GnRH-α联合小剂量替勃龙短期治疗子宫内膜异位症对患者骨密度的影响

Effect of GnRH-a combined with low-dose tibolone on bone mineral density in short-term treatment of patients with endometriosis

目的比较促性腺激素释放激素激动剂(GnRH-α)联合小剂量替勃龙短期治疗对子宫内膜异位症患者内分泌水平及骨质丢失的影响。方法选择2015年3月-2016年3月于新疆医科大学第一附属医院妇科一病区行腹腔镜保守性手术,病理结果证实为子宫内膜异位症,术后使用GnRH-α治疗的患者150例,随机分为单用GnRH-α组(A组)和反加组(B组)。B组自第1次注射GnRH-α同时口服替勃龙1.25 mg/d,至治疗结束。记录治疗前后两组内分泌激素、血清骨钙素(BGP)及骨密度变化。并随访两组停药后3、6个月的骨密度变化情况。结果两组患者内分泌水平均较治疗前降低,差异有明显统计学意义(P<0.05);BGP较治疗前有所上升,差异有统计学意义(P<0.05);A组骨密度均较治疗前降低,差异有统计学意义(P<0.05)。停药后3个月及6个月两组骨密度均未恢复至治疗前,但较治疗前比较无统计学差异(P>0.05)。结论单用GnRH-α治疗子宫内膜异位症3个月对骨密度无影响。

Objective To compare the effect of gonadotropin-releasing hormone agonist （GnRH-a） combined with low-dose tibolone on endocrine hormone levels and bone loss in short-term treatment of patients with endometriosis. Methods A total of 150 patients were diagnosed as endometriosis by pathological examiantion after lapaoscopic surgery, then they were treated by GnRH-a after surgery in the hospital from March 2015 to March 2016, all the patients were randomly divided into group A （GnRH-a） and group B （ GnRH-a combined with low-dose tibolone） , the patients in group B were treated by injection of GnRH-a and oral administration of tibolone i 1.25 mg/d） until end of the treatment. The changes of hormones levels, serum bone gla-protein （BGP） levels, and bone mineral density （BMD） in the two groups before and after treatment were recorded. The changes of BMD after three and six months of end of drug withdrawal in the two groups were followed up. Results The levels of hormones in the two groups after treatment were statistically significantly lower than those before treatment （P〈0. 05）; BGP levels in the two groups after treatment were statistically significantly higher than those before treatment （P〈 0. 05） ; in group A, BMD after treatment was statistically significantly lower than that before treatment （P〈0.05） . After three and six months of end of drug withdrawal in the two groups, BMD did not return to the level before treatment, but there was no statistically significant difference （ P〉0. 05 ） . Conclusion GnRH-a used for three months has no impact on BMD of endometriosis patients.