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目的观察促性腺激素释放激素激动剂(GnRH-a)联合不同反加疗法对子宫内膜异位症(内异症)患者生殖激素水平、低雌激素症状及骨质丢失的影响。方法 75例内异症术后使用GnRH-a(曲普瑞林,3.75 mg.次-1皮下注射,q 28 d,共6次)治疗的患者随机分为A组(雌二醇1 mg.d-1+甲羟孕酮4 mg.d-1)37例和B组(7-甲基异炔诺酮2.5 mg.d-1)38例,连续用药6个月。治疗前后记录Kupperman评分及视觉模拟评分法(VAS)疼痛评分,监测卵泡刺激素(FSH)、促黄体素(LH)、雌二醇(E2)及血清骨钙素(BGP)并随访反加治疗后患者首次月经复潮时间和月经复潮后VAS评分。结果两组患者反加治疗后FSH、LH、E2均较治疗前显著降低(P<0.05),组间比较无显著差异(P>0.05);两组反加治疗后BGP较治疗前无显著差异(P>0.05),组间比较A组低于B组(P<0.05)。两组患者反加治疗后潮热出汗,外阴、阴道不适(干、痛、痒),关节痛和Kupperman总分均显著低于治疗前(P<0.01);组间比较无显著差异(P>0.05)。两组患者反加治疗后慢性盆腔痛、性交痛及疼痛总分均较治疗前显著降低(P<0.01),月经复潮后两组痛经评分均较治疗前降低(P<0.05)。A组月经复潮时间为停药后(73.1±19.2)d,B组为停药后(72.1±20.9)d,组间无显著差异(P>0.05)。结论 GnRH-a联合雌二醇+甲羟孕酮及GnRH-a联合7-甲基异炔诺酮均能有效减轻使用GnRH-a引起的低雌激素症状及减少骨质丢失,并能有效缓解内异症的疼痛症状。
Objective To observe the effects of gonadotropin-releasing hormone agonist (GnRH-a) combined with different anti-addictive therapy on the levels of reproductive hormone, low estrogen and bone loss in patients with endometriosis (endometriosis). Methods A total of 75 patients with endometriosis who were treated with GnRH-a (triptorelin, 3.75 mg. Subcutaneous-1 subcutaneously, q 28 d for 6 times) were randomly divided into group A (estradiol 1 mg. d-1 + medroxyprogesterone 4 mg.d-1), 37 cases and group B (7-methyl norethindrone 2.5 mg.d-1) 38 cases, continuous medication for 6 months. Kupperman score and visual analogue scale (VAS) pain score were recorded before and after treatment. FSH, LH, E2 and BGP were monitored and followed up After the first menstruation tide time and VAS score after menstruation. Results The FSH, LH and E2 in the two groups were significantly lower than those before treatment (P <0.05), but there was no significant difference between the two groups (P> 0.05). There was no significant difference in BGP between the two groups (P> 0.05). The scores of A group were lower than those of B group (P <0.05). There was no significant difference between the two groups (P <0.01), and the scores of hot flashes, vulva, vaginal discomfort (dry, pain, itch), joint pain and Kupperman score were significantly lower than those before treatment > 0.05). Chronic pelvic pain, painful pain and total pain score after antiemptomatic treatment in both groups were significantly lower than those before treatment (P <0.01). The scores of dysmenorrhea in both groups were lower than those before treatment (P <0.05). The duration of menstrual resuscitation in group A was 73.1 ± 19.2 days after drug withdrawal, while in group B was 72.1 ± 20.9 days after drug withdrawal, there was no significant difference between the two groups (P> 0.05). Conclusions Both GnRH-a combined with estradiol + medroxyprogesterone and GnRH-a combined with 7-methyl-norethynodone can effectively reduce the symptoms of low estrogen caused by GnRH-a and reduce bone loss, and can effectively relieve Endometriosis pain symptoms.