GnRH-a联合地屈孕酮和戊酸雌二醇对子宫内膜异位症患者激素水平及骨密度的影响

Effect of GnRH-a combined with progesterone and estradiol on the level of hor- mone and bone mineral density in patients with endometriosis

目的研究促性腺激素释放激素激动剂（GnRH-a）联合地屈孕酮和戊酸雌二醇对子宫内膜异位症患者激素水平的影响。方法选择经腹腔镜或开腹手术确诊并治疗2个月内的Ⅲ-Ⅳ期子宫内膜异位症患者160例，根据随机数字表法分为对照组和观察组（各80例）。对照组给予GnRH·a3．6mg，sc，每28天注射1次，共3次；观察组患者同时口服戊酸雌二醇0．5mg及地屈孕酮5mg，治疗3个月。于治疗前后测定2组患者激素、骨密度（BMD）及血清骨钙素（BGP）水平，采用疼痛数字评价量表（NRS）评定疼痛程度，Kupperman评分（KMI）法评定围绝经期症状的严重程度，并随访治疗结束后第1次月经复潮情况及NRS评分。结果治疗后2组NRS总分及盆腔痛、性交痛、痛经各项评分均较治疗前降低（均P〈0．05），观察组NRS总分（1．7±0．2）分，低于对照组（3．6±0．5）分；观察组盆腔痛、性交痛、痛经各项NRS评分低于对照组（均P〈0．05）；各组激素水平均降低，但观察组E2水平高于对照组（P〈0．05），FSH、LH水平低于对照组（P〈0．05）；观察组BMD高于对照组（P〈0．05），BGP水平及骨丢失率低于对照组（P〈0．05）；观察组KMI评分低于对照组（P〈0．05）。结论GnRH-8联合地屈孕酮和戊酸雌二醇可调节子宫内膜异位症激素水平，缓解疼痛程度，抑制骨流失，对骨质起到一定保护作用。

AIM To study the effect of GnRH-a combined with progesterone and estradiol on the level of hormone and bone mineral density in patients with endometriosis. METHODS Totally 160 patients with m - IV endometriosisby laparoscopy or laparotomy and treatment within two months were selected, and were randomly di- vided into control group and the observation group （80 patients in each group）according to the random number ta- ble. The patients of control group were given subcutaneous injection of GnRH-a, 3.6 mg, once every 28 days, a total of $ times; the patients in the observation group were also given estradiol valerate 0.5 mg and dydrogesterone 5 mg for 3 months. Before and after the treatment, the hormone levels, pain evaluation of digital amount table （NRS） , peri menopausal symptoms severity （Kupperman score and KMI） , bone mineral density （BMD） and ser- um osteocalcin （BGP） levels were determined and compared between 2 groups. RESULTS After the treatment, the scores of NRS and pelvic pain, sexual intercourse pain, dysmenorrhea of 2 groups were lower than those before treatment （P 〈 0.05） ; the scores of NRS in the observation group were （ 1.7 ± 0.2） which were lower than those of the control group （3.6 ± 0.5） ; the NRS scores of pelvic pain, sexual intercourse pain and dysmenorrhea in ob- servation group were lower than those of the control group （P 〈 0.05）. After the treatment, the levels of hormone were decreased, but the level of Ez in observation group was higher than that of the control group （P 〈 0.05） ; thelevels of FSH and LH were lower than those of the control group （ P 〈 0.05 ）. In the observation group, the level of BMD was higher than that of the control group （P 〈 0.05） , the levels of BGP and bone loss rate were lower than those of the control group, P 〈 0.05 ; the KMI scores of the observation group were lower than those of the control group （P 〈 O. 05）. CONCLUSION GnRH-a combined with estradiol and progesterone can regulate the hormone level of endometriosis, relieve the pain and inhibit bone loss, and play a protective role on bone.