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实验研究

Effect of Gonadotropin Releasing Hormone agonist combined with Add-back therapy on experimental Endometriosis

目的 研究促性腺激素释放激素激动剂 (Gn RH- a)联合倍美力及安宫黄体酮治疗大鼠子宫内膜异位症(EM)的作用。方法 32只手术移植法造模成功大鼠随机分成 4组 :EM组 ,Gn RH- a组 ,Gn RH- a+倍美力 +安宫黄体酮 (反加组 ) ,卵巢切除 (OVX)组。用药 3周 ,测量异位灶体积 ,用放免法测定血激素水平 ,并应用光镜、电镜和组化方法进一步观察。结果 用药 3周 ,与 EM组相比 ,其余 3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 ) ;光镜示表面上皮及腺上皮萎缩 ;电镜示细胞器变性 ,溶酶体增多 ,细胞核不规则 ;异位内膜间质细胞糖原和表面上皮糖原含量显著下降 (P<0 .0 5 )。停药 3个月 ,Gn RH- a组和反加组均有不同程度的复发。结论 Gn RH- a联合反加疗法治疗 EM和 Gn RH- a同样有效 ,血 E2 水平降至一定阀值时效果相近 。

Objective To study the effect of Gonadotropin releasing hormone agonist(GnRH a) combined with premarin and medroxyprogesterone on experimental endometriosis.Methods Thirty two rats were randomized to four groups after endometrium autotransplantation:intact control,GnRH a treatment,GnRH a Premarin medroxyprogesterone treatment(Add back) and ovarioectomy.Three weeks later,endometrium explant was measured and observed microscopily,eletromicroscopily and histochemically.Serum hormone level was determined by radioimmunoassay.Results Explant almost disappeared and estradiol(E 2) level was reduced significantly in all three groups except control.Microscopy examination showed gland epithelium and surficial epithelium atrophy.By electromicroscopy,we could see the number of lysosome increase,cell nucleus and cytoplasmic organoids become irregular or decomposed;Glycogen content in interstitial cell and surficial epithelium decreased significantly.But the explant regrew three months after therapy discontinuation in GnRH a and Add back groups. Conclusion Add back therapy is as effective as GnRH a alone in the treatment of endometriosis.When serum level of E 2 is under a threshold,the same efficacy can be achieved.