腹腔镜联合GnRH-a治疗对EMS伴不孕症性激素、CA125水平及妊娠率的影响

Effect of laparoscopy combined with GnRH-a therapy on sex hormone and CA125 levels and pregnancy rate in EMS patients with infertility

目的探讨腹腔镜联合促性腺激素释放激素激动剂(GnRH-a)治疗对子宫内膜异位症(EMS)伴不孕症性激素、糖类抗原125(CA125)水平及妊娠率的影响。方法选择滨州医学院附属医院妇产科在2019年1月至2021年1月收治的98例EMS伴不孕症患者作为观察对象,按随机数表法分为C组和O组,每组各49例。C组采取腹腔镜手术治疗,O组采用腹腔镜联合GnRH-a(亮丙瑞林)治疗。比较两组的性激素水平、血清抗米勒管激素(AMH)和CA125水平、随访6、12个月的妊娠率与复发率。结果治疗后(C组术后3个月,O组持续用药3个月结束后),O组的血清黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E_(2))水平低于C组,差异有统计学意义(P<0.05)。O组的血清AMH水平高于C组,CA125水平低于C组,差异有统计学意义(P<0.05)。随访6个月,两组的妊娠率比较差异无统计学意义(P>0.05);随访12个月,O组的妊娠率高于C组,差异有统计学意义(P<0.05),EMS复发率低于C组,差异有统计学意义(P<0.05)。结论腹腔镜联合GnRH-a显著调节EMS伴不孕症患者的性激素水平,改善病情和卵巢功能,提高其妊娠率并减少疾病复发。

Objective To explore the effect of laparoscopy combined with gonadotropin-releasing hormone agonist(GnRH-a)on the sex hormone and carbohydrate antigen 125(CA125)levels and pregnancy rate in endometriosis(EMS)patients with infertility.Methods A total of 98 EMS patients with infertility in the Department of Obstetrics and Gynecology,Binzhou Medical University Hospital from January 2019 to January 2021 were selected as the observation objects,and were divided into Group C and Group O by the random number table method,with 49 patients in each group.Group C was treated with laparoscopic surgery,while group O was treated with laparoscopy combined with GnRH-a(leuprorelin).Levels of sex hormone,serum anti-mullerian hormone(AMH)and CA125,and rates of pregnancy and recurrence after 6 and 12 months of follow-up were compared between the two groups.Results After treatment(3 months after operation in group C and 3 months after continuous medication in group O),the levels of serum luteinizing hormone(LH),follicle stimulating hormone(FSH)and estradiol(E_(2))in group O were lower than those in group C,with statistically significant differences(P<0.05).The serum AMH level of group O was higher than that of group C,and the serum CA125 level of group O was lower than that of group C,with statistically significant differences(P<0.05).After 6 months of follow-up,there was no significant difference in pregnancy rate between the two groups(P>0.05).After 12 months of follow-up,the pregnancy rate in group O was higher than that in group C,with statistically significant difference(P<0.05);The recurrence rate of EMS was lower than that in group C with statistically significant difference(P<0.05).Conclusion Laparoscopy combined with GnRH-a can significantly regulate sex hormone levels,improve disease condition and ovarian function,increase pregnancy rate and reduce disease recurrence in EMS patients with inferti lity.