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目的探讨性腺激素释放激素激动剂(gonadotropin releasing hormone agonist,GnRHa)联合戊酸雌二醇反向添加疗法对重度子宫内膜异位症(endometriosis,EMs)患者血清糖类抗原CA125、血管内皮生长因子(vascular endothelial growth factor,VEGF)水平及远期复发的影响。方法将2013年5月至2014年5月在广东佛山市第五人民医院住院治疗的90例重症EMs患者进行保守腹腔镜手术治疗后按随机数字表法分为两组。对照组采用注射GnRHa治疗,研究组采用GnRHa联合戊酸雌二醇反向添加疗法治疗。对比两组疗效、抗原CA125及VEGF水平、不良反应、复发率发生情况。结果治疗后两组总有效率(92.86%vs 78.57%),差异无统计学意义(P>0.05);两组治疗后CA125及VEGF水平较治疗前均显著降低,改善程度比较差异无统计学意义(P>0.05);治疗后研究组不良反应如潮热出汗、失眠、关节痛、阴道干燥、性生活障碍、情绪异常的发生率显著低于对照组(P<0.05)。随访2年,两组复发率比较差异无统计学意义(P>0.05)。结论 GnRHa能降低重度EMs保守腹腔镜术后患者CA125、VEGF水平,具有较高的疗效,但不良反应发生率高。GnRHa联合戊酸雌二醇反向添加疗法对疗效、复发率无影响,但能显著减少低雌激素水平带来的不良反应发生率,提高患者的生活质量。
Objective To investigate the effects of gonadotropin releasing hormone agonist (GnRHa) combined with estradiol valerate reverse addition therapy on serum carbohydrate antigen CA125, vascular endothelial growth factor (VEGF) in patients with severe endometriosis (EMs) (vascular endothelial growth factor, VEGF) levels and long-term recurrence. Methods 90 cases of severe EMs hospitalized in Foshan Fifth People’s Hospital from May 2013 to May 2014 were treated with conservative laparoscopic surgery and divided into two groups according to random number table. The control group was treated with GnRHa injection and the study group was treated with GnRHa plus estradiol valerate reverse addition therapy. Compare two groups of curative effect, antigen CA125 and VEGF levels, adverse reactions, recurrence rate. Results After treatment, the total effective rate was 92.86% vs 78.57%, there was no significant difference between the two groups (P> 0.05). After treatment, the levels of CA125 and VEGF were significantly lower than those before treatment, with no significant difference in improvement (P> 0.05). After treatment, adverse reactions such as hot flashes sweating, insomnia, joint pain, vaginal dryness, sexual dysfunction and mood disorders in the study group were significantly lower than those in the control group (P <0.05). After 2 years of follow-up, there was no significant difference in relapse rate between the two groups (P> 0.05). Conclusions GnRHa can reduce CA125 and VEGF levels in patients with severe EMs after conservative laparoscopic surgery, with high efficacy, but high incidence of adverse reactions. GnRHa combined with estradiol valerate reverse addition therapy has no effect on the efficacy and relapse rate, but can significantly reduce the incidence of adverse reactions caused by low estrogen levels and improve the quality of life of patients.