醋酸亮丙瑞林联合反加不同剂量替勃龙对子宫内膜异位症患者的疗效及生活质量的影响

Effect of leuprorelin acetate combined with different doses of tibolone on the therapeutic efficacy and quality of life in patients with endometriosis

目的探讨醋酸亮丙瑞林联合反加不同剂量替勃龙对子宫内膜异位症患者疗效及生活质量的影响。方法收集我院2018年1月至2019年1月收治的子宫内膜异位症患者72例,随机分为对照组、观察A组及观察B组,每组24例。三组患者均接受腹腔镜手术,术后第2天,对所有患者于腹部前壁皮下注射醋酸亮丙瑞林缓释微球3.75 mg,每28天注射1次。第2次注射后,对照组应用钙尔奇D碳酸钙D3片600 mg,观察A组应用替勃龙片1.25 mg/(次·d),观察B组应用替勃龙片2.5 mg/(次·d)。所有患者注射醋酸亮丙瑞林缓释微球6次,治疗6个月。比较三组患者临床疗效、激素、骨钙素水平、视觉模拟评分法(VAS)评分、Kupperman评分、生活质量、不良反应发生率。结果治疗后,与对照组比较,观察组临床总有效率较高(P<0.05),FSH、E2、LH水平较高(P<0.05),BGP水平较低(P<0.05);与观察A组比较,观察B组FSH、E2、LH水平较高(P<0.05),BGP水平较低(P<0.05)。治疗后,与对照组比较,观察组VAS评分、Kupperman评分降低(P<0.05),观察A组、B组比较差异无统计学意义(P>0.05)。治疗后,观察组躯体功能、心理功能、社会功能及物质生活状态等生活质量评分高于对照组(P<0.05),观察A组、B组生活质量评分比较差异无统计学意义(P>0.05)。结论醋酸亮丙瑞林与反加替勃龙联合治疗能提高子宫内膜异位症患者的临床疗效及生活质量,改善患者疼痛和骨代谢;高剂量、低剂量替勃龙的临床疗效、疼痛评分和生活质量比较差异无统计学意义,小剂量替勃龙不良反应发生率较低。

Objective To investigate the effect of leuprorelin acetate combined with different doses of tibolone on the therapeutic efficacy and quality of life in patients with endometriosis.Methods Totally 72 patients with endometriosis admitted to our hospital from January 2018 to January 2019 were randomly divided into control group,observation group A and observation group B,24 cases in each group.All the patients received laparoscopic surgery,and leuprorelin acetate 3.75 mg sustained-release microspheres were subcutaneously injected into the anterior abdominal wall of patients at the second day after operation,once every 28 days.After the second injection,patients in control group received calcium carbonate D3 tablet 600 mg,and the patients in observation group A and group B received tibolone tablet,1.5 mg and 2.5 mg per time daily.All patients were injected with leuprorelin acetate sustained-release microspheres for 6 times for a period of 6 months.The clinical efficacy,hormone,osteocalcin level,VAS score,Kupperman score,quality of life and incidence of adverse reactions were compared among the three groups.Results After treatment,compared with control group,the total clinical effective rate and the levels of FSH,E2 and LH of observation groups were higher(both P<0.05),while the level of BGP was lower(P<0.05);compared with observation group A,the levels of FSH,E2 and LH of observation group B were higher(P<0.05),while the level of BGP was lower(P<0.05).After treatment,the VAS score and Kupperman score of observation groups were lower than those of control group(P<0.05),and there was no significant difference between the two observation groups(P>0.05);the scores of quality of life in observation groups,including physical function,psychological function,social function and material life state,were higher than those in control group(P<0.05),and there was no significant difference between the two observation groups(P>0.05).Conclusion The combination use of leuprorelin acetate with tibolone can improve the clinical efficacy and quality of life in patients with endometriosis,and improve the pain and bone metabolism.There is no significant difference in the clinical efficacy,VAS score or quality of life between the high-dose and low-dose tibolone,and the incidence rate of adverse reactions of low-dose tibolone is lower.