Kutaya thupi ndi chimodzi mwa zifukwa zomwe zimayambitsa kusabereka.Polycystic ovary syndrome (PCOS) ndi matenda omwe amafala kwambiri m'mimba.Kudziwa kwathu, insulini kukana kumagwirizana kwambiri ndi PCOS.Choncho, kwa odwala PCO, mankhwala oletsa insulini monga pioglitazone angagwiritsidwe ntchito kukondoweza ovulation.
Odwala makumi asanu ndi limodzi ndi mmodzi omwe ali ndi PCOS anaphatikizidwa mu phunziroli molingana ndi njira zophatikizira / kuchotsedwa atalandira chilolezo kuchokera ku Komiti ya Ethics ya Medical University of Mashhad. Odwalawo adagawidwa m'magulu awiri. Gulu loyamba linatenga ma milligrams a 30 (mg) pioglitazone tsiku lililonse kuyambira tsiku lachiwiri la kusamba kwawo.Wachiwiri analandira placebo.150 mg waclomiphene citrateinkaperekedwa kuyambira tsiku la 3 mpaka tsiku la 7 la msambo.Ukazi wa ultrasonography unkachitidwa kwa amayi onse, ndipo pamene ma follicle okhwima, intrauterine insemination inkachitika pambuyo pa jekeseni wa chorionic gonadotropin yaumunthu.
Panalibe kusiyana pakati pa magulu malinga ndi chikhalidwe cha anthu ndi mitundu ya infertility.Kukula kwa thupi kunali kwakukulu mu gulu la pioglitazone (28.3 ± 3.8 vs 26.2 ± 3.5, P value = 0.047) Kukula kwa follicle sikunasiyana kwambiri pakati pa magulu (2.2 ± 1.4 vs 1.3 ± 1.1, P mtengo = 0.742) Mimba [4 (12.9%) vs 4 (13.3%), P mtengo = 1] sizinali zosiyana pakati pa magulu.
Ngakhale kuchuluka kwa ma follicles mu gulu la pioglitazone, kafukufuku wathu sanawonetse kusiyana pakukondoweza kwa ovarian komanso kuchuluka kwa mimba.
Kusabereka kumakhudza pafupifupi 10-15% ya mabanja. 30% ya kusabereka kwa amayi ndi chifukwa cha kulephera kwa ovulation [1] . Society for Human Reproduction and Embryology ndi American Society for Reproductive Medicine (ESHRE/ASRM) njira zowunikira, kufalikira kwa PCOS kuli pafupifupi 15-20% [3].
Ma lipoprotein osadziwika bwino ndi omwe ali ndi PCOS, omwe ali ndi cholesterol (Chol), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), ndi apoptotic AI [4], 5,6]. Kusintha kwakukulu kwa lipids komwe kunanenedwa kunali kuchepa kwa HDL.Hyperinsulinemia ndi insulin resistance (IR) ndizofala ku PCOS.Mustafa et al.Pafupifupi 46% ya amayi a ku Aigupto omwe ali ndi PCOS anapezeka kuti ali ndi IR [4, 7].Insulin imasokoneza. steroidogenesis mu ovary popanda gonadotropin secretion I PCOS [1]. Ma insulin receptors ndi insulin-like growth factor-1 (IGF-I) amapezeka m'maselo a ovarian stromal [5]. kuzindikirika kwapakati, kumapezeka mu 50% ya azimayi omwe ali ndi PCOS [3].
Kusakhazikika kwa glucose metabolism kumathandizira kuchepetsa thupi;kuwonda kungachepetse hyperandrogenism ndikubwezeretsa ntchito ya ovulatory [7] .Amayi olemera kwambiri omwe ali ndi insulini kukana, kuchepetsa kalori, ndi kuchepa kwa thupi kumachepetsa kuopsa kwa insulini kukana.Kumbali inayi, kuchepa kwa insulini kumachepetsa kupanga androgen [8].
