Anovulation ndechimwe chezvikonzero zvinowanzokonzera kushaya mbereko.Polycystic ovary syndrome (PCOS) ndiyo inowanzogara isina anovulatory disorder.Sekuziva kwedu, insulin resistance inobatanidzwa zvakanyanya nePCOS.Saka, muvarwere vane PCO, insulin-sensitizing zvinodhaka zvakadai sepioglitazone inogona kushandiswa kukurudzira ovulation.
Varwere makumi matanhatu nemumwe vane PCOS vakaiswa muchidzidzo maererano nemaitiro ekubatanidza / kusabatanidzwa mushure mekuwana mvumo kubva kuEthics Committee yeMedical University yeMashhad.Varwere vakakamurwa kuva mapoka maviri.Boka rekutanga rakatora 30 milligrams (mg) ye pioglitazone zuva nezuva kutanga pazuva rechipiri rekutevera kwavo.Wechipiri akagamuchira placebo.150 mg yeclomiphene citrateyakaitwa kubva pazuva 3 kusvika pazuva 7 rekuenda kumwedzi.Vaginal ultrasonography yakaitwa kuvakadzi vose, uye mumamiriro ekukura kwefollicles, intrauterine insemination yakaitwa mushure mejojo ye chorionic gonadotropin yevanhu.
Pakanga pasina misiyano pakati pemapoka maererano nehuwandu hwevanhu uye marudzi ekushaya mbereko.Body mass index yakanga yakakwirira muboka repioglitazone (28.3 ± 3.8 vs 26.2 ± 3.5, P value = 0.047).Follicle size haina kusiyana zvakanyanya pakati pemapoka (2.2) ± 1.4 vs 1.3 ± 1.1, P value = 0.742).Kubata pamuviri [4 (12.9%) vs 4 (13.3%), P value = 1] haina kusiyana pakati pemapoka.
Pasinei nehuwandu hwepamusoro hwefollicles muboka repioglitazone, chidzidzo chedu chakaratidza hapana mutsauko mukukurudzira ovarian uye mazinga ekuzvitakura.
Kusabereka kunokanganisa nezve 10-15% yevakaroorana.30% yekushaya mbereko kwevakadzi inokonzerwa neovulation kukundikana [1] .Polycystic ovary syndrome (PCOS) ndiyo inonyanya kuoneka uye inowanzosangana nechirwere chisingaperi chine ovulatory disorders [2] .Paunenge uchishandisa European Society for Human Reproduction uye Embryology uye American Society for Reproductive Medicine (ESHRE/ASRM) diagnostic criteria, kuwanda kwePCOS kunosvika 15-20% [3].
Abnormal lipoprotein mazinga akajairika evarwere vePCOS, vane cholesterol yakazara yakazara (Chol), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), uye apoptotic AI [4], 5,6]. Kunyanya kushanduka kwe lipids kunonzi kuderera kweHDL.Hyperinsulinemia uye insulin resistance (IR) inowanikwa muPCOS.Mustafa et al.Inenge 46% yevakadzi veEgypt vane PCOS vakawanikwa vane IR [4, 7].Insulin inovhiringidza. steroidogenesis mu ovary yakazvimirira yegonadotropin secretion I PCOS [1].Insulin receptors uye insulini-yakafanana nekukura factor-1 (IGF-I) iripo mu ovarian stromal cells [5]. mediated signing, inowanikwa mu50% yevakadzi vane PCOS [3].
Abnormal glucose metabolism inonyanya kuvandudza uremu;kuora muviri kunogona kuderedza hyperandrogenism uye kudzorera ovulatory function [7] .Vakadzi vakaoma vane insulin resistance, calorie restriction, uye kurasikirwa kwehuremu kunoderedza kuoma kwe insulin resistance.Kune rumwe rutivi, kuderera kwe insulin concentration kunoderedza androgen production [8].
Nhasi,clomiphene citratendiyo inokurudzirwa kurapa ovulation induction kuvakadzi vane PCOS.Insulin resistance inobatanidzwa zvakanyanya ne polycystic ovary syndrome, saka mishonga inowedzera insulini receptor senitivity, yakadai semetformin uye beta-thiazolidinediones, inoonekwa pakurapa varwere ava.Kurapa kwe insulini. kushorwa kunogona kukonzera ovulation, kunyanya muvakadzi vakafuta vane dhigirii repamusoro re insulin kuramba [9].
