促性腺激素释放激素激动剂与口服避孕药联合治疗重度子宫内膜异位性疾病的研究

The study of GnRH-a with oral contraceptive for the treatment of advanced endometriosis

目的了解促性腺激素释放激素激动剂与口服避孕药联合治疗子宫内膜异位性疾病的疗效与安全性。方法对2002-12-2004-12复旦大学附属妇产科医院14例确诊为重度子宫内膜异位性疾病患者给予促性腺激素释放激素激动剂(诺雷德)与口服避孕药(妈富隆)的联合治疗。于治疗前(A组)、治疗后3个月(B组)、6个月(C组)、9个月(D组)、12个月(E组)比较疼痛症状评分、异位灶大小、生殖激素水平变化及低雌激素症状。结果治疗后B、C、D、E各组疼痛总主观症状评分均明显低于治疗前A组(P<0·01)。各组卵巢内膜样囊肿大小亦明显小于治疗前A组(P<0·01),子宫腺肌病病灶大小显示治疗后B组与C组均明显小于治疗前A组(P<0·05、P<0·01)。治疗后B组、C组黄体生成激素(LH)、雌二醇(E2)水平明显低于治疗前A组(P<0·05或P<0·01)。所有患者在应用诺雷德与妈富隆反加疗法后第1周期起月经即规则地周期性来潮,但痛经症状明显改善。单独应用诺雷德时潮热、出汗、关节疼痛等症状于妈富隆反加疗法后1周左右消失。结论促性腺激素释放激素激动剂与口服避孕药的联合疗法在控制重度子宫内膜异位性疾病疼痛、缩小异位病灶、缓解低雌激素血症等方面是安全有效的,对于已生育的育龄妇女患病者尤其适用。

Objective To investigate the effect and safety of GnRH-a with oral contraceptive in the treatment of endometriosis. Methods Fourteen patients with advanced endometriosis were recruited and treated with GnRH-a and oral contraceptive. All patients were followed up for twelve months at three-month intervals and were evaluated for the score of pain , the size of the ectopic loci, the level of the sex hormone and the symptoms of hypoestrogenism before the treatment （named with group A） and at every visit（ named with group B, C, D and E respectively）. Result The score of pain in group A was significantly higher than that in any others（P 〈0. 01 ） and the size of the ovarian endometrioid cyst in group A was also significantly larger than that in any others（P 〈0. 01 ）. Both the size of uterus in group B and C was significantly smaller than that in group A（ P 〈0. 05 and P 〈0. 01, respectively）. The level of LH and E2 in group B and C was significantly lower than that in group A （P 〈0. 05 and P 〈0. 01, respectively）. All patients had regular menstrual cycle after the first cycle of add-back therapy and the symptoms of dysmenorrhea was significantly improved. The symptoms of hot flashes, sweating and arthralgia due to using goserelin alone disappeared after using add-back therapy for one week. Conclusion GnRH-a combined with oral contraceptive is effective and safe in controlling the pain of advanced endometriosis , diminishing the size of ectopic loci and alleviating the symptom of hypoestrogenism, especially suitable for women of reproductive years.