Lero,clomiphene citratendi mankhwala ovomerezeka a ovulation induction kwa amayi omwe ali ndi PCOS.Kukana insulini kumayenderana kwambiri ndi polycystic ovary syndrome, kotero mankhwala omwe amawonjezera kukhudzidwa kwa insulini, monga metformin ndi beta-thiazolidinediones, amaganiziridwa pochiza odwalawa.Kuchiza kwa insulini kukana kungayambitse ovulation, makamaka mwa amayi onenepa kwambiri omwe ali ndi kuchuluka kwa insulin kukana [9].
Kukana kwa insulini kumatanthawuza kuchepa kwa glucose kuyankha kwa insulini, kutsatiridwa ndi hyperinsulinemia, yomwe imatsogolera ku triglycerides okwera, kuchepa kwa HDL-cholesterol, kusagwirizana kwa shuga, ndi chiopsezo cha mtima [10] .Pioglitazone, yomwe imagwiritsidwa ntchito pochiza matenda a shuga a mtundu wa 2, imakhudza mwachindunji kukhudzidwa kwa insulini yozungulira. M'maphunziro aposachedwa, pioglitazone yawonetsedwa kuti imachepetsa kuthamanga kwa magazi m'chiberekero. Itha kuthandizira kukondoweza kwa ovarian komanso zotsatira za in vitro fertilization (IVF) mwa odwala PCOS. Coffler adawonetsa kuti pioglitazone imatha kuyambitsa ovulation mwa odwala hyperinsulinemic [11] .
Mpaka pano, palibe kafukufuku yemwe adawona momwe pioglitazone imakhudzira chonde kwa odwala athu. Chifukwa chake, tidayerekeza kuti pioglitazone ngati mankhwala ophera tizilombo toyambitsa matenda a insulin imatha kupititsa patsogolo kutulutsa kwa dzira ndi kutenga pakati kwa odwala PCOS. mimba zachipatala, ndi chiwerengero cha ma follicles akuluakulu mwa amayi osabereka omwe ali ndi PCOS.
Mashhad Medical University idayang'anira kafukufuku wamankhwala wongochitika mwachisawawa kuyambira mu 2014 mpaka 2017 ndipo adagwiritsa ntchito njira yongoyesa mosayembekezereka kuti alembe odwala 61 a PCOS omwe adatumizidwa ku Milad Infertility Center kuti akalandire chithandizo cha infertility. "March 15, 2014" ndipo chilolezo cholembedwa chinapezedwa kuchokera kwa onse omwe adatenga nawo mbali.
Kuphatikizikako kunali amayi osabereka omwe ali ndi zaka 18-38 omwe ali ndi hysterosalpingography yachibadwa ndi spermogram. ) Kuwonongeka kwa ovarian ndi oligomenorrhea, kapena polycystic ovary imapezeka ngati mawonekedwe a khomo lachiberekero ndi ultrasound;(3) Kupititsa patsogolo zifukwa zachiwiri monga zotupa za ovarian ndi adrenal ndi pituitary adenomas.Polycystic ovary syndrome amapezeka ngati msambo uli oligomenorrhoea, kapena ngati chiwerengero cha zotumphukira zotumphukira mu ovary ndi 2-9 mm wamkulu kuposa 9 pa Ferriman-Gallway scale.
Odwala omwe ali ndi mbiri ya matenda aakulu a mtima, matenda a impso, matenda a shuga, matenda a chithokomiro, ndi matenda a m'mapapo sanaphatikizidwe.
Pambuyo posankha odwala oyenerera, adagawidwa m'magulu awiri mwachisawawa chosavuta kugwiritsa ntchito mapulogalamu a pakompyuta.Njira ya envelopu inagwiritsidwa ntchito popereka odwala kuti aziphunzira m'magulu ophunzirira.Mwa njira iyi, chiwerengero chachisawawa chidzaikidwa mu envelopu yosindikizidwa.Zomwe zili mkati mwa envelopu sangakhoze kuwonedwa kuchokera kunja.Gulu A linali ndi mapiritsi 30 a pioglitazone, 30 mg, ndi mapiritsi 15 a clomiphene, pamene gulu B linayikidwa ndi mapiritsi 30 a placebo ndi mapiritsi 15 a clomiphene. Odwala anachititsidwa khungu ku chithandizo chomwe anapatsidwa.