Insulin resistance inoreva kuderedzwa kweglucose kupindura kune insulini, inoteverwa ne hyperinsulinemia, iyo inotungamirira kune yakakwirira triglycerides, yakaderedzwa HDL-cholesterol, glucose kusagadzikana, uye ngozi yemwoyo [10] .Pioglitazone, inoshandiswa kurapa chirwere cheshuga chechipiri, inobata zvakananga peripheral insulin senitivity. Mune zvimwe zvidzidzo zvenguva pfupi yapfuura, pioglitazone yakaratidzwa kuderedza intra-ovarian stromal blood flow.Inogona kubatsira kuvandudza ovarian stimulation uye in vitro fertilization (IVF) migumisiro muvarwere vePCOS. .
Kusvika pari zvino, hapana zvidzidzo zvakaongorora kushanda kwepioglitazone pakubereka kwevarwere.Naizvozvo, takafungidzira kuti pioglitazone se insulin disinfectant inogona kuvandudza ovulation uye huwandu hwepamuviri muvarwere vePCOS.Chidzidzo ichi chine chinangwa chekushandisa pioglitazone pakubata pamuviri kwakabudirira, kusanganisira kemikari uye. pamuviri wekiriniki, uye nhamba yemafollicles makuru muvakadzi vasina mbereko vane PCOS.
Mashhad Medical University yakawona nezvechidzidzo chekiriniki ichi chisina kurongeka kubva muna 2014 kusvika 2017 uye yakashandisa nzira isingaite yesampling yekutsvaga varwere vePCOS vanosvika makumi matanhatu nerimwe vakaendeswa kuMilad Infertility Center kunorapwa kushaya mbereko. "Kurume 15, 2014" uye mvumo yakanyorwa yakawanikwa kubva kune vese vatori vechikamu.
Kuiswa kwemaitiro kwaiva vakadzi vasina mbereko vane makore 18-38 vane yakajairika hysterosalpingography uye spermogram.Kuongororwa kwepolycystic ovary syndrome kunobva pamaitiro eAES (Androgen Excess Society 2006) zvichienderana nemitemo iri pamusoro apa: (1) hirsutism kana hyperandrogenic zviratidzo. ) Ovarian dysfunction is oligomenorrhea, kana polycystic ovary inoonekwa seye cervical lace-yakafanana nekuonekwa ne ultrasound;(3) Kusimudzirwa kwezvikonzero zvechipiri zvakadai semaovarian uye adrenal tumors uye pituitary adenomas.Polycystic ovary syndrome inoonekwa kana nguva yekuenda kumwedzi iri oligomenorrhoea, kana kuti nhamba yeperipheral follicles mu ovary iri 2-9 mm yakakura kudarika 9 pa Ferriman-Gallway scale.
Varwere vane nhoroondo yechirwere chemoyo chisingaperi, chirwere chetsvo chisingaperi, chirwere cheshuga, chirwere chetachiona, uye chirwere chemapapu chakanga chisingabatanidzwi.
Mushure mekusarudza varwere vakakodzera, vakaparadzaniswa kuva mapoka maviri nemaitiro akareruka ekuenzanisa achishandisa purogiramu yekombiyuta.Nzira yehamvuropu yakashandiswa kugovera varwere kumapoka ekudzidza nenzira iyi.Nenzira iyi, nhamba isina kurongwa ichaiswa muhamvuropu yakavharwa.Zviri mukati iyo envelopu haigoni kuonekwa kubva kunze.Boka A raiva nemapiritsi makumi matatu epioglitazone, 30 mg, uye mapiritsi e15 eclomiphene, asi boka B rakaiswa nemapiritsi makumi matatu e placebo uye mapiritsi eclomiphene 15. Varwere vakapofumadzwa kune kurapa kwakapiwa.
Vese varwere vakaita transvaginal ultrasonography pazuva rechipiri rekuenda kumwedzi uye vakaverengerwa muchidzidzo kana pakanga pasina maovarian cysts akakura kupfuura 20 mm.
Nhamba yepakati uye yakakura follicles uye endometrial thickness yakaongororwa pazuva regumi kana regumi nerimwe rekuenda kumwedzi.Chemical uye kliniki pamuviri mazinga akaongororwa.
