I-Anovulation yenye yezona zizathu eziqhelekileyo zokungabikho komntwana.I-Polycystic ovary syndrome (PCOS) yeyona nto ixhaphakileyo ye-anovulatory disorder.Ngolwazi lwethu, ukuxhathisa kwe-insulin kuhambelana kakhulu ne-PCOS.Ngoko ke, kwizigulane ezine-PCO, i-insulin-sensitizing drug njenge-pioglitazone ingasetyenziselwa ukuvuselela i-ovulation.
Izigulane ezingamashumi amathandathu anenye ezine-PCOS zifakwe kwisifundo ngokwemigaqo yokubandakanywa / yokukhutshwa emva kokufumana imvume kwiKomiti ye-Ethics ye-Medical University yaseMashhad.Izigulane zahlulwa zibe ngamaqela amabini.Iqela lokuqala lathatha i-30 milligrams (mg) i-pioglitazone yonke imihla iqala kusuku lwesibini lokuya exesheni kwabo.Okwesibini ifumene i-placebo.150 mg yeclomiphene citrateyayilawulwa ukusuka kwi-3 ukuya kwi-7 yomjikelezo wokuya esikhathini. I-Ultrasonography ye-Vaginal yenziwa kubo bonke abafazi, kwaye kwiimeko ze-follicle ezivuthiweyo, i-intrauterine insemination yenziwa emva kwesitofu se-chorionic gonadotropin yabantu.
Kwakungekho nantlukwano phakathi kwamaqela ngokweempawu zedemographic kunye neentlobo zokungazali.Isalathisi sobunzima bomzimba sasiphezulu kwiqela le-pioglitazone (28.3 ± 3.8 vs 26.2 ± 3.5, P value = 0.047) .I-Follicle ubukhulu ayizange ihluke kakhulu phakathi kwamaqela (2.2) ± 1.4 vs 1.3 ± 1.1, P value = 0.742) .Amazinga okukhulelwa [4 (12.9%) vs 4 (13.3%), ixabiso le-P = 1] alizange lihluke phakathi kwamaqela.
Ngaphandle kwenani eliphezulu leefollicles kwiqela le-pioglitazone, uphononongo lwethu alubonisi mahluko ekuvuselelweni kwe-ovarian kunye namazinga okukhulelwa.
Ubudlolo buchaphazela malunga ne-10-15% yezibini ezitshatileyo. I-30% yokungabikho komfazi ngenxa yokungaphumeleli kwe-ovulation [1] .I-Polycystic ovary syndrome (PCOS) yeyona nto ibonakalayo kwaye ixhaphake ingxaki ehambelana nokuphazamiseka kwe-ovulatory engapheliyo [2] .Xa usebenzisa iYurophu yaseYurophu. Umbutho wokuzala kwabantu kunye ne-Embryology kunye ne-American Society for Reproductive Medicine (ESHRE / ASRM) i-diagnostic criteria, ukuxhaphaka kwe-PCOS malunga ne-15-20% [3].
Amanqanaba e-lipoprotein angaqhelekanga aqhelekileyo kwizigulane ze-PCOS, kunye ne-cholesterol epheleleyo (Chol), i-triglycerides (TG), i-lipoprotein ephantsi (i-LDL), i-high-density lipoprotein (HDL), kunye ne-apoptotic AI [4], 5,6]. Utshintsho oluphawulekayo kwi-lipids oluchazwe luhla lwe-HDL.I-Hyperinsulinemia kunye nokuxhatshazwa kwe-insulin (IR) zixhaphake kwi-PCOS.Mustafa et al. Malunga ne-46% yabasetyhini baseYiputa abane-PCOS bafunyenwe bene-IR [4, 7].I-insulin iphazamisa. i-steroidogenesis kwi-ovary ezimeleyo ye-gonadotropin secretion I-PCOS [1].I-insulin receptors kunye ne-insulin-like growth factor-1 (IGF-I) zikhona kwiiseli ze-ovarian stromal [5] .Ukunciphisa i-autophosphorylation, ingxaki ethile ehambelana ne-insulin receptor- ukubonakaliswa kwe-mediated, kufunyenwe kwi-50% yabasetyhini abane-PCOS [3].
I-glucose metabolism engaqhelekanga iphucula kakhulu ukulahleka kwesisindo;ukulahleka kwesisindo kunokunciphisa i-hyperandrogenism kunye nokubuyisela umsebenzi we-ovulatory [7] .Abafazi abakhulu kakhulu abanokumelana ne-insulin, ukukhawulwa kwekhalori, kunye nokunciphisa ubunzima bokunciphisa ubunzima bokuxhatshazwa kwe-insulin.Ngakolunye uhlangothi, ukuhla koxinzelelo lwe-insulin kunciphisa ukuveliswa kwe-androgen [8].
