雌孕激素替代治疗雷公藤所致卵巢早衰的疗效观察

Efficacy of estrogen combined with progestogen replacement therapy on patients with secondary premature ovary failure induced by Triptergium wifordii

目的通过雌、孕激素序贯性干预治疗,探讨雷公藤(TW)所致卵巢早衰(POF)的防治方法。方法选择雷公藤多甙片(TWP)治疗后继发性POF患者21例,给予雌、孕激素序贯性替代治疗(HPT),观察治疗前及停药后的临床症状、性激素变化和月经恢复情况。结果21例患者临床表现和性激素测定均符合POF的诊断。与替代治疗前相比,HPT治疗停止3个月后卵巢分泌雌激素(E2)明显增高[(329.90±77.53)pmol/L比(83.47±8.46)pmol/L,P<0.01],垂体分泌的卵泡刺激素(FSH)[(6.70±2.24)U/L比(110.87±20.34)U/L,P<0.01]和黄体生成素(LH)[(5.91+2.67)U/L比(52.62±15.65)U/L,P<0.01]则明显下降(P<0.01),围绝经期征候群改善,总有效率为90.47%。结论TW可造成育龄期妇女卵巢功能减退或衰竭,及时停药和规律地雌、孕激素干预治疗有较好疗效。

Objective To investigate the clinical effect of estrogen combined with progestogen replacement therapy on patients with secondary premature ovary failure (POF) induced by Triptergium wifordii (TW). Methods Twenty-one patients who suffered from secondary suspend menses by TW were treated by estrogen combined with progestogen replacement therapy periodically. The serum levels of E2, LH and FSH were examined and changes of menses and clinical manifestations were observed respectively before and 3 months after the ending of treatment.Results All of the patients were confirmed as POF according to the levels of blood sexual hormone and clinical manifestations. The E2 secreted by ovary was higher [ (392.90±77.53 )pmol/L vs. (83.47±8.46)pmol/L, P < 0.01 ] and L [ (5.91±2.67)U/L vs.(52.62±15.65)U/L,P < 0.01 ],FSH [ (6.70±2.24)U/L vs.( 110.87± 20.34)U/L, P < 0.01 ] secreted by pituitary were lower alter treating as compared to those before treating.Their clinical perimenopause symptoms were improved and situations were stable after treatment. The total efficiency for this treatment was 90.47%. Conclusions TW may result in POF. It is an effective method that stopping TW immediately and treating with estrogen combined with progestogen replacement therapy periodically in these patients.