促性腺激素释放激素激动剂及联合激素反加疗法治疗子宫内膜异位症对骨密度1年的影响

A Year effect on bone mineral density in the Treatment of Endometriosis with Gonadotropin Releasing Hormone Agonist Combined with Add back Therapy

目的 比较促性腺激素释放激素激动剂 (Gn RH- a)联合与不联合激素反加疗法治疗子宫内膜异位症随访 1年对骨密度的影响。方法 将 34例确诊为子宫内膜异位症及子宫肌腺症患者随机分成两组 :A组 17例 ,Goserelin3.6 mg,皮下注射 ,4周 1次 ;B组 17例 ,Goserelin同 A组 +倍美力 0 .3mg (每日口服 1次 ) +安宫黄体酮 5 mg(每日口服 1次 ) ,疗程 12～ 2 4周 ,比较两组治疗后血激素水平及治疗后 2 4周、停药后 6个月、 12个月骨密度变化。结果 两组血雌二醇均降至绝经期水平 ,A组比 B组下降更明显 (P<0 .0 5 )。A组于治疗 2 4周、停药后 6、12个月腰椎骨丢失率分别为 4 .15 %、 3.0 2 %和 1.4 5 % ,股骨颈骨丢失率分别为 2 .93%、 2 .13%和 0 .87% ;B组分别为 2 .39%、 1.75 %、 0 .4 4 %和 1.75 %、 1.12 %、 0 .2 8%。结论 Gn RH- a联合激素反加疗法与 Gn RH- a一样在治疗期间保持低雌激素状态 ,随访 1年 Gn RH- a组骨密度不完全恢复 ,经联合激素反加疗法可使骨密度下降更缓慢 。

Objective\ To evaluate the efficacy and safety of GnRH a alone and in combination with hormone add back therapy in treating endometriosis.Methods\ Thirty two patients with endometriosis were divided into two groups.Group A(17 patients)was treated by goserelin depot 3 6mg subcutaneously every 4 weeks,group B(17 patients)was treated by goserelin depot plus conjugated equine estrogens 0 3mg daily and medroxyprogesterone acetate(MPA)5mg daily for 12 or 24 weeks.Symptoms and signs were recorded before and after the treatment.Serum estradiol was measured by immunoassay before and 12 weeks after treatment and bone density was measured after 12 and 24 weeks.Results Total subjective symptom scores of group A showed 82 6% decrease after 12 weeks and 93 5% after 24 weeks of treatment(P<0 01),while reductions in ovary endometrial cyst were 42% and 71%,respectively(P<0 01) Of group B,there were 79 1% and 93 4% decreases in total subjective symptom scores after 12 and 24 weeks of treatment(P<0 01)with a reduction of 44% and 82% in ovary endometrial cyst,respectively(P<0 01) Suppression of E 2 level in group A was more significantly than in group B(P<0 05) Also hypoestrogenic side effects such as hot flush were more common in group A(87 5%)than in group B(25%).In group A,bone loss rates of lumber and femoral neck were 4 32% and 2 97% respectively 24 weeks later.In group B,they were 2 35% and 1 76%.Conclusions Add back therapy with conjugated equine estrogens and MPA was as effective as GnRH a alone and can alleviate GnRH a induced bone density decrease,hot flush and other side effects.Its suitable for long time therapy. Endometriosis;GnRH a;Add back therapy;Bone mineral density