Namhlanje,clomiphene citratelunyango olucetyiswayo lwe-ovulation induction kubasetyhini abane-PCOS.Ukumelana ne-insulin kuhambelana kakhulu ne-polycystic ovary syndrome, ngoko ke iziyobisi ezandisa i-insulin receptor sensitivity, ezifana ne-metformin kunye ne-beta-thiazolidinediones, ziqwalaselwa kunyango lwezi zigulane.Unyango lwe-insulin. Ukuchasana kunokubangela i-ovulation, ngakumbi kubasetyhini abatyebileyo abanenqanaba eliphezulu lokumelana ne-insulin [9].
Ukuxhatshazwa kwe-insulin kuthetha ukunciphisa impendulo ye-glucose kwi-insulin, elandelwa yi-hyperinsulinemia, ekhokelela kwi-triglycerides ephakamileyo, ukunciphisa i-HDL-cholesterol, ukunyanzeliswa kwe-glucose, kunye nomngcipheko we-cardiovascular risk [10] .I-Pioglitazone, esetyenziselwa ukuphatha uhlobo lwe-2 yeswekile, ichaphazela ngokuthe ngqo i-peripheral insulin sensitivity. Kwezinye izifundo zamva nje, i-pioglitazone ibonakaliswe ukunciphisa ukuhamba kwegazi kwe-intra-ovarian stromal.Inokunceda ukuphucula ukukhuthazwa kwe-ovarian kunye neziphumo ze-in vitro fertilization (IVF) kwizigulana ze-PCOS.UCoffler ubonise ukuba i-pioglitazone inokubangela ukuba kubekho i-ovulation kwizigulane ze-hyperinsulinemic [11] .
Ukuza kuthi ga ngoku, akukho zifundo ziye zavavanya umphumo we-pioglitazone ekuchumeni kwizigulane zethu.Ngoko ke, sicinge ukuba i-pioglitazone njenge-insulin disinfectant inokuphucula i-ovulation kunye namazinga okukhulelwa kwizigulane ze-PCOS.Olu phononongo lujolise ekusebenziseni i-pioglitazone ukukhulelwa okuphumelelayo, kubandakanywa nemichiza kunye ukukhulelwa kweklinikhi, kunye nenani leefollicles ezinkulu kubasetyhini abangenabantwana abane-PCOS.
IYunivesithi yezoNyango yaseMashhad yongamela olu phononongo lolingo lwezonyango olungenamkhethe ukusuka ngo-2014 ukuya ku-2017 kwaye yasebenzisa indlela yokuthatha iisampulu ekunokwenzeka ukuba ifune izigulane ze-PCOS ezingama-61 ezazithunyelwe kwiZiko lokungachumisi iMilad ukuze zifumane unyango lobudlolo. "NgoMatshi 15, 2014" kunye nemvume ebhaliweyo enolwazi yafunyanwa kubo bonke abathathi-nxaxheba.
Imilinganiselo yokubandakanywa yayingabafazi abangenabantwana abaneminyaka eyi-18-38 iminyaka kunye ne-hysterosalpingography eqhelekileyo kunye ne-spermogram. Ukuxilongwa kwe-polycystic ovary syndrome kusekelwe kwiinkqubo ze-AES (i-Androgen Excess Society 2006) ngokusekelwe kule migaqo ingentla: (1) i-hirsutism okanye iimpawu ze-hyperandrogenic. (2) ) Ukungasebenzi kakuhle kwe-Ovarian yi-oligomenorrhea, okanye i-polycystic ovary ifunyanwe njengembonakalo yomlomo wesibeleko efana ne-ultrasound;3 Isikali seFerriman-Gallway.
Izigulane ezinembali yesifo senhliziyo esingapheliyo, isifo sezintso ezingapheliyo, isifo sikashukela, isifo se-thyroid, kunye nesifo semiphunga sasingabandakanyiwe.
Emva kokukhetha izigulane ezifanelekileyo, zahlulahlulwe zibe ngamaqela amabini ngesampulu esilula kusetyenziswa isoftwe yekhompyutha.Indlela yemvulophu yayisetyenziselwa ukunika izigulane ngokungenamkhethe kumaqela okufunda.Ngale ndlela, inombolo engacwangciswanga iya kufakwa kwimvulophu evaliweyo.Imixholo imvulophu ayinakubonwa ngaphandle.Iqela A liqulethe iipilisi ze-30 ze-pioglitazone, i-30 mg, kunye neepilisi ze-clomiphene ze-15, ngelixa iqela le-B libekwe kunye neepilisi ze-30 ze-placebo kunye neepilisi ze-15 ze-clomiphene.Izigulane zazingaboni kunyango olunikezelweyo.
