促性腺激素释放激素激动剂联合反加疗法对子宫内膜异位症患者激素水平及低雌激素状态的影响研究-现代医学

促性腺激素释放激素激动剂联合反加疗法对子宫内膜异位症患者激素水平及低雌激素状态的影响研究

单位：惠州市第一人民医院妇科, 广东惠州 516000

分类号：R711.74

出版年·卷·期（页码）：2018·46·第三期（244-248）

摘要：

目的：探讨促性腺激素释放激素激动剂联合反加疗法对子宫内膜异位症患者激素水平及低雌激素的影响。方法：选择2016年1月至2016年12月我院接诊的64例子宫内膜异位症患者，按随机数表法分为观察组及对照组各32例。对照组使用促性腺激素释放激素激动剂进行治疗，观察组在此基础上使用反加疗法进行联合治疗。比较两组的卵泡刺激素（follicle stimulating hormone，FSH）、雌二醇（estradiol，E₂）和促黄体素（luteinizing hormone，LH）水平以及视觉模拟评分法（visual analogue scale，VAS）评分和绝经症状发生情况。结果：治疗后，观察组FSH水平低于对照组[（2.55±1.25） U·L^-1 vs（3.83±1.54） U·L^-1]（P<0.05）；观察组E₂水平高于对照组[（130.26±46.64） pmol·L^-1 vs（103.66±52.09） pmol·L^-1]（P<0.05）；两组LH水平差异无统计学意义[（1.59±0.62） U·L^-1 vs（1.61±0.61） U·L^-1]（P>0.05）；两组VAS评分无明显差异[（2.11±1.97）分vs（2.37±2.00）分]（P>0.05）；观察组潮热、骨痛、情绪波动和性欲减退等症状的发生率均低于对照组[16（50.00%）vs 29（90.63%），2（6.25%）vs 16（50.00%），8（25.00%）vs 26（81.25%），4（12.50%）vs 13（40.63%）]（P<0.05）。结论：促性腺激素释放激素激动剂联合反加疗法治疗子宫内膜异位症可有效缓解低雌激素状态，降低潮热、骨痛、情绪波动和性欲减退等不良反应发生率，疗效可靠，值得应用推广。

Objective: To study the effect of gonadotropin-releasing hormone agonist(GnRH-a) combined with add-back therapy on endocrine hormone level and low estrogen status in patients with endometriosis.Methods: 64 patients of endometriosis who received therapy from Jan 2016 to Dec 2016 were selected. According to random number table, those patients were divided into the observation group and the control group, 32 cases each group. The control group was treated with GnRH-a. On the basis of this, the observation group was treated with add-back therapy. The levels of follicle stimulating hormone (FSH), estradiol (E₂) and luteinizing hormone (LH), visual analogue scale (VAS) score and the incidence of menopausal symptoms were compared between the two groups. Results: After treatment, the FSH level in the observation group was lower than that in the control group[(2.55±1.25)U·L^-1 vs(3.83±1.54)U·L^-1](P<0.05). The level of E₂ in the observation group was higher than that in the control group[(130.26±46.64) pmol·L^-1 vs(103.66±52.09) pmol·L^-1](P<0.05). There was no significant difference in LH level between the two groups[(1.59±0.62)U·L^-1 vs(1.61±0.61)U·L^-1](P>0.05). There was no significant difference in VAS scores between the two groups[(2.11±1.97)scores vs (2.37±2.00)scores](P>0.05). The incidences of hot flashes, bone pain, emotional fluctuation, and sexual hypoactivity in the observation group were lower than those in the control group[16(50.00%) vs29(90.63%),2(6.25%) vs16(50.00%),8(25.00%) vs26(81.25%),4(12.50%) vs13(40.63%)](P<0.05).Conclusion: GnRH-a combined with add-back therapy in the treatment of endometriosis can effectively alleviate the low estrogen state, reduce the incidences of adverse reactions such as hot flashes, bone pain, emotional fluctuation and sexual hypoactivity. The efficacy is safe and reliable, and it is worthy of application and promotion.

