiro;kugabanya ibiro birashobora kugabanya hyperandrogenism no kugarura imikorere yintanga ngore [7] .Abagore bafite umubyibuho ukabije wa insuline, kugabanya kalori, no kugabanya ibiro bigabanya ubukana bwa insuline. Ku rundi ruhande, kugabanuka kwa insuline bigabanya umusaruro wa androgene [8].
Uyu munsi,clomiphene citrateni inama isabwa kuvura ovulation ku bagore barwaye PCOS.Induline irwanya insuline ifitanye isano cyane na syndrome ya polycystic ovary, bityo imiti yongerera insuline reseptor, nka metformin na beta-thiazolidinediones, ifatwa mukuvura aba barwayi.Kuvura insuline. Kurwanya bishobora gutera intanga ngabo, cyane cyane ku bagore bafite umubyibuho ukabije bafite insuline nyinshi yo kurwanya insuline [9].
Kurwanya insuline bisobanura kugabanuka kwa glucose kuri insuline, bigakurikirwa na hyperinsulinemia, biganisha kuri triglyceride nyinshi, kugabanya HDL-cholesterol, kutihanganira glucose, hamwe n’indwara zifata umutima. Mu bushakashatsi bumwe na bumwe buherutse gukorwa, pioglitazone yerekanwe kugabanya umuvuduko wamaraso wimbere-ovarian. Birashobora gufasha kunoza intanga ngore no mubisubizo bya vitro ifumbire (IVF) kubarwayi ba PCOS.Coffler yerekanye ko pioglitazone ishobora gutera intanga ngabo kubarwayi ba hyperinsulinemic [11] .
Kugeza ubu, nta bushakashatsi bwigeze busuzuma ingaruka za pioglitazone ku burumbuke ku barwayi bacu. Kubera iyo mpamvu, twavuze ko pioglitazone nk'imiti yica insuline ishobora kuzamura intanga ngabo ndetse no gutwita ku barwayi ba PCOS. Ubu bushakashatsi bwari bugamije gukoresha pioglitazone mu gutwita neza, harimo imiti ndetse na gutwita kwa kliniki, n'umubare munini w'abagore batabyara bafite PCOS.
Ishuri Rikuru ry’Ubuvuzi rya Mashhad ryagenzuye ubu bushakashatsi bw’ubuvuzi bwateganijwe kuva 2014 kugeza 2017 kandi bukoresha uburyo bwo gupima bidashoboka mu gushaka abarwayi 61 PCOS boherejwe mu kigo cya Milad Infertility Centre kugira ngo bavure ubugumba. Komite ishinzwe imyitwarire ya kaminuza y’ubuvuzi ya Mashhad yemeje ko ihagarikwa ry’agateganyo. “Ku ya 15 Werurwe 2014 ″ kandi abitabiriye amahugurwa babimenyeshejwe babimenyeshejwe.
Ibipimo byashyizwemo byari abagore batabyara bafite hagati yimyaka 18-38 bafite hysterosalpingography na spermogramme. Gusuzuma syndrome ya polycystic ovary bishingiye kubipimo bya AES (Androgen Excess Society 2006) hashingiwe kubipimo byavuzwe haruguru: (1) hirsutism cyangwa ibimenyetso bya hyperandrogenic. (2 ) Ovarian idakora neza ni oligomenorrhea, cyangwa ovary polycystic ovary isuzumwa nkigitereko cyinkondo y'umura isa na ultrasound;. Igipimo cya Ferriman-Gallway.
Abarwayi bafite amateka y’indwara zidakira z'umutima n'imitsi, indwara zidakira zidakira, diyabete, indwara ya tiroyide, n'indwara y'ibihaha.
Nyuma yo gutoranya abarwayi bujuje ibisabwa, bagabanyijwemo amatsinda abiri hakoreshejwe uburyo bworoshye bwo gutoranya hakoreshejwe porogaramu ya mudasobwa. Uburyo bw ibahasha bwakoreshejwe mu guha abarwayi amahirwe yo kwiga amatsinda yo kwiga. Muri ubu buryo, umubare uteganijwe uzashyirwa mu ibahasha ifunze. Ibirimo ibahasha ntishobora kuboneka hanze. Itsinda A ryarimo ibinini 30 bya pioglitazone, mg 30, na tableti 15 za clomiphene, mugihe itsinda B ryashyizwemo ibinini 30 bya platbo na tableti 15 za clomiphene. Abarwayi bahumye amaso kugirango bavurwe.
