促性腺激素释放激素激动剂联合反向添加治疗卵巢子宫内膜异位症的前瞻性研究  

A prospective study of gonadotropin-releasing hormone agonist combined with add-back therapy on ovarian endometriosis

作　　者：王晓楠 郭瑞霞[1] 刘亚娜 张颖[1] 白晶[1] 毛萌[1] Wang Xiaonan;Guo Ruixia;Liu Yana;Zhang Ying;Bai Jing;Mao Meng(Department of Obstetrics and Gynecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院妇产科,郑州450000

出　　处：《中国实用医刊》2023年第1期85-89,共5页Chinese Journal of Practical Medicine

基　　金：河南省中原千人计划-中原名医基金(ZYQR201810107);中青年卫生健康科技创新人才(领军, YXKC2020012);中国人口基金会妇幼关爱基金。

摘　　要：目的探讨促性腺激素释放激素激动剂(GnRH-a)联合反向添加治疗卵巢子宫内膜异位症的有效性及安全性。方法抽取2019年9月至2020年10月郑州大学第一附属医院收治的108例卵巢子宫内膜异位症患者进行前瞻性研究。按照随机数字表法将其分为对照组、治疗组A和治疗组B,每组36例。对照组单用GnRH-a治疗,治疗组A给予GnRH-a联合反向添加雌二醇凝胶及地屈孕酮片,治疗组B给予GnRH-a联合反向添加替勃龙片。比较三组不同治疗时期的性激素水平、改良Kupperman绝经指数(KMI)评分,统计三组治疗结束后1年的复发情况。结果反向添加治疗后第12、16周,治疗组E2水平高于对照组(P<0.05),治疗组A与治疗组B E2水平比较差异未见统计学意义(P>0.05);治疗组KMI评分低于对照组,差异有统计学意义(P<0.05),治疗组A与治疗组B KMI评分比较差异未见统计学意义(P>0.05)。治疗结束后随访1年,对照组复发率为5.6%(2/36),治疗组A复发率为2.8%(1/36),治疗组B复发率为2.8%(1/36),三组复发率比较差异未见统计学意义(P>0.05)。结论 GnRH-a联合雌二醇凝胶和地屈孕酮片反向添加治疗卵巢子宫内膜异位症安全有效。Objective To investigate the efficacy and safety of gonadotropin-releasing hormone agonist(GnRH-a)combined with add-back therapy on ovarian endometriosis.Methods A total of 108 patients with ovarian endometriosis admitted to the First Affiliated Hospital of Zhengzhou University from September 2019 to October 2020 were selected for the prospective study,and the patients were divided into control group,treatment group A and treatment group B according to the random number table method,with 36 cases in each group.The control group was given GnRH-a treatment alone,the treatment group A was given GnRH-a combined with add-back therapy with estradiol gel and dydrogesterone tablets,and the treatment group B was given GnRH-a combined with add-back therapy with tibolone tablets.The levels of sex hormones and modified Kupperman menopause index(KMI)scores were compared among the three groups in different periods of treatment.And the recurrence rates within 1 year after the end of treatment of the three groups were counted.Results At the 12th and 16th weeks after the add-back treatment,the estradiol level of the two treatment groups were higher than that of the control group(P<0.05),and there was no significant difference in the estradiol level between the treatment group A and the treatment group B(P>0.05);the KMI of the two treatment groups were lower than that of the control group,and the difference was significant(P<0.05);there was no significant difference in the KMI scores between the treatment group A and the treatment group B(P>0.05).During 1-year follow-up after treatment,the recurrence rate of the control group was 5.6%(2/36),the recurrence rate of the treatment group A was 2.8%(1/36),and the recurrence rate of the treatment group B was 2.8%(1/36),there was no significant difference in the recurrence rate among the three groups(P>0.05).Conclusions GnRH-a combined with add-back therapy with estradiol gel and dydrogesterone tablets is safe and effective in the treatment of ovarian endometriosis.

关 键 词：子宫内膜异位症 反向添加治疗 雌二醇凝胶 促性腺激素释放激素激动剂 

分 类 号：R711.71[医药卫生—妇产科学]