子宫内膜异位症保留生育功能术后应用性腺激素释放激素激动剂联合不同反加疗法的效果及对相关血清学指标的影响  

Effect of gonadotropin releasing hormone agonist combined with different add-back therapy and its influence on the related serological indexes after the operation of maintaining fertility function of endometriosis

作　　者：罗宁[1] Luo Ning(Department of Gynecology,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属南京医院妇科,210000

出　　处：《中国综合临床》2020年第5期393-398,共6页Clinical Medicine of China

摘　　要：目的分析子宫内膜异位症保留生育功能手术后应用性腺激素释放激素激动剂联合不同反加疗法的临床疗效及相关血清学指标的变化。方法选取2016年5月至2018年7月在南京医科大学附属南京医院就诊并确诊为子宫内膜异位症Ⅲ、Ⅳ期的108例患者的临床资料,采用回顾性病例对照研究进行分析。按干预方法不同将其分为3组(性腺激素释放激素激动剂组、性腺激素释放激素激动剂+戊酸雌二醇组、性腺激素释放激素激动剂+替勃龙组),每组36例。3组患者均接受腹腔镜下保留生育功能手术。术后,性腺激素释放激素激动剂组采用性腺激素释放激素激动剂药物治疗,性腺激素释放激素激动剂+戊酸雌二醇组采用性腺激素释放激素激动剂联合戊酸雌二醇反加疗法,性腺激素释放激素激动剂+替勃龙组采用性腺激素释放激素激动剂联合替勃龙反加疗法。比较3组患者疼痛视觉模拟评分(visual analog scale,VAS)、更年期综合征改良Kupperman评分,卵泡刺激素(follicle-stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇,肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素6(interleukin-6,IL-6)及不良反应发生率的差异。结果治疗前3组VAS评分分别为(6.77±2.15)、(6.86±1.97)、(6.73±2.06)分,改良Kupperman评分分别为(8.15±1.36)、(8.22±1.29)、(8.19±1.31)分;FSH分别为(5.22±1.21)、(5.18±1.19)、(5.26±1.23)U/L;LH分别为(6.89±1.64)、(7.12±1.57)U/L、(7.04±1.61)U/L;雌二醇分别为(152.64±23.57)、(161.65±20.48)、(158.49±19.37)pmol/L;TNF-α分别为(41.25±6.49)、(38.62±7.41)、(38.18±7.35)mg/L,IL-6分别为(127.64±16.35)ng/L、(126.73±15.84)ng/L、(128.23±15.91)ng/L;治疗后VAS评分分别为(1.71±0.63)、(1.82±0.59)、(1.74±0.55)分,改良Kupperman评分分别为(17.33±3.67)、(12.41±3.35)、(14.45±3.18)分;FSH分别为(1.62±0.39)、(1.74±0.43)、(1.78±0.45)U/L,LH分别为(1.96±0.59)、(2.11±0.4Objective To analyze the application and serological effect of add-back drugs during gonadotropin releasing hormone agonist(GnRH-a)administration for patients with endometriosis after laparoscopic treatment.Methods From May 2016 to July 2018,the clinical data of 108 patients with stage III and IV endometriosis diagnosed in Nanjing Hospital Affiliated to Nanjing Medical University were analyzed by retrospective case-control study.According to different intervention methods,they were divided into three groups(gonadal hormone releasing hormone agonist group,gonadal hormone releasing hormone agonist+estradiol valerate group,gonadal hormone releasing hormone agonist+tibolone group),36 cases in each group.All the patients in the three groups received laparoscopic fertility preserving surgery.After the operation,the gonadal hormone releasing hormone agonist group was treated with gonadal hormone releasing hormone agonist,the gonadal hormone releasing hormone agonist+estradiol valerate group was treated with gonadal hormone releasing hormone agonist and estradiol valerate,the gonadal hormone releasing hormone agonist+tibolone group was treated with gonadal hormone releasing hormone agonist and tibolone.The visual analog scale(VAS),modified Kupperman score,follicular stimulating hormone(FSH),luteinizing hormone(LH),estradiol,tumor necrosis factor(TNF)-α,interleukin(IL)-6 were evaluated and compared among the three groups.Results Before treatment,the VAS scores of the three groups were(6.77±2.15),(6.86±1.97),(6.73±2.06),the modified Kupperman scores were(8.15±1.36),(8.22±1.29),(8.19±1.31),the FSH scores were(5.22±1.21),(5.18±1.19),(5.26±1.23)U/L,the LH scores were(6.89±1.64),(7.12±1.57)U/L,and the estradiol scores were(152.64±23.57),(161.65±20.48),(158.49±19.37)pmol/L.TNF-αwere(41.25±6.49),(38.62±7.41),(38.18±7.35)mg/L,IL-6 were(127.64±16.35),(126.73±15.84),and(128.23±15.91)ng/L,respectively.After treatment,VAS scores were(1.71±0.63),(1.82±0.59),(1.74±0.55),modified Kupperman scores were(17.33±3.6

关 键 词：子宫内膜异位症 性腺激素释放激素激动剂 反加疗法 

分 类 号：R713[医药卫生—妇产科学]