促性腺激素释放激素激动剂联合克龄蒙在子宫内膜异位症保守性手术治疗后的应用

The postoperative application of Gonadotropin-releasing hormone agonist (GnRHa) combined with Climen in the conservative treatment of endometriosis

目的探讨促性腺激素释放激素激动剂(GnRHa)联合克龄蒙在子宫内膜异位症(EMS)保守性手术治疗后的临床疗效和安全性。方法分析本院2012年1月—2013年1月收治的82例EMS患者,术后按照随机数字表法分为治疗组(n=42)和对照组(n=40)。2组均给予GnRHa,3.6 mg/次,28 d给药一次,连续应用6次。治疗组在此基础上加用克龄蒙,戊酸雌二醇2 mg/d,连用11 d,雌二醇环丙孕酮2 mg/d,连用10 d。连续服用21 d,连续服用6个月。比较2组临床总体疗效、激素水平[间雌二醇(E2)]、尿促卵泡素(FSH)、黄体生成素(LH)变化和VAS疼痛评分、改良Kupperman评分、骨密度、骨钙素(BGP)、复发及1年内妊娠率及安全性等指标。结果对照组完全缓解率为55.0%,部分缓解率为37.5%,复发率为7.5%;治疗组完全缓解率为83.3%,部分缓解率为14.3%,复发率为2.4%。2组上述指标比较差异有统计学意义(χ2=7.778,P<0.05);治疗后2组E2、FSH、LH水平均较治疗前显著降低,且治疗组显著低于对照组,差异有统计学意义(P<0.05);2组治疗后Kupperman评分、BGP、1年内妊娠率比较差异有统计学意义(P<0.05);2组治疗后乏力、性欲减退、头晕、盗汗发生率比较差异有统计学意义(P<0.05)。结论 GnRHa联合克龄蒙治疗EMS能显著提高临床疗效,同时减轻激素水平,提高患者生活质量,减少不良反应。

Objective To explored the clinical efficacy and security of Gonadotropin - re- leasing hormone agonist （GnRHa） combined with Climen in the conservative treatment of en- dometriosis. Methods A total of 82 patients with EMS were analyzed from January 2012 to Jan- uary 2013, the patients were divided into the treatment group （42 patients） and control group（40 patients） by random number table method after operation. The two groups were both given 3.6 mg GnRHa each time in every 28 days and the treatment lasted 6 times. In addition, the patients in the treatment group were continuously given Climen and pentanoic acid estradiol 2 nag a day for 11 days and 2 mg of estradiol cyproterone a day and the treatment lasted for 10 days. A number of index were compared in terms of clinical curative effect, hormonal level[ estradiol （E2）], follicle- stimulating hormone （FSH）, luteinizing hormone （LH）, the score of Visual Analogue Scale （VAS）, bone mineral density, bone density, Bone Gla Protein （BGP）, recurrence, pregnancy rate in one year and safety . Results The entire response rate was respectively 55.0 % and 83.3 %, the partial response rate was 37.5 % and 14.3 %, the recurrence rate was 7.5 % and 2.4 % in control group and the treatment group （P 〈 0.05）. The postoperative levels of E2, FSH, LH were significantly lower than the previous treatment in two groups （P 〈0.05）. The differences were statistically significant according to comparison of the scores of Kupperman, BGP as well as pregnancy rate in one year in the two groups. The results of feebleness, sexual hypoactivity, dizziness and night sweating revealed that the differences were statistically significant （P 〈 0.05）. Conclusion The therapy of GnRHa combined with Climen could improve clinical curative effect, reduce the hormone levels, enhance the quality of life in patients and decrease adverse reactions.