激素反添加法在GnRHa治疗EMS中的疗效及安全性  

Efficacy and safety of hormone anti-add method in GnRHa for treatment of endometriosis

作　　者：王越凤[1] 刘高焰 陈涛[1] 

机构地区：[1]四川省彭州市人民医院,四川彭州611930

出　　处：《中国妇幼健康研究》2016年第6期748-751,共4页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨促性腺激素释放激素激动剂（GnRHa）联合激素反添加法在治疗子宫内膜异位症（EMS）中的有效性及安全性。方法将2012年1月至2013年7月经彭州市人民医院诊治并确诊为子宫内膜异位症的患者共计108例随机分入反添加组和单用组,每组各54例,比较两组患者治疗前后或月经来潮后Kupperman评分、绝经症状、激素水平、骨密度及VAS评分上的差异。结果治疗末,两组患者Kupperman评分均有不同程度上升,但反添加组上升程度低于单用组,差异具有统计学意义（t=7.332,P〈0.01）,且反添加组绝经症状以潮热改善为主;在激素水平上,反添加组雌二醇（E2）水平（22.62±10.42）pg/m L略高于单用组（14.35±7.42）pg/m L,促卵泡激素（FSH）水平（2.41±0.93）m IU/m L略低于单用组（5.23±1.89）m IU/m L;此外,反添加组治疗前后骨质无明显流失,而单用组在左髋部、腰椎L1~4骨质流失较为明显（t左髋部=10.445、t腰椎L1~4=5.531,均P〈0.05）;另外,对于痛经、盆腔痛、性交痛等疼痛指标,反添加组改善效果优于单用组。结论 GnRHa联合激素反添加法在治疗子宫内膜异位症时,不仅可使部分激素水平处于有效治疗窗内,减少绝经症状的发生,同时还有助于延缓骨质流失,减少疼痛症状,从而提高患者服药依从性及治疗效果,值得临床推广应用。Objective To discuss the efficacy and safety of gonadotropin-releasing hormone agonist（ GnRHa） combining hormone anti-add method in the treatment of endometriosis（ EMS）. Methods From January 2012 to July 2013 totally 108 cases of EMS confirmed in People＇s Hospital of Pengzhou City were randomly divided into anti-add method group and single therapy group with 54 cases in each.Comparison was made between two groups in Kupperman score before and after treatment or after menstrual onset,menopausal symptoms,hormone levels,bone density,and scores on VAS. Results At the end of treatment,Kupperman increased to various degrees in both groups. The extent of increase in the anti-add method group was less than single therapy group with significant difference（ t = 7. 332,P〈0. 01）,and the dominant improvement was hot flushes in the former group. Considering hormone levels,E2 level in anti-add method group（ 22. 62 ± 10. 42） pg/m L was slightly higher than that of single therapy group（ 14. 35 ± 7. 42） pg/m L,and FSH level（ 2. 41 ± 0. 93）m IU / m L was slightly lower than that of single therapy group（ 5. 23 ± 1. 89） m IU / m L. In addition,the anti-add method group had no significant bone loss,while bone loss was significant in left hip and L1-4 lumbar spine in single therapy group（ t value was 10. 445 and5. 531,respectively,both P〈0. 05）. For improvement of pain indexes such as dysmenorrhea,pelvic pain and sexual pain,anti-add method group obtained better results. Conclusion In the treatment of EMS,GnRHa combining hormone anti-add method can not only keep some hormone levels within therapeutic window and reduce the incidence of menopausal symptoms,but also help to slow down bone loss and reduce pain. Thereby it can improve patients＇ medication compliance and treatment efficacy,and it is worthy of clinical application.

关 键 词：子宫内膜异位症 促性腺激素释放激素激动剂 反加法 骨密度 

分 类 号：R711.71[医药卫生—妇产科学]