GnRH-a及反加疗法治疗子宫内膜异位症的疗效和安全性分析  

Efficacy and Safety Analysis of the Treatment of Gn RH-a and Add Back Therapy on Endometriosis

作　　者：杨冰[1] 江红[1] 王晓谦[1] 尹茳平[1] 

机构地区：[1]广西桂林医学院附属医院,桂林541001

出　　处：《基因组学与应用生物学》2017年第10期3963-3969,共7页Genomics and Applied Biology

基　　金：广西桂林医学院附属医院资助

摘　　要：为了探讨促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist,Gn RH-a)用于子宫内膜异位症(endometriosis,EM)保守手术后治疗的临床疗效及药物不良反应,我们将108例保守手术治疗后的EM患者随机分为3组:Gn RH-a反加组(34例)、Gn RH-a单药组(34例)和对照组(38例)。其中,Gn RH-a反加组患者于术后皮下注射诺雷得3.6 mg,每月一次,用药第4个月时使用倍美力0.625 mg/d、安宫黄体5 mg/d,持续3个月;Gn RH-a单药组患者术后仅用诺雷得治疗;对照组患者不进行药物治疗。我们发现,Gn RH-a反加组与单药组患者症状完全缓解率显著高于对照组,患者疾病复发率显著低于对照组,且差异均具有统计学意义(p<0.05);Gn RH-a单药组和对照组患者用药后血清黄体生成素(luteotropic hormone,LH)、卵泡雌激素(follicle-stimulating hormone,FSH)和雌二醇(estradiol,E2)水平明显低于用药前,差异有统计学(p<0.05),而Gn RH-a反加疗法在缓解低雌激素症状、减缓骨转换方面是安全有效的,既能减轻Gn RH-a的副作用而又不影响其疗效,说明Gn RH-a反加疗法比单加Gn RH-a时对于子宫内膜异位症保守手术治疗的疗效和安全性更好。我们的研究为子宫内膜异位症的术后治疗提供了一定的理论依据。To explore the clinical efficacy and side effects of gonadotropin-releasing hormone agonist（Gn RH-a）in the treatment of endometriosis after conservative surgery, 108 patients with EM after conservative surgery were randomlydivided into 3 groups： Gn RH-a add back group（n=34）, Gn RH-a single group（n=34） and control group（n=38）.Patients in the Gn RH-a add back group received Gn RH-a（3.6 mg） by subcutaneous injections once a month, and then CEE（0.625 mg/d） and MPA（5 mg/d） were used as add back therapy from the 4 th month for 3 months. Patients in Cn RH-a single group were treated only with Gn R-a after conservative surgery, while patients in the control group did not receive drug treatment. We found that the complete remission rate of Gn RH-a add back group and Gn RH-a single group was obviously higher than that of the control group, and the recurrence rate of treatment groups was significantly lower than that of the control group, and the difference was statistically significant（p〈0.05）.Thelevels ofserum LH, FSH and E2 in Gn RH-a single group and control group were significantly lower than those of before treatment, and the difference was statistically significant（p〈0.05）. In addition, Gn RH-a add back therapy was safe and effective in the alleviation of low estrogen symptoms and reduction of bone turnover, and it could reduce the side effects of Gn RH-a without affecting its efficacy, which meant that Gn RH-a add back therapy was safer andmore effective than Gn RH-a single therapy in the conservative surgery of endometriosis. Our study might provide theoretical foundation for the aftertreatment of endometriosis.

关 键 词：促性腺激素释放激素激动剂 子宫内膜异位症 保守手术 反加疗法 

分 类 号：R711.71[医药卫生—妇产科学]