GnRH-a联合反向添加疗法在卵巢恶性生殖细胞肿瘤患者保留生育功能手术后化疗中的临床观察

Efficacy of GnRH agonist combined with add-back therapy for patients with ovarian malignant germ cell tumors who underwent chemotherapy after conservative surgery

目的探讨卵巢恶性肿瘤患者保留生育功能手术化疗中应用促性腺激素释放激素激动剂(GnRH-a)戈舍瑞林联合反向添加疗法的临床意义。方法将36例卵巢恶性生殖细胞肿瘤行保留生育功能手术,术后接受BEP方案化疗的患者,分成两组,单一用药组为术后单独给予戈舍瑞林治疗的患者18例,联合用药组为术后给予戈舍瑞林联合反向添加疗法治疗患者18例,比较两组患者治疗过程中血清雌二醇(E_2),卵泡刺激素(FSH)水平和窦卵泡数(F_0)变化,观察戈舍瑞林的不良反应及严重程度。结果治疗后6、12个月:联合用药组F_0多于单一用药组,差异有统计学意义(P<0.05);治疗后6个月:联合用药组E_2、FSH水平与单一用药组比较,差异均有统计学意义(均P<0.05),治疗后12个月差异均无统计学意义(均P>0.05)。治疗第6个月:单一用药组与联合用药组的改良Kupperman评分总分分别为(14.2±3.10)分和(8.60±4.22)分,两组比较差异有统计学意义(P<0.05)。结论戈舍瑞林联合反向添加疗法能改善化疗对卵巢的损伤和减轻戈舍瑞林对患者的不良反应。

Objective To assess the efficacy of GnRH agonist （GnRH- a） combined with low dose estrogen add- back therapy for patients with malignant germ celltumors of the ovary who underwent chemotherapy after conservative surgery. Methods Thirty six patients with ovarian malignant germ celltumors, who underwent chemotherapy of BEP regimen after conser-vative surgery, were assigned to receive GnRH agonist Goserelin （Zoladex） （single GnRH- a group, n=18） or Goserelin combined with add- back therapy （estradiol valerate 1mg plus dehydrogesterone 5mg daily, combination group, n=18）. Serum levels of E2 and FSH were measured;adverse reactions were evaluated with improved Kupperman scale. Results F0 number in combination group was more than that in single GnRH- a group at 6 and 12 months after treatment （P〈0.05）. Serum level of E2 in combination group was higher, FSH was lower than that in single drug group at 6 months after treatment （P〈0.05）. There were no differences in serum levels of E2 and FSH at 12 months after treatment between two groups. The improved Kupperman scores in single drug and combination groups were 14.2 ±3.10 and 8.60 ±4.22, respectively （P〈0.05） after 6 month of treatment. Conclusion GnRH- a Goserelin combined with add- back therapy provides protection against chemotherapy- induced ovarian damage and reduces adverse drug reactions in patients with ovarian malignant germ celltumors after conservative surgery.