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

摘要：

目的　探讨来曲唑联合子午流注经皮电刺激（ZLT）对肥胖型多囊卵巢综合征（PCOS）患者诱导排卵及妊娠率的影响。方法　纳入2021年7月至2022年6月于广东省妇幼保健院生殖健康与不孕症科就诊的20～40岁、体质量指数（BMI）≥24 kg/m²和/或腰围≥80 cm、至少一侧输卵管通畅的PCOS患者295例进行队列研究。收集患者诱导排卵前基线情况。按患者实际情况分成两组：接受ZLT治疗者为ZLT组，从月经第5天开始口服来曲唑每天2.5 mg，共5 d，配合每周2～3次ZLT治疗，每次30 min，共5次；不接受ZLT治疗者为对照组，于月经周期第5天开始口服来曲唑每天2.5 mg，共5 d。收集两组患者排卵妊娠情况。对两组多重插补后进行多因素COX回归分析及倾向性评分匹配后的敏感性分析。结果　共招募到295例肥胖型PCOS患者，其中ZLT组45例（56周期），对照组250例（373周期）。两组基线资料差异均无统计学意义（均P>0.05）。ZLT组无排卵周期率3.57%（2/56），对照组1.88%（7/373），两组之间差异无统计学意义（P>0.05）。ZLT组多卵泡生长周期率0，对照组0.80%（3/373），两组之间差异无统计学意义（P>0.05）。COX多因素分析显示，调整BMI、基础窦卵泡数（AFC）后调整HR=2.03（95%CI 1.08～3.81），P=0.027。多重插补3套数据后，COX多因素分析显示，调整BMI、AFC后调整HR=2.04（95%CI 1.42～2.93），P<0.001。以BMI分成超重（24～28 kg/m²）与肥胖（≥28 kg/m²）两组进行亚组分析，超重组中对照组、ZLT组妊娠率分别为20.2%、26.9%，调整HR=1.32（95%CI 0.58～3.03），P=0.509；肥胖组中对照组、ZLT组妊娠率分别为11.1%、31.6%，调整HR=3.93（95%CI 1.31～11.72），P=0.014；交互作用P=0.171。设定BMI卡钳值为0.2，设定AFC卡钳值为1.0，按1∶1进行倾向性评分匹配，调整HR=1.99（95%CI 1.06～3.73），P=0.031。结论　来曲唑联合ZLT能将肥胖型PCOS患者诱导排卵妊娠率提高1倍，在肥胖组提高了3倍。

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