促性腺激素释放激素类似物治疗子宫内膜异位症是否需要个体化

Should the GnRHa Therapy for Endometriosis be Individualized

目的:探讨子宫内膜异位症(EMs)手术后补充治疗和预防复发用药的个体化治疗问题。方法:回顾性分析腹腔镜手术后的EMs患者应用GnRHa引起的不良反应、随访月经恢复时间、恢复月经后痛经改善等情况。结果:共收集病例资料80例,应用GnRHa3-6个月。80例中30例因不良反应反向添加雌、孕激素类药物,不良反应主要表现为阴道出血(52例,65.0%)、潮热(62例,77.5%)、出汗(60例,75.0%)、阴道干燥(42例,52.5%)、性欲下降(32例,40.0%)、情绪改变(17例,21.2%)、骨痛(16例,20%)、乏力(7例,8.7%)、停用GnRHa 1-3个月后月经恢复;月经恢复后痛经缓解率为73.6%(35/59)。结论:①因应用GnRHa引起的雌激素低落导致的不良反应存在明显的个体差异,常规反向添加剂量并不能缓解所有患者的症状。②不良反应发生情况与疗效相关,建议对患者进行个体化治疗,对于阴道出血持续时间长者建议增加GnRHa剂量,对于不良反应显著者可在第2个月时减低GnRHa剂量。

Objective： To explore the individualization of GnRHa therapy after endometriosis operation. Methods： Eighty post-operative patients with endometriosis were recruited and the duration of menstruation restored and the improvement of dysmenorrhea were evaluated retrospectively. Results： The patients received 3-6 months treatment with GnRHa, and 30 of them took estrogen supplement. There were 65.0 %（52/80） of patients suffered from vaginal bleeding, 52.5 % （42/80） with vaginal dryness, 77.5 % （62/80） with hot flushs, 75 % （60/80） with sweating, 40.0 % （32/80） with decreased sexual desire, 21.2 % （17/80） with mood swings, 20.0%（16/80） with bone ache, 8.7%（7/80） with fatigue, and 1.3 %（1/80） with pelvic pain. The menstruation restored in 1-3 months after treatment and 35 out of 59 patients were reported improvement of dysmenorrhea. Conclusions： （1） There was significant difference among the low-estrogenic symptoms caused by short time GnRHa therapy. The routine add-back therapy could not release all the symptoms occurred among the patients. （2） Since the side effects were correlated to the efficacy of treatment, individualized therapy would be beneficial for patients who were undergoing the GnRHa therapy. It is recommended to increase the dosage of Diphereline for patients suffering from persistent vaginal bleeding, and to reduce the dosage at the second month for patients with significant estrogen deficiency symptoms.