Boka rekutanga rakagamuchira 30 mg yepioglitazone zuva nezuva;boka rechipiri rakagamuchira placebo kutanga pazuva rechipiri rekuenda kumwedzi.Pakati pemazuva 3 ne7 ekuenda kumwedzi, mapoka ose akapiwa 150 mg yeclomiphene citrate.Transvaginal ultrasonography pazuva rechigumi kana 11. Funga nezvechorionic gonadotropin (HCG) ichiteverwa neintrauterine insemination (IUI) mumadzimai ane endometrial makubvu anopfuura 7 mm uye follicles anopfuura 16 mm.
Muchiitiko chemazuva mashanu ekunonoka kuenda kumwedzi, sampuli dzeropa dzakatorwa kuti dziongorore mazinga e-βHCG.Pioglitazone-yakabatana nemigumisiro uye nhamba dzefollicle yakakura kudarika 16 mm uye endometrial thickness yakaongororwa panguva yekudzidza.Pakupedzisira, kukurudzirwa kwe ovarian uye mazinga ekuzvitakura akaonekwa. zvichienzaniswa nemapoka.
Saizi yemuenzaniso yakaverengerwa uchishandisa PASS 11 software uye nhamba yefollicles muboka rimwe nerimwe yakafananidzwa.Nekusagadzikana, Rudzi rwe 1 zvikanganiso 5% uye Type 2 zvikanganiso ndeye 20%.Takafungidzira varwere ve22 neboka, asi nekuda kwekugona. attrition, 30 vatori vechikamu paboka vakaonekwa.
Dhiyabhorosi yakaiswa muSPSS version 16.Pakutanga, maitiro eboka rimwe nerimwe akatsanangurwa nenzira dzinotsanangura nhamba, kusanganisira nzira uye kutsauka kwemaitiro ezvimwe zvinoramba zvichiitika uye nhamba pamwe nefrequencies yezvikamu zvakasiyana-siyana.Zvino, kuenzanisa nhamba dzehuwandu mumapoka maviri ekudzidza yakazvimirira t-test kana Mann-Whitney-U bvunzo yakashandiswa mushure mekuongorora zvakajairika uchishandisa Kolmogorov-Smirnov bvunzo.Kusiyana kwemhando kwakaenzaniswa uchishandisa chi-square test.Muzviverengero zvese, P-values isingasviki 0.05 yaionekwa seyakakosha mazinga .
Nezvekubatanidzwa kwemaitiro, vakadzi ve93 vakapinda muchidzidzo, 19 yakanga ine maitiro ekuregererwa uye 13 yakaderera.Varwere makumi matatu vakaiswa muboka re placebo uye 31 muboka rekupindira.The CONSORT algorithm inoratidzwa muMufananidzo 1.Mamiriro evanhukadzi inoratidzwa muTebhenekeri 1.Pakanga pasina misiyano pakati pemapoka maererano nehuwandu hwevanhu uye rudzi rwekushaya mbereko.Ivhareji yezera reboka rekupindira raiva 28.20 ± 5.46 uye yeboka rekutonga raiva 27.07 ± 4.18, uye kusiyana kwakanga kusingaverengeki. .Zvisinei, body mass index (BMI) yakanga yakakwirira muboka repioglitazone.
Tafura 2 inopfupikisa zvakawanikwa nemurwere zve sonographic, zvakaita sehuwandu hwemafollicles ari pakati nepakati, nhamba yefollicles yakakura, yakakura follicle saizi, uye endometrial ukobvu.Sezvinoratidzwa muTable 2, ukuru hwefollicles hwaive muboka kunze kweiyo pakati nepakati follicles.
Ruzivo pamusoro pemhedzisiro yekurapa ovulation induction, senge ovulation volume, chemikemikari, uye kliniki yekuzvitakura mazinga painotenderera, inoratidzwa muTable 3.Ovarian stimulation uye nhumbu mitengo haina kusiyana pakati pemapoka.
Zvigumisiro zvechidzidzo ichi zvakaratidza kuti paiva nekusiyana kukuru kwehuwandu hwekukurudzira ovulation pakati pevarwere vanobatwa nepioglitazone.Ultrasonography, yakaitwa pazuva regumi rekuenda kumwedzi, yakaratidza kuwedzera kukuru kwenhamba yefollicles muboka rekupindira.Zvatinowana simbisa zvakawanikwa zvekuongorora kwe2012 pamusoro pebasa repioglitazone mu ovulation induction mu hyperinsulinemic varwere vane PCOS [12].Morley et al.Kuwedzera ovulation kwakataurwawo muPCOS varwere vanotora pioglitazone [13].
