雌孕激素反向添加法在GnRHa治疗子宫内膜异位症中的疗效及安全性研究

Efficacy and safety of the GnRHa combined with hormone in the treatment of endometriosis

目的:探讨在促性腺激素释放激素激动剂(GnRHa)治疗方案中联合运用雌孕激素反向添加对子宫内膜异位症病人的治疗效果,并分析临床安全性。方法:选择子宫内膜异位症病人124例,按照完全随机分组原则分为对照组和观察组。2组病人均首先接受保守性手术治疗,其后,对照组病人接受皮下注射诺雷得治疗,观察组病人接受皮下注射诺雷得联合口服地屈孕酮和戊酸雌二醇治疗。分别评估病人治疗前后盆腔痛、性交痛和痛经的疼痛程度;测定不同时间点病人血清雌激素(E2)、黄体生成素(LH)和卵泡刺激素(FSH)水平;评估治疗后病人性欲减退、失眠、骨痛等绝经症状的发生率。结果:治疗前,2组病人盆腔痛、性交痛、痛经痛得分以及E2和LH、FSH表达水平差异均无统计学意义(P> 0. 05),治疗后,2组病人的盆腔痛和性交痛得分显著低于治疗前,疼痛感均明显降低(P <0. 01),同时2组病人的LH、FSH表达水平显著低于治疗前(P <0. 01);此外,治疗后2组病人在失眠、盗汗、性欲减退这三种绝经症状的发生率上差异无统计学意义(P> 0. 05),但在潮热、情绪波动和骨痛3种绝经症状的发生率上观察组病人低于对照组病人(P> 0. 05)。结论:雌孕激素反向添加法在GnRHa治疗子宫内膜异位症中可以使维持雌激素处于正常水平,改善绝经症状,缓解疼痛,值得临床推广。

Objective: To investigate the effects and safety of the GnRHa combined with hormone in the treatment of endometriosis.Methods: One hundred and twenty-four patients with endometriosis were randomly divided into the control group and experimental group. Two groups were treated with conservative surgery,then the control group were additionally treated with Zoladex by subcutaneous injection,and the experimental group were additionally treated with Zoladex by subcutaneous injection combined with flexion progesterone and estradiol valerate by oral. The pain degrees of the pelvic pain,dyspareunia and dysmenorrhea were evaluated before and after treatment. The serum levels of estrogen( E2),LH and follicle stimulating hormone( FSH) at different time-points were measured. The incidence rate of insomnia,libido and bone pain in two groups were evaluated after treatment. Results: Before treatment,the differences of the scores of pelvic pain,dyspareunia and dysmenorrhea,and serum levels of E2,LH and FSH between two groups were not statistically significant( P > 0. 05). After treatment,the scores of pelvic pain and dyspareunia,and its pain degree in two groups significantly decreased compared before treatment( P < 0. 01),and the serum levels of LH and FSH were significantly lower than those before treatment( P < 0. 01). After treatment,the differences of the incidence rates of the insomnia,night sweat,sexual desire drop between two groups were not statistically significant( P > 0. 05),but the incidence rates of hectic fever,mood swing and bone pain in experimental group were significantly lower than those in control group( P < 0. 05). Conclusions: The GnRHa combined with hormone in the treatment of endometriosis can maintain the normal level of estrogen,improve menopausal symptoms and relieve pain,and which is worthy of clinical promotion.