促性腺激素释放激素激动剂延长用药间隔治疗子宫内膜异位症和子宫腺肌病的疗效观察

Effect of triptorelin and an extended-interval dosing regimen in the treatment of patients with endometriosis and adenomyoma

目的探讨促性腺激素释放激素激动剂(GnRHa)在治疗子宫内膜异位症(内异症)、子宫腺肌病和子宫肌瘤中的作用以及延长用药间隔对疗效的影响。方法内异症、子宫腺肌病和子宫肌瘤患者共70例,随机分为两组即延长用药间隔组(E组,30例)与常规用药组(C组,40例),分别用曲普瑞林3·75mg肌内注射4次(间隔6周)或6次(间隔4周),疗程均为24周,比较用药前后症状、子宫体积和病灶体积、血清生殖激素水平变化。结果E、C两组中内异症和子宫腺肌病患者的痛经缓解率均为100%;药物治疗结束时子宫体积平均缩小35%和37%,治疗前后比较,差异有统计学意义(P<0·05)。两组患者药物治疗前后血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇水平,E组从用药前的(6·7±1·4)U/L、(4·713±1·048)U/L、(209±29)pmol/L,下降到第1次用药后6周的(2·1±0·5)U/L、(0·496±0·212)U/L、(95±18)pmol/L,分别与用药前比较,差异均有统计学意义(P<0·05);用药前及第1次用药后12、24、28周,E、C两组分别比较,差异均无统计学意义(P>0·05)。结论GnRHa通过降低血清FSH、LH和雌二醇水平而缓解痛经、缩小病灶;大多数患者用药间隔延长至6周对疗效无影响,并且可降低医疗费用,可在有血清生殖激素监测条件下推荐应用。

Objective To study the role of triptorelin in the treatment of patients with endometriosis, adenomyoma and fibromyoma and the effect of an extended-interval dosing regimen. Methods Seventy patients suffering from endometriosis, adenomyoma and fibromyoma were divided into two groups： extended-interval dosing （group E） and conventional dosing （group C）. There were treated with injection of triptorelin 3. 75 mg intramuscularly either every 6 weeks of totally four dose regimen （ group E） or every 4 weeks of six dose regimen （ group C）. Comparison was made in improvement of symptoms, size of uterus and volume of tumor, as well as in serum levels of 17β-estradiol, luteinizing hormone, and follicle-stimulating hormone. Results In each group, symptoms and tumor growth significantly improved after treatment （P 〈 0. 05）. For the patients of both groups E and C, the levels of gonadotropins and gonadal steroids were obviously reduced throughout the treatment period and up to 8 - 10 weeks after the injection of the last dose （P〈0.05）. The hormonal profile of group E was similar to group C （P 〉 0.05）. Conclusions Gonadotropin-releasing hormone agonist is efficacious in the treatment of endometriosis and adenomyoma through reducing the serum levels of follicle-stimulating hormone, luteinizing hormone and 17β-estradiol. The curative effect is satisfactory in most patients receiving an extended interval dosing regimen. To reduce the cost of treatment, the extended-interval dosing regimen of triptorelin should be adopted in well-equipped hospitals.