Zonke izigulane zenze i-ultrasound ye-transvaginal ngosuku lwesibini lokuya esikhathini kwaye zifakwe kwisifundo ukuba akukho zi-ovarian cysts ezinkulu kune-20 mm.
Inani leefollicles eziphakathi kunye ezinkulu kunye nobukhulu be-endometrial zavavanywa ngosuku lweshumi okanye lweshumi elinanye lokuya esikhathini.Amazinga okukhulelwa amachiza kunye nekliniki ahlolwe.
Iqela lokuqala lafumana i-30 mg ye-pioglitazone yonke imihla;iqela lesibini lafumana i-placebo ukuqala ngosuku lwesibini lokuya exesheni.Phakathi kweentsuku ze-3 kunye ne-7 zomjikelezo wokuya exesheni, omabini amaqela anikwe i-150 mgclomiphene citrate.Transvaginal ultrasonography ngosuku lwe-10 okanye 11. Qwalasela i-chorionic gonadotropin (HCG) yabantu elandelwa yi-intrauterine insemination (IUI) kubasetyhini abanobunzima be-endometrial obungaphezulu kwe-7 mm kunye neefollicles ezingaphezu kwe-16 mm.
Kwimeko yokulibaziseka kweentsuku ezi-5 ukuya esikhathini, iisampulu zegazi zathathwa ukuvavanya amanqanaba e-βHCG.Iimpembelelo ezichaphazelekayo ze-Pioglitazone kunye neenombolo ze-follicle ezingaphezu kwe-16 mm kunye nobukhulu be-endometrial zihlolwe ngexesha lokufunda. Ekugqibeleni, ukukhuthazwa kwe-ovarian kunye namazinga okukhulelwa ayenziwa. xa kuthelekiswa ngokwamaqela.
Ubungakanani besampula bubalwe kusetyenziswa i-software ye-PASS 11 kunye nenani eliqhelekileyo leefollicle kwiqela ngalinye lifaniswa.Ngokungagqibekanga, uhlobo lwe-1 yeempazamo ze-5% kunye ne-Type 2 iimpazamo ziyi-20%.Siqikelele izigulane ze-22 kwiqela ngalinye, kodwa ngenxa yezinto ezinokwenzeka Attrition, 30 abathathi-nxaxheba kwiqela ngalinye baqwalaselwa.
Idatha ifakwe kwi-SPSS version ye-16.Ekuqaleni, iimpawu zeqela ngalinye zichazwe ngeendlela ezichazayo zobalo, kubandakanywa iindlela kunye nokuphambuka okusemgangathweni kwiinguqu eziqhubekayo kunye nenani kunye ne-frequency ye-categorical variables.Emva koko, ukuthelekisa ukuguquguquka kobuninzi kumaqela amabini okufunda, Iimvavanyo ezizimeleyo ze-t okanye iimvavanyo ze-Mann-Whitney-U zisetyenzisiwe emva kokuvavanya ukuqheleka kusetyenziswa uvavanyo lwe-Kolmogorov-Smirnov. Iinguqu ezisemgangathweni zifaniswa ngokusebenzisa uvavanyo lwe-chi-square. .
Ngokuphathelele imigaqo yokubandakanywa, abafazi be-93 bathathe inxaxheba kwisifundo, i-19 yayinemilinganiselo yokukhutshwa kwaye i-13 yaphuma ngaphandle.Izigulana ezingamashumi amathathu zahlulwa kwiqela le-placebo kunye ne-31 kwiqela lokungenelela.I-algorithm ye-CONSORT iboniswe kwi-Figure 1.Iimpawu ze-demographic of women are kuboniswe kwiThebhile 1.Kwakungekho nantlukwano phakathi kwamaqela ngokweempawu zabantu kunye nohlobo lokungazali.Umndilili weqela lokungenelela laliyi-28.20 ± 5.46 kwaye iqela lokulawula laliyi-27.07 ± 4.18, kwaye umehluko wawungabalulekanga ngokwezibalo. .Nangona kunjalo, i-body mass index (BMI) yayiphezulu kwiqela le-pioglitazone.
Itheyibhile yesi-2 ishwankathela iziphumo ze-sonographic yesigulane, njengenani leefollicles eziphakathi, inani leefollicles ezinkulu, ubukhulu be-follicle ubukhulu, kunye nobukhulu be-endometrial. iifollicles ezinobungakanani obuphakathi.
Ulwazi malunga neziphumo zonyango lwe-ovulation induction, ezifana nomthamo we-ovulation, iikhemikhali, kunye namazinga okukhulelwa kwekliniki ngomjikelezo ngamnye, kuboniswe kwiThebhile 3. Ukuvuselela i-Ovarian kunye namazinga okukhulelwa awazange ahluke phakathi kwamaqela.
