GnRHa联合反向添加疗法治疗子宫内膜异位症对腰椎骨量的影响

Effect of gonadotropin releasing hormone agonist combined with add-back therapy on bone mineral density of lumbar vertebrae in treatment of endometriosis

目的:研究比较GnRHa联合经皮雌激素及口服安宫黄体酮反加治疗与单用GnRHa治疗子宫内膜异位症对腰椎骨量的影响。方法:选择子宫内膜异位症患者28例,均经腹腔镜手术确诊并手术治疗两个月内,随机分为单用GnRHa组(A组)和反加组(B组)。A组患者于月经周期的第2天或于术后3～5天予诺雷德3.6 mg皮下注射,隔28天注射1次,共3次;B组患者于月经周期的第2天或于术后3～5天予诺雷德3.6 mg皮下注射,隔28天注射1次,共3次,于注射第1次同时每周1/2片松奇贴剂贴于腹部皮肤,并每晚口服安宫黄体酮6 mg至治疗结束。于治疗前测量患者腰椎骨密度,同时抽取外周静脉血测量E2水平,检测血清BGP水平;治疗3月后再次检测上述各项指标。结果:①A组L1～L4骨密度治疗3月后较治疗前显著降低(P<0.01),而B组虽较治疗前也有降低趋势,但差异无统计学意义(P=0.201);治疗后A组血清BGP较治疗前显著升高(P<0.01),而B组虽较治疗前也有升高趋势,但差异无统计学意义。②治疗3月后,两组患者血清E2水平均较治疗前显著降低(P<0.01),而B组E2显著高于A组(P<0.01)。结论:反加组L1～L4骨密度虽较治疗前也有降低趋势,但骨量丢失少于单用GnRHa组,血清BGP水平变化与腰椎骨密度变化呈负相关,提示该研究的反加方案能减少骨量的丢失,对骨密度起到一定的保护作用。

Objective：To research and compare the effects of gonadotropin releasing hormone agonist（GnRHa） combined with percutaneous injection of estrogen and add-back therapy with oral administration of medroxyprogesterone acetate and GnRHa alone on bone mineral density of lumbar vertebrae in treatment of endometriosis. Methods：Twenty-eight patients with endometriosis were selected,all of them were diagnosed definitely by laparoscopy within two months,then they were randomly divided into CnRHa alone group（group A） and GnRHa plus add-back therapy group（group B）.The patients in group A were treated with percutaneous injection of Zoladex on the second day during menstrual cycle or at 3-5 days after operation;percutaneous injection was conducted every 28 days for three times;while the patients in group B were treated with percutaneous injection of Zoladex on the second day during menstrual cycle or at 3-5 days after operation,percutaneous injection was conducted every 28 days for three times,at the same time,half of patch was pasted on the abdominal skin every week from percutaneous injection for the first time,and they were treated with oral administration of medroxyprogesterone acetate（6 mg） every night until the end of treatment.Bone mineral density of lumbar vertebrae was measured before treatment,at the same time,peripheral venous blood samples were obtained to detect the levels of estradiol and serum BGP;the above-mentioned indexes were reexamined at three months after treatment. Results：In group A,the bone mineral densities of L1-L4 at three months after treatment were significantly lower than those before treatment（P0.01）;while in group B,compared with before treatment,the bone mineral densities of L1-L4 at three months after treatment showed decreasing trends,but there was no significant difference（P=0.201）.In group A,the serum level of BGP after treatment was significantly higher than that before treatment（P0.01）;while in group B,compared with before treatment,the serum level of BGP showed a increasing trend,but there was no significant difference.At three months after treatment,the serum levels of estradiol in the two groups were significantly lower than those before treatment（P0.01）;the serum level of estradiol in group B was significantly higher than that in group A（P0.01）. Conclusion：Compared with before treatment,the bone mineral densities of L1-L4 in GnRHa plus add-back therapy group showed decreasing trends after treatment,but the bone loss was less than that in GnRHa alone group,the changes of serum BGP levels were negatively correlated with the changes of bone mineral density of lumbar vertebrae,which indicate that add-back therapy can reduce bone loss and play a protective role for bone mineral density.