曲普瑞林治疗子宫内膜异位症应个体化

Clinical Study of Individualized Treatment of Triptorelin in Endometriosis

目的:探讨曲普瑞林(商品名:达菲林)个体化治疗子宫内膜异位症(EMs)的必要性。方法:对34例卵巢子宫内膜异位囊肿剥除术后的患者进行前瞻性临床观察,辅助注射曲普瑞林3.75mg3～6个月,每28天1次。观察曲普瑞林治疗后的近期不良反应,尤其是异常阴道出血和潮热、盗汗症状,同时测定用药第0,7,21天血清卵泡刺激素(FSH)、黄体生成激素(LH)和雌二醇(E2)水平。结果:根据是否阴道异常出血将患者分成2组,用药第7天血清E2水平差异有统计学意义(Z=2.612,P=0.009)。E2水平与阴道出血的天数呈正相关(rs=0.587,P<0.05)。再根据是否出现严重潮热、盗汗将患者分成2组,发现用药第21天FSH水平和FSH/LH比值差异均有统计学意义(Z=2.247,P=0.025;Z=2.201,P=0.028)。FSH水平和FSH/LH比值均与潮热、盗汗的程度呈负相关(rs=-0.541,rs=-0.588,P<0.05)。结论:个体差异可能导致曲普瑞林治疗后内分泌变化和近期不良反应不同,应该实施个体化治疗。曲普瑞林注射后第7天的E2水平可以预测是否有异常阴道出血发生,第21天血清FSH水平或FSH/LH比值可以预测潮热、盗汗的严重程度,协助选择最佳治疗方案。

Objective： To study the necessarity of individualized treatment of Triptorelin （trade name Diphereline） in the patients with endometriosis. Methods： A prospective clinical study involving 31 patients who underwent chocolate cystectomy. These patients were administered Triptorelin 3.75 mg for 3 to 6 times, 28 days apart. We evaluated the symptoms of genital bleeding and hot flashes during Triptorelin treatment, as well as the levels of serum FSH, LH and estradiol at the first and third weekend after the start of treatment. Results： We divided all the patients into 2 groups according to the genital bleeding（i.e. the group of menstruation-like bleeding and the group of abnormal genital bleeding）. Statistically difference of estradiol was found in the first weekend after the treatment between the 2 groups（Z=2.612, P=0.009）. The estradiol was positively correlated to the days of genital bleeding （rs=0.587, P0.05）. According to the severe hot flashes we divided the patients into 2 groups and found that the serum FSH and FSH/LH ratio was statistically difference in the 3 weekend after treatment（Z=2.247, P=0.025; Z=2.201, P=0.028）. The serum FSH and FSH/LH ratio were inversely correlated to the degree of hot flashes（rs=-0.541, rs=-0.588, P0.05）. Conclusions： These differences in the endocrinological changes in response to Triptorelin might be derived from the patient′s individual difference. The estradiol at the first weekend after the start of Triptorelin treatment can predict the abnormal genital bleeding. The serum FSH and FSH/LH ratio at the third weekend after the start of Triptorelin treatment can predict the degree of hot flashes and help us to choice the best treatment plan.