Odwala onse anadutsa transvaginal ultrasonography pa tsiku lachiwiri la msambo ndipo anaphatikizidwa mu phunziro ngati panalibe ovarian cysts aakulu kuposa 20 mm.
Chiwerengero cha ma follicles apakati ndi aakulu ndi makulidwe a endometrial anayesedwa pa tsiku lakhumi kapena lakhumi ndi limodzi la kusamba.Ziwerengero zamakina ndi zachipatala za mimba zinayesedwa.
Gulu loyamba lidalandira 30 mg wa pioglitazone tsiku lililonse;gulu lachiwiri linalandira placebo kuyambira tsiku lachiwiri la msambo. Pakati pa masiku 3 ndi 7 a msambo, magulu onse awiri anapatsidwa 150 mgclomiphene citrate.Transvaginal ultrasonography pa tsiku la 10 kapena 11. Ganizirani za chorionic gonadotropin (HCG) yotsatiridwa ndi intrauterine insemination (IUI) mwa amayi omwe ali ndi endometrial makulidwe oposa 7 mm ndi ma follicles oposa 16 mm.
Pankhani ya kuchedwa kwa masiku a 5 m'mimba, zitsanzo za magazi zinatengedwa kuti ziwone milingo ya βHCG. Zotsatira zokhudzana ndi Pioglitazone ndi nambala ya follicle yoposa 16 mm ndi makulidwe a endometrial anayesedwa panthawi yophunzira. poyerekeza m'magulu onse.
Kukula kwachitsanzo kunawerengedwa pogwiritsa ntchito pulogalamu ya PASS 11 ndipo chiwerengero cha follicles mu gulu lililonse chinafaniziridwa.Mwachisawawa, zolakwika za mtundu wa 1 ndi 5% ndi zolakwika za mtundu wa 2 ndi 20%.Timayesa odwala 22 pa gulu, koma chifukwa cha kuthekera. attrition, otenga nawo gawo 30 pagulu lililonse adaganiziridwa.
Deta inalowetsedwa mu SPSS version 16.Poyamba, makhalidwe a gulu lirilonse adafotokozedwa ndi njira zofotokozera zowerengera, kuphatikizapo njira ndi zosiyana zowonongeka mosalekeza ndi mawerengero ophatikizira mafupipafupi a magulu a magulu. Mayeso odziyimira pawokha a t-mayeso kapena mayeso a Mann-Whitney-U adagwiritsidwa ntchito atatha kuyesa kukhazikika pogwiritsa ntchito mayeso a Kolmogorov-Smirnov. Zosintha zoyenera zidafananizidwa pogwiritsa ntchito chi-square test. .
Ponena za njira zophatikizira, amayi a 93 adachita nawo phunziroli, 19 anali ndi njira zodzipatula ndipo 13 anasiya. Odwala makumi atatu adayikidwa m'gulu la placebo ndi 31 mu gulu lothandizira.The CONSORT algorithm ikuwonetsedwa mu Chithunzi 1. Makhalidwe a chiwerengero cha amayi ndi zomwe zikuwonetsedwa mu Table 1. Panalibe kusiyana pakati pa magulu okhudzana ndi chikhalidwe cha anthu ndi mtundu wa kusabereka. Zaka zambiri za gulu lothandizira linali 28.20 ± 5.46 ndipo gulu lolamulira linali 27.07 ± 4.18, ndipo kusiyana kwake sikunali kofunikira. .Komabe, index mass index (BMI) inali yapamwamba mu gulu la pioglitazone.
Table 2 ikufotokoza mwachidule zomwe wodwalayo apeza, monga chiwerengero cha ma follicles apakati, chiwerengero cha follicles zazikulu, kukula kwake kwakukulu, ndi makulidwe a endometrial. ma follicles apakati.
Zambiri zokhudzana ndi zotsatira za chithandizo cha ovulation induction, monga kuchuluka kwa ovulation, mankhwala, ndi chiwerengero cha mimba zachipatala pa nthawi iliyonse, zimaperekedwa mu Table 3.Kukondoweza kwa ovarian ndi chiwerengero cha mimba sichinali chosiyana pakati pa magulu.