Abarwayi bose babazwe ultrasonography transvaginal kumunsi wa kabiri wimihango kandi bashyizwe mubushakashatsi niba nta cysts ovarian irenze mm 20.
Umubare wimyanya mito nini nini nubunini bwa endometrale wasuzumwe kumunsi wa cumi cyangwa cumi na rimwe wimihango. Hasuzumwe ibipimo byo gutwita kwa chimique na clinique.
Itsinda rya mbere ryakiriye mg 30 za pioglitazone buri munsi;itsinda rya kabiri ryakiriye ikibanza gitangira kumunsi wa kabiri wimihango. Hagati yiminsi 3 na 7 yukwezi, amatsinda yombi yahawe mg 150 zaclomiphene citrate.Transvaginal ultrasonography kumunsi wa 10 cyangwa 11.Reba chorionic ya gonadotropine ya muntu (HCG) ikurikirwa no gutera intanga (IUI) kubagore bafite umubyimba wa endometrale urenze mm 7 na folike irenze mm 16.
Ku bijyanye no gutinda kw'iminsi 5 mu mihango, hafashwe urugero rw'amaraso kugira ngo harebwe urugero rwa βHCG. Ingaruka ziterwa na Pioglitazone n'imibare ya follicle irenga mm 16 n'ubugari bwa endometrale byasuzumwe mu gihe cyo gukora ubushakashatsi. Amaherezo, gutera intanga ngabo no gutwita byari ugereranije mumatsinda.
Ingano yicyitegererezo yabazwe ukoresheje porogaramu ya PASS 11 kandi umubare ugereranije wa follicles muri buri tsinda wagereranijwe.Kubisanzwe, amakosa yo mu bwoko bwa 1 ni 5% naho amakosa yo mu bwoko bwa 2 ni 20% .Twagereranije abarwayi 22 kuri buri tsinda, ariko kubera ubushobozi attrition, 30 bitabiriye itsinda.
Ibyatanzwe byinjijwe muri verisiyo ya SPSS 16.Mu ntangiriro, ibiranga buri tsinda byasobanuwe nuburyo bwo gusobanura imibare, harimo uburyo no gutandukana kubihinduka bikomeza hamwe numubare wongeyeho inshuro zingana kubihinduka. Hanyuma, kugereranya impinduka zingana mumatsinda abiri yo kwiga, ibizamini byigenga cyangwa Mann-Whitney-U byakoreshejwe nyuma yo gusuzuma ibisanzwe ukoresheje ikizamini cya Kolmogorov-Smirnov. Impinduka zingana zagereranijwe ukoresheje ikizamini cya chi-kare.Mu mibare yose, P-agaciro kari munsi ya 0.05 byafatwaga nkurwego rukomeye .
Ku bijyanye n'ibipimo byo kwishyiriraho, abagore 93 bitabiriye ubushakashatsi, 19 bafite ibipimo byo guhezwa naho 13 barangije.Abarwayi mirongo itatu bashyizwe mu itsinda rya placebo na 31 mu itsinda ryita ku bantu. yerekanwa mu mbonerahamwe ya 1.Nta tandukaniro ryari hagati yitsinda ukurikije imiterere yabaturage nubwoko bwubugumba. Impuzandengo yimyaka yitsinda ryabatabaye yari 28.20 ± 5.46 naho iyitsinda ryagenzuraga 27.07 ± 4.18, kandi itandukaniro ntabwo ryari rifite imibare ikomeye .Nyamara, indangagaciro z'umubiri (BMI) zari hejuru mumatsinda ya pioglitazone.
Imbonerahamwe 2 irerekana muri make ibyavuye mu murwayi wa sonografiya, nkumubare wumubyimba muto uringaniye, umubare wibinini binini, ubunini bwikigero kinini, nubunini bwa endometrale.Nkuko bigaragara mu mbonerahamwe ya 2, ubunini bwawo bwari mu itsinda usibye u urwego ruciriritse.
Ibisobanuro ku bisubizo byo kuvura intanga ngore, nk'ubunini bwa ovulation, imiti, n'amavuriro yo gutwita kwa buri cyiciro, bigaragara mu mbonerahamwe ya 3. Gutera intanga ngabo no gutwita ntibyatandukanye hagati y'amatsinda.