Pakange pasina misiyano mukuburitsa uye mazinga ekuzvitakura pakati pemapoka maviri ezvidzidzo.Izvi zvinogona kunge zvakakonzerwa nekureba kwepioglitazone yakashandiswa isati yatanga clomiphene.Ota yakaratidza kuti 2008 mhedzisiro yakaratidza kuti vanomwe pavapfumbamwe varwere vakatora pioglitazone kwemavhiki 12-30 zvisati zvaitika. clomiphene akava nepamuviri [14] .Chidzidzo chaKim cha2010 chakaratidza kuderera kukuru kwenhamba yefollicles mushure mokunge pioglitazone yapiwa.Uyezve, mukudzidza kwake, boka repioglitazone raiva nepamusoro pekliniki yepamuviri yepamuviri, asi kusiyana uku kwakanga kusingakoshi. inopesana nemigumisiro yedu, asi inogona kutsanangurwa nemaitiro ekusarudzwa kwevarwere, kusanganisira clomiphene-resistant varwere [15].
Ota yakaratidza kuti pioglitazone inogona kuvandudza hutano hwepamuviri muvarwere vePCOS vanopesana neclomiphene uye dexamethasone [14].Zvinoita sokuti PCOS nyaya dzine hyperandrogenemia dzinofanira kusarudzwa zvakanyatsonaka.Varwere vari muchirongwa cheOta vane maitiro akasiyana ehomoni, izvo zvinogona kukanganisa mugumisiro we Pioglitazone kurapwa.Muchidzidzo chedu, mazinga ehomoni haana kusiyana zvakanyanya pamberi uye mushure mekupindira.
Muchidzidzo chedu, pakanga pasina misiyano yakakura muhuwandu hwemafollicles makuru uye kupera kwe endometrial pakati pemapoka ekupindira uye kutonga.Zvisinei, pakanga pane kuwedzera kukuru kwenhamba yepakati-kati muboka rekupindira.
Muchidzidzo chemazuva ano, boka rekupindira raiva neBMI yakakwirira, zvinoreva kuti boka iri rinogona kunge rakanyanya kuwedzera hyperinsulinemia uye kukanganisa mugumisiro, kunyange zvazvo kusiyana uku kwakanga kusingaverengeki pakati pemapoka maviri.
Hapana mumwe wevarwere vedu akawana migumisiro yemigumisiro.Kwakanga kusina kuchinja kwenhamba huru mukuedza kwechiropa chekushanda panguva yekudzidza.
Chinhu chikuru chinokanganisa chekudzidza kwedu chaiva chokuti chidzidzo chacho chakagadzirirwa sechirongwa chekugadzirisa nyaya, izvo zvakaguma nekusiyana kweBMI pakati pemapoka maviri.Saka, zvigumisiro zvinogona kuchinjwa nemusiyano uyu.Zvisinei, hapana zvidzidzo zvakafanana zveizvi zviviri- chirongwa chezvinodhaka chakaitwa kune varwere munharaunda yedu.Zvisinei, nekuda kwepioglitazone inokonzera insulini kuramba, zvinoratidzika kuti kubudirira kunowedzera kana varwere vakagamuchira pioglitazone kwenguva yakareba vasati vatanga kudya kwe clomiphene.Naizvozvo, tsvakurudzo yakawanda inokurudzirwa sarudza nguva yakanaka yekushandisa pioglitazone.
Pasinei nehuwandu hwepamusoro hwefollicles muboka repioglitazone, chidzidzo chedu chakaratidza hapana mutsauko mukukurudzira ovarian uye mazinga ekuzvitakura pakati pemapoka maviri aya.
Muchokwadi, isu takanyatso kurapa zvakananga matambudziko akadai sekushaya mbereko, kubuda ropa kubva muchibereko kusagadzikana uye hirsutism munguva yakapfuura.Iye zvino tave nemukana (uye zvechokwadi mutoro) wekupa kupindira kudzivirira kana kugadzirisa zvimwe zve metabolic matambudziko ekushaya mbereko (iyo inogona kukanganisa zvakanyanya hutano hwese pamwe nemhando uye huwandu hwehupenyu).
Nguva yekutumira: Mar-30-2022