Zotsatira za phunziroli zinasonyeza kuti panali kusiyana kwakukulu kwa chiwerengero cha ovulation stimulations pakati pa odwala omwe amathandizidwa ndi pioglitazone.Ultrasonography, yomwe inachitika pa tsiku la 10 la kusamba, inasonyeza kuwonjezeka kwakukulu kwa chiwerengero cha follicles mu gulu lothandizira. kutsimikizira zomwe zapezedwa mu kafukufuku wa 2012 wokhudza gawo la pioglitazone mu ovulation induction mu hyperinsulinemic odwala omwe ali ndi PCOS [12].Morley et al.Kuwonjezeka kwa ovulation kunanenedwanso kwa odwala PCOS omwe amatenga pioglitazone [13].
Panalibe kusiyana ovulation ndi mimba mitengo pakati pa magulu awiri phunziro.Izi zikhoza kukhala chifukwa cha nthawi ya pioglitazone ntchito isanayambe clomiphene.Ota anasonyeza kuti 2008 zotsatira anasonyeza kuti 7 mwa 9 odwala amene anatenga pioglitazone kwa 12-30 milungu isanafike. clomiphene anakhala ndi pakati [14] .Kufufuza kwa Kim mu 2010 kunasonyeza kuchepa kwakukulu kwa chiwerengero cha follicles pambuyo pa kuperekedwa kwa pioglitazone. ndizosiyana ndi zotsatira zathu, koma zikhoza kufotokozedwa ndi zosankha za odwala, kuphatikizapo odwala omwe ali ndi clomiphene [15].
Ota anasonyeza kuti pioglitazone ikhoza kupititsa patsogolo kuchuluka kwa mimba kwa odwala PCOS omwe amatsutsana ndi clomiphene ndi dexamethasone [14].Zikuwoneka kuti matenda a PCOS omwe ali ndi hyperandrogenemia ayenera kusankhidwa mosamala kwambiri. Pioglitazone mankhwala.Mukafukufuku wathu, milingo ya mahomoni sinali yosiyana kwambiri isanayambe komanso itatha.
Mu phunziro lathu, panalibe kusiyana kwakukulu kwa chiwerengero cha ma follicles akuluakulu ndi makulidwe a endometrial pakati pa magulu othandizira ndi olamulira.
Pakafukufuku wamakono, gulu lothandizira linali ndi BMI yapamwamba, zomwe zikutanthauza kuti gululi likhoza kukhala ndi hyperinsulinemia ndikukhudza zotsatira zake, ngakhale kusiyana kumeneku sikunali kofunikira pakati pa magulu awiriwa.
Palibe odwala athu omwe adakumana ndi zotsatirapo.Panalibe kusintha kwakukulu kwachiwerengero mu mayesero a ntchito ya chiwindi panthawi yophunzira.
Cholepheretsa chachikulu cha phunziro lathu chinali chakuti phunziroli linapangidwa ngati polojekiti yoyendetsera milandu, yomwe inachititsa kuti kusiyana kwa BMI pakati pa magulu awiriwa. Komabe, chifukwa cha momwe pioglitazone imakhudzira insulin kukana, zikuwoneka kuti chiwongola dzanja chikuwonjezeka ngati odwala alandira pioglitazone kwa nthawi yayitali asanayambe kudya kwa clomiphene. Dziwani nthawi yabwino yogwiritsira ntchito pioglitazone.
Ngakhale kuchuluka kwa ma follicles mu gulu la pioglitazone, kafukufuku wathu sanawonetse kusiyana pakukondoweza kwa ovary komanso kuchuluka kwa mimba pakati pamagulu awiriwa.
M'malo mwake, tathana bwino ndi mavuto enaake monga kusabereka, kutuluka magazi kuchokera ku kusagwira bwino ntchito kwa chiberekero ndi hirsutism m'mbuyomu.Tsopano tili ndi mwayi (ndiponso udindo) wopereka njira zothandizira kupewa kapena kukonza zovuta zina za metabolic za infertility (omwe ali ndi mwayi). zitha kukhudza kwambiri thanzi komanso kuchuluka kwa moyo).
Nthawi yotumiza: Mar-30-2022