促性腺激素释放激素激动剂联合反加疗法治疗大鼠子宫内膜异位症的骨形态计量学研究

Effect of Gonadotropin Releasing Hormone Agonist Combined with Add-back Therapy on Bone Histomorphometric Parameters of Rats with Experimental Endometriosis

目的 观察应用促性腺激素释放激素激动剂 (Gn RH- a)联合不同剂量的雌激素对大鼠子宫内膜异位症(EMT)的疗效及对大鼠股骨远端骨干骨形态参数的影响。方法 6 0只手术移植法造模成功的大鼠随机分成 5组 :A组(对照 ) ,B组 (Gn RH- a) ,C组 (Gn RH- a+倍美力 0 .0 2 mg.kg- 1 ) ,D组 (Gn RH- a+倍美力 0 .1mg.kg- 1 ) ,E组 (Gn RH-a+倍美力 0 .5 mg. kg- 1 )。用药 3周及停药后 3个月 ,测量异位灶体积 ,用放免法测定血激素水平 ,并用骨形态计量学方法研究各组骨形态和动力学参数的变化。结果 用药 3周后 ,与 A组相比 ,B、 C、 D三组异位囊肿均消失 (P<0 .0 1) ,雌二醇 (E2 )水平显著下降 (P<0 .0 5 ) ;E组异位囊肿也有减小 ,但 E2 水平下降不明显。从骨形态参数可以看出 B、C组有明显的骨密度降低 ,D、E组则基本和对照组一样不存在骨密度降低。停药 12周后 ,C组和 D组均有不同程度的复发。结论 在一定剂量范围倍美力不影响 Gn RH- a治疗 EMT的效果 ,而且能预防骨密度的下降。

Objective To study the effect of Gonadotropin releasing hormone agonist(GnRHa)combined with premarin on rat experimental endometriosis and bone histomorphometric parameters.Method Sixty rats were randomized to five groups after endometrium autotransplantation:control(A),GnRHa treatment(B),GnRHa+Premarin 0 02mg.kg 1 (C),GnRHa+Premarin 0 1mg kg 1 (D),GnRHa+Premarin 0 5mg kg 1 (E).Volume of endometrium explant was measured,serum hormones levels were determined by radioimmunoassay,effects of medication on bone microarchitecture and dynamics were evaluated by bone histomorphometrics after three weeks and after three months respectively.Results Explant almost disappeared and estradiol(E 2)level was reduced significantly in group B,C and D,explant in group E was reduced with a slight decrease in E 2 level. after three weeks treatment.Bone denesity of group B and C was reduced,but there was no significant change in group D and E.The explant regrew twenty weeks after therapy discontinuation in group D and E.Conclusion\ Add back therapy is as effective as GnRHa alone in the treatment of endometriosis and can avoid GnRHa a induced bone density decrease.