关键词:

肥胖型多囊卵巢综合征, 子午流注, 经皮穴位电刺激, 来曲唑, 排卵妊娠率

Abstract:

Objective　To investigate the effect of letrozole combined with Ziwu Liuzhu transcutaneous electrical acupoint stimulation (ZLT) on the rate of ovulation induced pregnancy in obese patients with polycystic ovary syndrome (PCOS). Methods　Two hundred and ninety-five 20-40 years old patients with PCOS, a body mass index (BMI) ≥24 kg/m² and/or a waist circumference≥ 80 cm, and at least one unobstucted fallopian tube who were treated at Guangdong Women and Children Hospital were selected for the cohort study. The patients' baseline conditions before ovulation induction were collected. According to the patients' actual conditions, they were divided into 2 groups. The patients who were willing to take ZLT were set as a ZLT group; on the fifth day of menstruation, they started to orally take 2.5 mg letrozole per day for 5 days, and took ZLT 2-3 times per week, 30 min per time, for 5 cycles. The patients who did not wish to took ZLT were set as a control group; on the fifth day of menstruation, they started to orally administer 2.5 mg letrozole per day for 5 days. The pregnancy status in both groups was collected. Multivariate COX regression analysis and sensitivity analysis of propensity score matching (PSM) were performed for the two groups after multiple interpolation. Results　A total of 295 obese patients with PCOS were enrolled, including 45 cases (56 cycles) in the ZLT group and 250 cases (373 cycles) in the control group. There were no statistical differences in the baseline data between the two groups. The anovulatory cycle rate was 3.57% (2/56) in the ZLT group, and was 1.88% (7/373) in the control group, with no statistical difference between the two groups (P>0.05). The multi-follicle growth cycle rate was 0 in the ZLT group, and was 0.80% (3/373) in the control group, with no statistical difference between the two groups (P>0.05). The COX multi-factor analysis showed that after adjusting BMI and antral follicle count (AFC), the adjusted HR=2.03 (95%CI 1.08-3.81), P=0.027. After the multiple interpolation of the 3 sets of data, the COX multi-factor analysis showed that after adjusting BMI and AFC, the adjusted HR=2.04 (95%CI 1.42-2.93), P<0.001. According to the BMI, the patients were divided into an overweight group and an obese group for subgroup analysis, and found that the pregnancy rates of the control group and the ZLT group in the overweight group were 20.2% and 26.9%, and the adjusted HR=1.32 (95%CI 0.58-3.03), P=0.509; the pregnancy rates of the control group and ZLT group in the obese group were 11.1% and 31.6%, and the adjusted HR=3.93 (95%CI 1.31-11.72), P=0.014; the interaction P=0.171. The caliper values of BMI and AFC were set as 0.2 and 1.0; the propensity score matching was performed at 1∶1, and the adjusted HR=1.99 (95%CI 1.06-3.73), P=0.031. Conclusion　Ledrazole combined with ZLT can increase the ovulation induction pregnancy rate of obese patients with PCOS by 1 times, and by 3 times in the obese group.

Key words:

Obese polycystic ovary syndrome, Ziwu Liuzhu, transcutaneous electrical acupoint stimulation, Letrozole, ovulation pregnancy rate