摘要
目的 观察促性腺激素释放激素激动剂(GnRH-a)及地诺孕素序贯疗法对子宫内膜异位症(EMT)的应用效果。方法 该研究为前瞻性研究,研究对象为安阳市人民医院2022年1月至2023年1月期间收治的102例EMT患者,应用电脑随机分组法生成随机序列,并进行分配隐藏后,将入组患者分别列为常规组(51例)和序贯组(51例),两组患者均实施手术治疗,常规组仅采用GnRH-a进行术后维持治疗,序贯组采用GnRH-a序贯地诺孕素进行术后维持治疗,比较两组患者的激素水平[雌二醇(E2)、孕酮(P)、促卵泡生成素(FSH)、促黄体生成素(LH)],子宫内膜受容性[胎盘蛋白14(PP14)、半乳糖凝集素-1(Gal-1)表达评分、骨桥蛋白(OPN)分子表达量、子宫内膜厚度],子宫内膜新生血管生成指标[血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)、肿瘤坏死因子-α(TNF-α)、糖类抗原125(CA125)]及低雌激素所致不良反应(盗汗潮热、骨关节痛、性欲减退、失眠)。结果 在不同治疗方案下,序贯组的E2、P、FSH、LH分别为(102.33±20.45) pmol/L、(0.38±0.11) nmol/L、(3.52±0.36) U/L、(3.41±0.26) U/L,均低于常规组[(117.45±20.36) pmol/L、(0.71±0.18) nmol/L、(4.41±1.26) U/L、(4.35±1.21) U/L](t=3.742、 11.172、4.850、5.424,P<0.05);序贯组的PP14、Gal-1、OPN、子宫内膜厚度分别为(25.33±5.25)μg/L、(5.41±1.44)分、(45.29±10.36) kDa、(10.32±2.27) mm,均高于常规组[(22.62±5.14)μg/L、(4.57±1.52)分、(40.36±10.23) kDa、(8.33±1.52)mm](t=2.634、2.865、2.418、5.202,P<0.05);序贯组的VEGF、bFGF、TNF-α、CA125分别为[(20.36±5.33)pg/mL、(10.22±2.45) pg/mL、(21.33±5.28) ng/mL、(30.23±5.16) U/mL],均低于常规组[(23.39±5.34) pg/mL、(12.42±3.24) pg/mL、(24.19±5.33) ng/mL、(33.46±5.37) U/mL](t=2.868、3.868、2.722、3.097,P<0.05);序贯组的低激素所致不良反应发生率[3.92%(2/51)]低于常规组[21.57%(11/51)](χ^(2)=7.141,P<0.05)。结论 GnRH-a序贯地诺孕素治疗EMT能改善患者激素水平及子宫内膜受容性,对抑制子宫内膜新生血管生成、降低低雌激素所致不良反应发生风险均有积极意义。
【Objective】To observe the application effect of GnRH-a and sequential therapy with dienogest on endometriosis(EMT).【Methods】It was a prospective study,with 102 EMT patients admitted to Anyang People's Hospital from January 2022 to January 2023 as the research subjects.Random sequences were generated using computer randomization,and after allocation concealment,the enrolled patients were divided into a conventional group(51 cases)and a sequential group(51 cases).Both groups of patients underwent surgical treatment,with the conventional group receiving only GnRH-a for postoperative maintenance treatment,and the sequential group receiving gonadotropin releasing hormone agonist(GnRH-a)and sequential dienogest for postoperative maintenance treatment.The hormone levels[estradiol(E2),progesterone(P),follicle stimulating hormone(FSH),luteinizing hormone(LH)],endometrial receptivity[placental protein 14(PP14),galectin-1(Gal-1)expression score,osteopontin(OPN)molecular expression level,endometrial thickness],endometrial neovascularization indicators[vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF),tumor necrosis factor-α(TNF-α),carbohydrate antigen 125(CA125)]and adverse reactions caused by low hormones(night sweats,hot flashes,bone and joint pain,decreased libido,insomnia)were compared between the two groups.【Results】Under different treatment regimens,the E2,P,FSH,and LH levels in the sequential group were 102.33±20.45 pmol/L,0.38±0.11 nmol/L,3.52±0.36 U/L,and 3.41±0.26 U/L,respectively,which were lower than those in the conventional group(117.45±20.36 pmol/L,0.71±0.18 nmol/L,4.41±1.26 U/L,4.35±1.21 U/L),and the difference was statistically significant(t=3.742,11.172,4.850,5.424;P<0.05).The PP14,Gal-1,OPN,and endometrial thickness in the sequential group(25.33±5.25μg/L,5.41±1.44 score,45.29±10.36 kDa,10.32±2.27 mm)were all higher than those in the conventional group(22.62±5.14μg/L,4.57±1.52 score,40.36±10.23 kDa,8.33±1.52 mm),and the difference was statistically significant(t=2.634,2.865,2.418,5.202;P<0.05).VEGF,bFGF,TNF-α,and CA125 in the sequential group were 20.36±5.33 pg/mL,10.22±2.45 pg/mL,21.33±5.28 ng/mL,and 30.23±5.16 U/mL,respectively,all lower than the conventional group(23.39±5.34 pg/mL,12.42±3.24 pg/mL,24.19±5.33 ng/mL,33.46±5.37 U/mL),and the difference was statistically significant(t=2.868,3.868,2.722,3.097;P<0.05).The incidence of menopausal adverse reactions caused by low hormones in the sequential group was 3.92%(2/51),lower than that in the conventional group[21.57%(11/51)],and the difference was statistically significant(χ^(2)=7.141;P<0.05).【Conclusion】GnRH-a sequential treatment with dienogest can improve hormone levels and endometrial receptivity in patients with EMT,and has a positive effect on inhibiting endometrial neovascularization and reducing the risk of adverse reactions caused by low hormones.
作者
徐晨
薛惠英
XU Chen;XUE Huiying(Department of Obstetrics and Gynecology,Anyang People's Hospital,Anyang,Henan 455000,China)
出处
《中国医学工程》
2025年第9期77-81,共5页
China Medical Engineering