参考文献：

[1] 张玲玲,应小燕.腹腔镜手术联合促性腺激素释放激素激动剂治疗子宫内膜异位症疗效的比较研究[J].中国微创外科杂志,2015,15(4):305-308.
[2] 胡晓军,刘玉玲,党群.重度子宫内膜异位症腹腔镜术后应用GnRHa及反向添加疗法的临床效果[J].实用医学杂志,2014,30(4):557-560.
[3] 马小平,成臣,张真真,等.GnRHa联合温肾消癥汤用于腹腔镜子宫内膜异位症术后辅助治疗的临床观察[J].中国中西医结合杂志,2014,34(8):922-925.
[4] BEDAIWY M A, ALLAIRE C, ALFARAJ S.Long-term medical management of endometriosis with dienogest and with a gonadotropin-releasing hormone agonist and add-back hormone therapy[J].Fertil Steril,2017,107(3):537-548.
[5] 宋飞銮,蔡安利,黄丁,等.促性腺激素释放激素激动剂联合去氧孕烯炔雌醇治疗重度子宫内膜异位症的疗效观察[J].中国全科医学,2014,17(27):3245-3248.
[6] SEO J W,LEE D Y,YOON B K,et al.The efficacy of postoperative cyclic oral contraceptives after gonadotropin-releasing hormone agonist therapy to prevent endometrioma recurrence in adolescents[J].J Pediatr Adolesc Gynecol,2017,30(2):223-227.
[7] 刘长青,秦爱新,姜芳芳,等.促性腺激素释放激素激动剂联合坤泰胶囊治疗中重度子宫内膜异位症的临床观察[J].中国中西医结合杂志,2014,34(11):1288-1291.
[8] 王芳芳,傅朝霞,袁庆新.子宫内膜异位症患者腹腔镜术后应用GnRH-a的效果分析[J].中国生化药物杂志,2014,34(7):108-110,113.
[9] TAKAESU Y,NISHI H,KOJIMA J,et al.Dienogest compared with gonadotropin-releasing hormone agonist after conservative surgery for endometriosis[J].J Obstet Gynaecol Res,2016,42(9):1152-1158.
[10] 张春燕,耿爱芝.促性腺激素释放激素激动剂联合克龄蒙在子宫内膜异位症保守性手术后的应用[J].广东医学,2013,34(3):454-457.
[11] 王灵彬,李辞妹.腹腔镜术后药物治疗子宫内膜异位症周期及疗效的临床探讨[J].中国妇幼保健,2013,28(7):1084-1088.
[12] 王晓,孙定苗,何绍民.促性腺激素释放激素激动剂治疗子宫内膜异位症的不良反应分析[J].中国妇幼保健,2013,28(17):2804-2805.
[13] GUL Ü,KACAR BAYRAM A,KENDIRCI M,et al.Pseudotumour cerebri presentation in a child under the gonadotropin-releasing hormone agonist treatment[J].J Clin Res Pediatr Endocrinol,2016,8(3):365-367.
[14] 陈思宇,马彩玲,张媛媛,等.促性腺激素释放激素激动剂联合不同反加疗法治疗子宫内膜异位症[J].中国新药与临床杂志,2013,32(6):464-468.
[15] SADLER GALLAGHER J,FELDMAN H A,STOKES N A,et al.The Effects of gonadotropin-releasing hormone agonist combined with add-back therapy on quality of life for adolescents with endometriosis:a randomized controlled trial[J].J Pediatr Adolesc Gynecol,2017,30(2):215-222.
[16] 陈守真,陆鹏荣.子宫内膜异位症术后短期应用促性腺激素释放激素激动剂及反向添加疗法的临床治疗效果观察[J].中国妇幼保健,2012,27(11):1726-1728.
[17] DIVASTA A D,FELDMAN H A,SADLER GALLAGHER J,et al.Hormonal add-back therapy for females treated with gonadotropin-releasing hormone agonist for endometriosis:a randomized controlled trial[J].Obstet Gynecol,2015,126(3):617-627.
[18] 成开花,张立新.促性腺激素释放激素激动剂治疗子宫内膜异位症对性激素及骨密度的影响及处理方法[J].山东大学学报:医学版,2012,50(3):83-86.
[19] CHEN J M,GAO H Y,DING Y,et al.Efficacy and safety investigation of Kuntai capsule for the add-back therapy of gonadotropin releasing hormone agonist administration to endometriosis patients:a randomized, double-blind, blank-and tibolone-controlled study[J].Chin Med J (Engl),2015,128(4):427-432.
[20] 李雪莹,肖丽,黄薇,等.促性腺激素释放激素激动剂治疗子宫内膜异位症反向添加药物疗效比较研究[J].中国实用妇科与产科杂志,2017,33(6):605-608.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录