摘要
目的:比较促性腺激素释放激素激动剂(GnRH-a)联合与不联合激素反加疗法治疗子宫内膜异位症的疗效及安全性。方法:将32例确诊为子宫内膜异位症随机分成两组,A组16例,Goserelin 3.6mp,皮下注射,4周1次;B组16例,Goserelin同A组+倍美力0.3mg每日口服1次+安宫黄体酮5mg每日口服1次,疗程12或24周,比较两组治疗前后症状、体征、血激素水平及骨密度变化。结果:A组总主观症状评分于治疗12周后下降了82.6%,24周后下降了93.5%(P<0.01),卵巢子宫内膜异位囊肿于12周后缩小了42%,24周后缩小了71%(P<0.01);B组总主观症状评分于12、24周后分别下降了79.1%、93.4%。卵巢内膜异位囊肿分别缩小了44%、82%(P<0.01)。两组血雌二醇均降至绝经期水平,A组比B组下降更明显(P<0.05)。潮热等副反应,A组8.75%,B组仅25%(P<0.01);A组于治疗24周腰椎、股骨颈骨丢失率分别为4.32%和2.97%,B组分别为2.35%和1.76%。结论:GnRH-a联合激素反加疗法与GnRH-a一样有效,且能降低GnRH-a所致骨密度下降及潮热等副反应,为长期和反复治疗提供一个良好的方案。
Objective:To evaluate the efficacy and safety of GnRH-a alone and in combination with hormone add-back therapy in treationg endometriosis. Methods: Thirty-two patients with endometriosis were divided into two groups. Group A(16 patients)was treated by goserelin depot 3.6mg subcutaneously every 4 weeks, group B(16 patients) was treated by goserelin depot plus conjugated equine estrogens 0.3mg daily and medroxyprogesterone acetate (MPA) 5mg daily for 12 or 24 weeks, Symptoms and signs were recorded before and after the treatment. Serum estradiol was measured by immunoassay before and 12 weeks after treatment and bone density was measured aher 12 and 24 weeks. Resnlts: Total subjective symptom scores of group A showed 82.6% decrease after 12 weeks and 93.5% after 24 weeks of treatment(P<0.01), while reductions in ovary endometrial cyst were 42 % and 71%, respectively(P<0.01). Of group B, there were 79.1% and 93.4 % decreases in total subjective symptom scores after 12 and 24 weeks of treatment (P<0.01)with a reduction of 44 % and 82 % in ovary endomtrial cyst, respectively (P<0.01). Suppression of E_2 level in group A was more significandy than in group B(P<0.05). Also hypoestrogenic side effects such as hot flush were more common in group A (87.5%) than in group B(25%). In group A, bone loss rates of lumber and femoral neck were 4.32 % and 2.97 % respectively 24 weeks later. In group B, they were 2.35 % and 1.76 %. Coati,ions: Add-back therapy with conjugated equine estrogens and MPA was as effective as GnRH-a alone and can alleviate GnRH-a induced bone density decrease, hot flush and other side effects. It's suitable for long time therapy.
出处
《福州总医院学报》
2002年第2期73-76,共4页
Journal of Fuzhou General Hospital