Iziphumo zolu pho nonongo zibonise ukuba kukho umahluko omkhulu kwinani le-ovulation stimulations phakathi kwezigulane eziphathwa nge-pioglitazone.I-Ultrasonography, eyenziwa ngosuku lwe-10 yokuya esikhathini, ibonise ukwanda okukhulu kwinani leefollicle kwiqela lokungenelela.Iziphumo zethu. qinisekisa iziphumo zophando lwe-2012 malunga nendima ye-pioglitazone kwi-ovulation induction kwizigulane ze-hyperinsulinemic ezine-PCOS [12] .Morley et al.Ukwanda kwe-ovulation kuye kwabikwa kwizigulane ze-PCOS ezithatha i-pioglitazone [13].
Kwakungekho mahluko kwi-ovulation kunye namazinga okukhulelwa phakathi kwamaqela amabini ophononongo. Oku kunokuba ngenxa yobude bexesha le-pioglitazone esetyenziswe phambi kokuba i-clomiphene. i-clomiphene yakhulelwa [14] .Uphononongo lukaKim luka-2010 lubonise ukunciphisa okukhulu kwinani leefollicles emva kokuba i-pioglitazone inikwe.Ngaphezu koko, kwisifundo sakhe, iqela le-pioglitazone linezinga eliphezulu lokukhulelwa kwekliniki, kodwa lo mahluko wawungabalulekanga ngokwezibalo. ihluke kwiziphumo zethu, kodwa inokuchazwa ngeendlela zokukhetha isigulane, kubandakanywa nezigulane ezichasene ne-clomiphene [15].
I-Ota ibonise ukuba i-pioglitazone inokuphucula izinga lokukhulelwa kwizigulane ze-PCOS ezichasene ne-clomiphene kunye ne-dexamethasone [14].Kubonakala ngathi iimeko ze-PCOS ezine-hyperandrogenemia kufuneka zikhethwe ngokucophelela. I-pioglitazone unyango.Kuphononongo lwethu, amanqanaba e-hormone awazange ahluke kakhulu ngaphambi nangemva kokungenelela.
Kwisifundo sethu, kwakungekho nantlukwano ephawulekayo kwinani leefollicles ezinkulu kunye nobukhulu be-endometrial phakathi kwamaqela okungenelela kunye nokulawula.Nangona kunjalo, kukho ukwanda okukhulu kwinani leefollicles eziphakathi kwiqela lokungenelela.
Kuphononongo lwangoku, iqela lokungenelela line-BMI ephezulu, oku kuthetha ukuba eli qela linokuthi likwazi ukuphuhlisa i-hyperinsulinemia kwaye lichaphazele umphumo, nangona lo mahluko wawungabalulekanga ngokwezibalo phakathi kwamaqela amabini.
Akukho nanye izigulane zethu eziye zafumana iziphumo ezibi.Kwakungekho utshintsho oluphawulekayo kwiimvavanyo zesibindi ngexesha lokufunda.
Umda omkhulu wokufunda kwethu kukuba isifundo senziwe njengeprojekthi yokulawula imeko, eyabangela ukungafani kwe-BMI phakathi kwamaqela amabini.Ngoko ke, iziphumo zinokuchaphazeleka kulo mahluko.Nangona kunjalo, akukho zifundo ezifanayo zezi zimbini- Irejimeni yeziyobisi yenziwe kwizigulane kummandla wethu.Nangona kunjalo, ngenxa yempembelelo ye-pioglitazone ekuxhathiseni kwe-insulin, kubonakala ukuba amazinga okuphumelela ayanda ukuba izigulane zifumana i-pioglitazone ixesha elide ngaphambi kokuba ziqalise ukutya kwe-clomiphene.Ngoko ke, uphando olungakumbi lucetyiswa ukuba misela elona xesha lilungileyo lokusebenzisa i-pioglitazone.
Ngaphandle kwenani eliphezulu leefollicles kwiqela le-pioglitazone, uphononongo lwethu alubonisi mahluko ekuvuselelweni kwe-ovarian kunye namazinga okukhulelwa phakathi kwamaqela amabini.
Enyanisweni, siye saphatha ngokufanelekileyo iingxaki ezithile ezifana nobudlolo, ukopha ngenxa yokungasebenzi kakuhle kwesibeleko kunye ne-hirsutism kwixesha elidlulileyo.Ngoku sinethuba (kwaye ngokwenene uxanduva) ukubonelela ngongenelelo lokuthintela okanye ukulungisa ezinye zeengxaki ze-metabolic of infertility (okuyinto inokuchaphazela kakhulu impilo jikelele kunye nomgangatho kunye nobungakanani bobomi).
Ixesha lokuposa: Mar-30-2022