促性腺激素释放激素激动剂联合反向添加疗法治疗子宫内膜异位症的临床疗效研究

Clinical Study of Efficacy of GnRH-α Combined with Add Back Therapy in the Treatment of Endometrosis

目的探讨促性腺激素释放激素激动剂(GnRH-α)联合戊酸雌二醇(estrad iol valerate)和安宫黄体酮(MPA)反向添加疗法用于中重度子宫内膜异位症术后巩固治疗的临床疗效及安全性。方法将32例中重度子宫内膜异位症腹腔镜手术后患者随机分为两组:单药组(A组,16例)患者于月经周期的第2天或于术后月经来潮第2天予曲普瑞林3.75 mg皮下注射,隔28 d注射1次,共3次;反加组(B组,16例)患者于月经周期的第2天或于术后月经来潮第2天予曲普瑞林3.75 mg皮下注射,隔28 d注射1次,共3次,于注射第1支曲普瑞林的同时口服戊酸雌二醇1 mg及安宫黄体酮6 mg至治疗结束。比较两组患者治疗前、后血清激素及癌胚抗原125(CA125)水平、疼痛症状视觉模拟评分(VAS)、绝经症状严重程度(以Kupperman评分表示)等。结果 (1)A、B两组患者治疗后的血清卵泡刺激素(FSH)、黄体生成激素(LH)、雌激素(E2)水平分别为(2.2±2.1)U/L、(1.70±0.61)U/L、(27.6±6.05)pg/m l和(1.9±1.4)U/L、(1.59±0.74)U/L、(39.5±9.01)pg/m l,均明显低于治疗前水平,差异均有统计学意义(P<0.05);CA125水平较治疗前明显降低,差异亦有统计学意义(P<0.01)。(2)A、B两组患者治疗前VAS评分为(5.41±2.92)分和(5.64±3.17)分,明显高于治疗后的(2.03±1.92)分和(2.45±2.06)分,差异有统计学意义(P<0.01)。但两组间治疗后评分比较,差异无统计学意义(P>0.05)。(3)A、B两组患者治疗后的改良Kupperman评分分别为(14.71±7.63)分和(11.13±6.54)分,两组间比较差异无统计学意义(P>0.05)。但两组患者中潮热出汗的发生率分别为93.8%和56.3%,差异有统计学意义(P<0.01)。结论 GnRH-α联合戊酸雌二醇、安宫黄体酮反向添加疗法在缓解低雌激素症状方面是安全有效的。反向添加疗法能减轻GnRH-α的副作用而不影响其疗效。

Objective To evaluate the effect and safety of gonadotrophin-releasing hormone agonist（GnRH-α） combined with estradiol valerate and medroxyprogesterone acetate in the treatment of endometriosis after conservative laparoscopic operation.Methods Thirty two patients with endometriosis were randomly divided into 2 groups after laparoscopic operation,with 16 patients on the second day of their period in group A receiving 3.75mg triptorelin once every 4 weeks,12 weeks in all and 16 patients on the second day of their period in group B receiving triptorelin and added 1mg CA and 6mg oral medroxy progesterone acetate per day,12 weeks in all.Serum E2,FSH,LH,CA125,visual analogue scale（VAS） of pain and the form of Kupperman were compared in patients before and after treatment.Results（1） After treatment,the levels of FSH,LH,E2 were（2.2±2.1） U/L,（1.70±0.61） U/L,（27.6±6.05）pg/ml in group A and（1.9±1.4） U/L,（1.59±0.74） U/L,（39.5±9.01）pg/ml in group B respectively,and they were significantly lower than those before treatment（P0.05）.The level of CA125 was significantly decreased compared with those before GnRH-α treatment（P0.01）.（2） Before the treatment,patients VAS scores of A and B group were（5.41±2.92） and（5.64± 3.17） respectively,they were significantly higher than the（2.03±1.92） and（2.45±2.06） after GnRH-α treatment（P0.01）,however,no statistically significant difference was found between the two groups after treatment（P0.05）.（3） The form of Kupperman after treatment were（14.71±7.63） in group A and（11.13±6.54） in group B,the difference was not statistically significant（P0.05）.The incidence of flash and sweat were 93.8% in group A,which was significant higher than the 56.3% in group B（P0.01）.Conclusion The add-back therapy that consists of transdermal estradiol and medroxy progesterone acetate is effective and safe in the treatment for endometriosis.