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目的探讨延长促性腺激素释放激素激动剂(GnRHa)注射间隔期的治疗方案在重度子宫内膜异位症(EM)患者(r-AFSⅢ、Ⅳ期)腹腔镜手术后应用的疗效及安全性。方法选取经腹腔镜手术治疗的重度EM患者32例分为两组,观察组(n=15)每隔6周皮下注射1次长效GnRHa制剂(曲普瑞林3.75mg),共4次;对照组(n=17)每隔4周皮下注射1次长效GnRHa制剂,共6次;疗程均为24周。比较GnRHa治疗过程中两组患者间性激素水平变化、绝经期症状出现情况及腰椎骨密度(DXA法,L2-L4)变化,评价两种GnRHa治疗方案的近期疗效及安全性并随访患者至术后2年。结果 GnRHa治疗过程中,两组患者促卵泡激素(FSH)、黄体生成素(LH)、雌二醇(E2)水平均显著降低,与治疗前比较差异有统计学意义(P<0.05),且对照组降低更明显,差异有统计学意义(P<0.05)。治疗12周后,对照组患者绝经期症状出现率(58.8%)显著高于观察组(13.3%),差异有统计学意义(χ2=7.036,P<0.05)。治疗结束时,观察组患者腰椎骨密度无明显改变,而对照组患者较治疗前出现明显下降,差异有统计学意义(P<0.05)。术后2年,观察组EM复发率为6.7%(1例),对照组为11.8%(2例),差异无统计学意义(χ2=0.244,P>0.05)。对照组患者术后2年腰椎骨密度为(1.016±0.103)g/cm2,仍低于GnRHa治疗前的(1.058±0.120)g/cm2,差异有统计学意义(P<0.05)。结论延长GnRHa注射间隔期的治疗方案可适度缓解GnRHa对垂体和卵巢的过度抑制,在不降低疗效的前提下,改善近期及远期治疗的安全性,且费用减少。
Objective To investigate the efficacy and safety of the treatment regimen of prolonged GnRHa injection interval after laparoscopic surgery in severe endometriosis (EM) patients (r-AFS Ⅲ and Ⅳ). Methods 32 patients with severe EM treated with laparoscopic surgery were divided into two groups. The observation group (n = 15) was given subcutaneous injection of long-acting GnRHa preparation (triptorelin 3.75 mg) once every 6 weeks for 4 times. The control group (n = 17) was given a subcutaneous injection of long-acting GnRHa formulation once every 4 weeks for a total of 6 times; the course of treatment was 24 weeks. To compare the changes of sex hormone levels, the occurrence of menopausal symptoms and the changes of lumbar spine bone mineral density (DXA method, L2-L4) between the two groups during GnRHa treatment, evaluate the short-term efficacy and safety of the two GnRHa regimens and follow-up 2 years. Results During GnRHa treatment, the levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) were significantly decreased in both groups, with statistical significance (P <0.05) The control group decreased more significantly, the difference was statistically significant (P <0.05). After 12 weeks of treatment, the incidence of menopausal symptoms in the control group (58.8%) was significantly higher than that in the observation group (13.3%), with significant difference (χ2 = 7.036, P <0.05). At the end of treatment, there was no significant change in lumbar BMD in the observation group, while the control group showed a significant decrease compared with that before treatment (P <0.05). At 2 years after operation, the recurrence rate of EM in the observation group was 6.7% (1 case) and in the control group 11.8% (2 cases), the difference was not statistically significant (χ2 = 0.244, P> 0.05). The BMD of lumbar vertebra was (1.016 ± 0.103) g / cm2 at 2 years after operation in the control group, which was still lower than that before GnRHa treatment (1.058 ± 0.120) g / cm2. The difference was statistically significant (P <0.05). Conclusion Prolonging GnRHa injection interval can alleviate the excessive inhibition of pituitary and ovary in GnRHa, and improve the safety of short-term and long-term treatment without any reduction in the therapeutic effect.