克龄蒙反加疗法对子宫内膜异位症患者血清性激素及GnRHa所致不良反应的影响

Effect of add-back therapy with climen on the serum levels of sex hormone and the adverse reactions caused by GnRHa in patients with endometriosis

目的 :探讨克龄蒙反加疗法对子宫内膜异位症患者血清性激素及GnRHa所致不良反应的影响。方法 :选取行腹腔镜手术治疗后的子宫内膜异位症患者100例,依据随机数表法分为对照组和反加组各50例,对照组患者于月经来潮3 d后给予3.75 mg曲普瑞林皮下注射治疗,反加组患者在此基础上给予口服克龄蒙治疗,采用酶联免疫吸附法(ELISA)检测血清雌二醇(E2)、黄体期的卵泡刺激素(FSH)、黄体生成素(LH)水平,采用视觉模拟评分法(VAS)评估疼痛程度,随访6个月,统计分析所有患者妊娠、复发和治疗前后血清FSH、E2、LH水平、治疗前、治疗后2、4、6个月的疼痛程度及治疗期间不良反应发生情况。结果 :对照组和反加组患者妊娠率和复发率基本相同(P>0.05);反加组患者治疗后E2、LH水平明显高于对照组(P<0.05);反加组患者FSH水平、治疗后2、4、6个月的VAS得分及不良反应发生率明显低于对照组(P<0.05)。结论 :克龄蒙反加疗法对子宫内膜异位症无不良影响,可有效改善患者血清性激素水平和疼痛症状,减少治疗期间不良反应的发生。

Objective： To discuss the effect of add-back therapy with climen on the serum levels of sex hormone and the adverse reactions caused by gonadotrophin releasing hormone agonist（Gn RHa） in patients with endometriosis. Methods： One hundred patients with endometriosis, who underwent laparoscopic surgery, were selected and divided into a control group and an add-back therapy group according to the random number table with 50 cases each. The control group was treated by subcutaneous injection of 3.75 mg triptorelin three days after menstrual cramps while the add-back therapy group by oral climen besides triptorelin. The levels of serum estradiol（E2）, luteal phase follicle-stimulating hormone（FSH）, luteinizing hormone（LH） were determined by enzyme-linked immunosorbent（ELISA）, and pain intensity was assessed by visual analogue scale（VAS）. All the patients were followed up for 6 months, and the indexes mentioned above at different time points and the adverse reactions occurred during the treatment were statistically analyzed. Results： The rates of pregnancy and recurrence were basically same in all the patients（P〉0.05）. The E2 and LH levels were significantly higher in the add-back therapy group than in the control group（P〈0.05） while the FSH levels, VAS scores at 2, 4, 6 months after treatment and the incidence of adverse reactions were significantly lower in the add-back therapy group than in the control group（P〈0.05）. Conclusion： The add-back therapy with climen shows no adverse effect in the treatment of endometriosis, can effectively improve the serum levels of sex hormone and pain symptoms of the patients and reduce the occurrence of adverse reactions during the treatment.