黑升麻在中重度子宫内膜异位症GnRH-a反加治疗中的疗效评估

Assessment of efficacy of Black cohosh in addback therapy on GnRH-a treatment for severe endometriosis

目的:比较黑升麻和替勃龙在中重度子宫内膜异位症腹腔镜术后GnRH-a反加治疗中的疗效。方法:前瞻性随机对照比较中重度子宫内膜异位症腹腔镜术后患者90例,分为戈舍瑞林+黑升麻组、戈舍瑞林+替勃龙组、戈舍瑞林组,各30例,分析各组用药3个月后血清雌二醇(E2)、促卵泡激素(FSH)水平;子宫内膜厚度;Kupperman(KMI)评分;视觉疼痛症状评分法(VAS)评分;血清骨钙素(BGP);CA125、肝肾功能、血脂等变化。结果:戈舍瑞林+替勃龙组血清E2水平显著高于戈舍瑞林+黑升麻组及戈舍瑞林组(P均<0.05),FSH显著低于戈舍瑞林+黑升麻组及戈舍瑞林组(P均<0.05),戈舍瑞林+黑升麻组和戈舍瑞林组间无差异(P>0.05);戈舍瑞林组KMI评分明显高于戈舍瑞林+替勃龙组和戈舍瑞林+黑升麻组(P<0.05),而戈舍瑞林+替勃龙组和戈舍瑞林+黑升麻组间无差异(P>0.05);戈舍瑞林+替勃龙组血清BGP浓度显著低于戈舍瑞林组和戈舍瑞林+黑升麻组(P均<0.05),而戈舍瑞林组和戈舍瑞林+黑升麻组间无差异(P>0.05)。各组间EM、VAS评分、CA125、肝肾功能及血脂等均无明显差异(P>0.05)。结论:黑升麻是中重度子宫内膜异位症腹腔镜术后GnRH-a反加治疗安全有效的选择之一。

Objective：To compare the efficacy of Black cohosh and Tibolone in addback therapy on Gonadotropin releasing hormone analogues treatment for severe endometriosis after laparoscopic surgery.Methods：90 cases of severe endometriosis patients who underwent GnRH-a treatment after laparoscopic surgery were retrospectively analyzed.They were randomly divided into three groups：GnRH-a ＋Black cohosh group（n=30）,GnRH-a ＋Tibolone group（n=30）,and GnRH-a group（n=30）.Three months later,the degree of pain was measured according to a visual analog scale（VAS）,the menopausal symptoms were assessed with the Kupperman Menopausal Index（KMI）.Serum E2,FSH,BGP,CA125,Lipid,electrolytes,Liver and kidney function were measured respectively.Endometrial thickness was detected by Ultrasound.Results：The level of serum E2 in Tibolone group was significantly higher than that in Black cohosh group and GnRH-a group（P0.05）;and the level of serum FSH in Black cohosh group and GnRH-a group was significantly lower than that in Tibolone group（P0.05）.The score of KMI significantly increased in GnRH-a group（P0.05）,but there was no significant differences between Tibolone group and Black cohosh group（P0.05）.The serum of BGP significantly decreased in Tibolone group（P0.05）,but there was no significant difference between GnRH-a group and Black cohosh group（P0.05）.The score of VAS,endometrial thickness,serum CA125,lipid,liver and kidney function were all similar in three groups（P0.05）.Conclusion：Black cohosh add-back therapy can relieve the side effect of GnRH-a,and it may be a better choice for add-back therapy in GnRH-a treatment for severe endometriosis after laparoscopic surgery.