Ibyavuye muri ubu bushakashatsi byagaragaje ko hari itandukaniro rikomeye ry’umubare w’intanga ngore mu barwayi bavuwe na pioglitazone.Ultrasonography, yakozwe ku munsi wa 10 w’imihango, yerekanye ubwiyongere bugaragara bw’umubare muto w’udusimba tw’itsinda ryitabiriwe. Ibyo twabonye wemeze ibyavuye mu bushakashatsi bwakozwe mu mwaka wa 2012 ku ruhare rwa pioglitazone mu kwinjiza ovulation ku barwayi ba hyperinsulinemic barwaye PCOS. 12
Nta tandukanyirizo ryatewe no gutera intanga no gutwita hagati yaya matsinda yombi yiga.Ibi birashobora guterwa nigihe pioglitazone yakoreshejwe mbere yo gutangira clomiphene.Ota yerekanye ko ibisubizo bya 2008 byerekanaga ko abarwayi 7 kuri 9 bafashe pioglitazone ibyumweru 12-30 mbere clomiphene yarasamye [14] .Ubushakashatsi bwaKim bwo mu mwaka wa 2010 bwerekanye ko igabanuka ryinshi ry’imisemburo nyuma yo gutangwa na pioglitazone.Ikindi kandi, mu bushakashatsi bwe, itsinda rya pioglitazone ryagize umubare munini wo gutwita kwa muganga, ariko iri tandukaniro ntabwo ryari rifite imibare. Ubu bushakashatsi itandukanye n'ibisubizo byacu, ariko irashobora gusobanurwa n'ibipimo byo gutoranya abarwayi, harimo n'abarwayi barwanya clomiphene.
Ota yerekanye ko pioglitazone ishobora kuzamura igipimo cyo gutwita ku barwayi ba PCOS irwanya clomiphene na dexamethasone [14] .Birasa nkaho indwara ya PCOS ifite hyperandrogenemia igomba guhitamo neza.Abarwayi bo muri gahunda ya Ota bafite imisemburo itandukanye, ishobora kugira ingaruka ku musaruro wa kuvura pioglitazone.Mu bushakashatsi bwacu, urugero rwa hormone ntirwatandukanye cyane mbere na nyuma yo gutabarwa.
Mu bushakashatsi bwacu, nta tandukanyirizo ryibanze ryagaragaye mu mubare munini w’ibibyimba n’ububyimba bwa endometrale hagati yitsinda ryigenzura no kugenzura.Nyamara, habayeho kwiyongera gukabije kw’umubare muto wo mu itsinda rishinzwe gutabara.
Muri ubu bushakashatsi, itsinda ryitabiriwe ryagize BMI yo hejuru, bivuze ko iri tsinda rishobora kuba ryanduye hyperinsulinemia kandi rikagira ingaruka kubisubizo, nubwo iri tandukaniro ritari rifite imibare hagati yaya matsinda yombi.
Nta n'umwe mu barwayi bacu wagize ingaruka mbi.Nta mpinduka zigeze zihinduka mu mibare y'ibizamini by'umwijima mu gihe cyo kwiga.
Intambamyi nyamukuru yubushakashatsi bwacu nuko ubushakashatsi bwakozwe nkumushinga wo kugenzura imanza, bigatuma habaho itandukaniro muri BMI hagati yaya matsinda yombi.Noneho rero, ibisubizo birashobora guterwa niri tandukaniro.Nyamara, nta bushakashatsi busa bwibi byombi- gahunda yo gufata ibiyobyabwenge yakorewe mubarwayi bo mukarere kacu.Nyamara, kubera ingaruka za pioglitazone mukurwanya insuline, bigaragara ko intsinzi yiyongera niba abarwayi bakiriye pioglitazone mugihe kirekire mbere yo gutangira indyo ya clomiphene.Niyo mpamvu, hasabwa ubushakashatsi bwinshi menyesha igihe cyiza cyo gukoresha pioglitazone.
Nubwo umubare munini wibibyimba biri mu itsinda rya pioglitazone, ubushakashatsi bwacu bwerekanye ko nta tandukaniro riri hagati yo gutera intanga ngabo no gutwita hagati yaya matsinda yombi.
Mubyukuri, twakemuye neza ibibazo byihariye nko kutabyara, kuva amaraso mu mikorere mibi ya nyababyeyi na hirsutism kera.Ubu dufite amahirwe (kandi rwose ni inshingano) yo gutanga ingamba zo gukumira cyangwa gukosora zimwe mungaruka ziterwa no kutabyara (ibyo irashobora kugira ingaruka zikomeye kubuzima muri rusange kimwe nubwiza nubunini bwubuzima).
Igihe cyo kohereza: Werurwe-30-2022