【摘要】 目的探讨不同促排卵方案用于多囊卵巢综合征(Polycystic ovary syndrome,PCOS)患者宫腔内人工授精(Intrauterine insemination,IUI)的临床疗效及成本效果分析。方法病例来源于2011年1月-2015年1月期间来该院生育技术科就医接受IUI不孕症患者90例,共145个治疗周期,按随机数字表法将纳入病例分为观察组和对照组,每组45例。对应随机数字偶数者为观察组(78个IUI周期),奇数者为对照组(67个IUI周期)。对照组进行自然周期排卵IUI,观察组采取促排卵方案进行IUI,并将其按照采取不同的促排卵方案分为3组,分别为克罗米酚(CC)组、来曲唑(LE)组及人类绝经期促性腺激素(HMG)组。比较两组患者的妊娠结局及观察组内的不同促排卵方案下患者的妊娠结局和成本效果。结果观察组患者的临床妊娠率及多胎人数明显高于对照组,差异均具有统计学意义(χ~2=5.203,P<0.05;χ~2=4.448,P<0.05),两组患者中发生流产及异位妊娠的人数比较,差异均无统计学意义(χ~2=1.172,P>0.05;χ~2=0.865,P>0.05);LE组的妊娠率明显高于CC组,差异具有统计学意义(χ~2=6.139,P<0.05),其余各促排卵方案之间的妊娠率、流产人数、异位妊娠、多胎情况比较,差异均无统计学意义(χ~2=0.789,P>0.05);LE组获得单位效果所需花费的成本最少,方案最优。结论促排卵周期IUI妊娠率明显高于自然周期IUI,且未明显增加流产及异位妊娠人数,CC促排卵效果好,花费少,值得在临床推广使用。更多还原

【Abstract】 Objective To explore the clinical curative effect of controlled ovarian hyperstimulation( COH) regimens used for intrauterine insemination( IUI) among polycystic ovary syndrome( PCOS) patients,conduct a cost-effectiveness analysis. Methods Ninety infertile patients treated by IUI in Department of Reproductive Technology in the hospital from January 2011 to January 2015 were selected,145 treatment cycles were included. The patients were divided into observation group( 78 IUI cycles) and control group( 67 IUI cycles),45 patients in each group according to random number table. The patients in control group were treated by natural ovulation cycle IUI,while the patients in observation group were treated by COH cycle IUI. The patients were divided into clomiphene( CC) group,letrozole( LE) group,and human menopausal gonadotropin( HMG) group according to different COH regimens. The pregnancy outcomes in the two groups were compared,the pregnancy outcomes and cost-effectiveness of patients in observation group treated by different COH regimens were also compared. Results The clinical pregnancy rate and the number of multiple pregnancy in observation group were statistically significantly higher than those in control group( χ~2= 5. 203,4. 448,P<0. 05). There was no statistically significant difference in the numbers of abortion and ectopic pregnancy between the two groups( χ~2= 1. 172,0. 865,P > 0. 05). The pregnancy rate in LE group was statistically significantly higher than that in CC group( χ~2= 6. 139,P<0. 05). There was no statistically significant difference in pregnancy rate,the numbers of abortion,ectopic pregnancy,and multiple pregnancy among different COH regimens( χ~2= 0. 789,P>0. 05). In LE group,the cost to obtain a unit effect was the least,the regimen was the best. Conclusion The pregnancy rate of COH cycle IUI is significantly higher than that of natural ovulation cycle IUI,COH cycle IUI does not increase the numbers of miscarriage and ectopic pregnancy. The COH effect of letrozole is good,the cost is low,which is worthy clinical popularization and application.更多还原