性腺激素释放激素激动剂联合戊酸雌二醇对重度子宫内膜异位症患者血清CA125、VEGF水平及远期复发的影响

Effect of GnRHa combined with estradiol valerate on serum levels of CA125, VEGF and long- term recurrence in patients with severe endometriosis

目的探讨性腺激素释放激素激动剂(gonadotropin releasing hormone agonist,GnRHa)联合戊酸雌二醇反向添加疗法对重度子宫内膜异位症(endometriosis,EMs)患者血清糖类抗原CA125、血管内皮生长因子(vascular endothelial growth factor,VEGF)水平及远期复发的影响。方法将2013年5月至2014年5月在广东佛山市第五人民医院住院治疗的90例重症EMs患者进行保守腹腔镜手术治疗后按随机数字表法分为两组。对照组采用注射GnRHa治疗,研究组采用GnRHa联合戊酸雌二醇反向添加疗法治疗。对比两组疗效、抗原CA125及VEGF水平、不良反应、复发率发生情况。结果治疗后两组总有效率(92.86%vs 78.57%),差异无统计学意义(P>0.05);两组治疗后CA125及VEGF水平较治疗前均显著降低,改善程度比较差异无统计学意义(P>0.05);治疗后研究组不良反应如潮热出汗、失眠、关节痛、阴道干燥、性生活障碍、情绪异常的发生率显著低于对照组(P<0.05)。随访2年,两组复发率比较差异无统计学意义(P>0.05)。结论 GnRHa能降低重度EMs保守腹腔镜术后患者CA125、VEGF水平,具有较高的疗效,但不良反应发生率高。GnRHa联合戊酸雌二醇反向添加疗法对疗效、复发率无影响,但能显著减少低雌激素水平带来的不良反应发生率,提高患者的生活质量。

Objective To investigate the effect of reverse add therapy with gonadotropin releasing hormone agonist （GnRHa） combined with estradiol valerate on serum levels of cancer embryo antigen CA125, vascular endothelial growth factor （VEGF） and recurrence of severe endometriosis （EMs） patients. Methods 90 patients with severe EMs treated in Foshan Fifth People ~ Hospital from May 2013 to May 2014 were randomly divided into two groups after conservative laparoscopic surgery. The control group was injected with GnRHa,and GnRHa combined with estradiol valerate was used in the research group. Compare the efficacy of the two groups, the levels of CA125 and VEGF, the incidence of adverse reaction and recurrence. Results Total effective rate of the two groups was compared after treatment （92. 86% vs 78.57% ）. There was no significant difference （ P 〉 0. 05 ）. After treatment, the levels of CA125 and VEGF in both groups were significantly lower than before treatment （ P 〈 0. 05 ）. But the difference between the two groups were not statistically significant （P 〉 0. 05 ）. After treatment, incidence rate of side effects such as hectic fever and sweating, insomnia, joint pain, vaginal dryness, sexual life disorder and abnormal emotion in the research group were significantly lower than that of the control group. The difference was statistically significant （P 〈 0.05 ）. After two years of follow - up, recurrence rates of the two groups were compared and the difference was not statistically significant （ P 〉 0.05 ）. Conclusion GnRHa can decrease the level of CA125 and VEGF in patients with severe EMs after conservative laparoscopic surgery with high curative effect, but the incidence of side effects is also high. GnRHa combined with estradiol valerate therapy has no significant effect on curative effect and relapse rate, but it can significantly reduce the incidence of side effects and improve the quality of life of patients with low estrogen levels.