GnRH-a联合结合雌激素和甲羟孕酮治疗子宫腺肌病伴不孕21例疗效观察

Clinical observation of GnRH-a combined with conjugated equine estrogen and medroxy progesterone acetate in the treatment of adenomyosis with infertility

目的探讨促性腺激素释放激素激动剂（GnRH-a）联合结合雌激素（倍美力）和甲羟孕酮治疗子宫腺肌病伴不孕的临床疗效和安全性。方法将21例子宫腺肌病伴不孕患者随机分成两组，反加组11例，采用GnRH-a联合倍美力和甲羟孕酮治疗。对照组10例，采用GnRH-a治疗。观察两组治疗前后总主观症状、子宫体积、性激素水平变化、腰椎骨密度变化、不良反应及停药后妊娠率。结果两组总主观症状评分及子宫体积于治疗后明显下降，反加组发生低雌激素症状较对照组明显减少，两组妊娠率分别为45．4％、50．0％（P〉0．05）。结论GnRH-a联合倍美力、甲羟孕酮反加疗法在子宫腺肌病伴不孕症中缓解低雌激素症状、减缓骨转换安全有效，反加疗法能减轻GnRH-a的不良反应而不影响其疗效。

Objective To observe the therapeutic effects and safety of endocrine response of gonadotropin （hormone）-releasing hormone-analogue （GnRH-a） combined with conjugated equine estrogen （CEE） and medroxy progesterone acetate （MPA） in the treatment of adenomyosis with infertility. Methods Twenty-one cases of adenomyosis with infertility patients were randomly divided into 2 groups. Add-back group （n = 11 ） were treated by GnRH-a 3.6 mg by hypodermic injection of 6 doses,each given for 4 weeks apart,CEE （0.625 mg/d） and MPA （5 mg/d） were also used as add -back therapy from 4 to 6 course of treatment, but control group （n = 10） were only treated by GnRH-a. Add-back group were treated by GnRH-a 3.6 mg by hypodermic injection of 6 doses,combined with CEE （0.625 rag/d） and MPA （5 mg/d） from 4 to 6 course of treatment. Total subjective symotom scores, uterine volume, gonadal hormone of serum, BMD, side effect and pregnancy rate were examined before and after the treatment. Results Total subjective symptom scores and uterine volume decreased obviously after treatment in two groups. Compared to the control group, symptom of hypoestrogenemia of add-back group obviously decreased. Pregnancy rate of two groups were 45.4 % and 50.0%, respectively （P 〉 0.05）. Conclusions GnRH-a combined with CEE and MPA in add-back therapy is an effective therapy in the treatment of adenomyosis with infertility. It could improve the symptom of hypoestrogenemia and decrease bone turn-over. It also can relieve side effects and won＇t influence therapeutic effects induced by GnRH-a at the same time.