Ailawadi Radhika K, Jobanputra Smeeta, Kataria Meera, Gurates Bilgin, Bulun Serdar E
Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois, USA.
Fertil Steril. 2004 Feb;81(2):290-6. doi: 10.1016/j.fertnstert.2003.09.029.
To determine the role of an aromatase inhibitor, letrozole, in the treatment of reproductive-age women with endometriosis and associated chronic pelvic pain.
Phase 2, open-label, nonrandomized proof-of-concept study.
Outpatient tertiary-care center.
PATIENT(S): Ten patients with endometriosis, all previously treated both medically and surgically, with unsatisfactory results.
INTERVENTION(S): Endometriosis was diagnosed by biopsy and scored from an initial diagnostic laparoscopy performed within 1 month before treatment was begun. Oral administration of letrozole (2.5 mg), the progestin norethindrone acetate (2.5 mg), calcium citrate (1,250 mg), and vitamin D (800 IU) was done daily for 6 months. Within 1-2 months after completion of the treatment, a second-look laparoscopy was performed to score and biopsy endometriosis.
MAIN OUTCOME MEASURE(S): Changes in American Society for Reproductive Medicine (ASRM) scores for endometriosis, pelvic pain assessed by visual analog scale, serum hormone levels (FSH, LH, E(2), and estrone [E(1)]), and bone density (DEXA scan).
RESULT(S): No histologically demonstrable endometriosis was present in any patient during the second-look laparoscopy. ASRM and pelvic pain scores decreased significantly in response to treatment. Overall, no significant change in bone density was detected. Gonadotropin levels were not significantly altered by treatment, and although circulating E(2) and E(1) levels were reduced, the decrease was not statistically significant.
CONCLUSION(S): The combination of letrozole and norethindrone acetate achieved marked reduction of laparoscopically visible and histologically confirmed endometriosis in all 10 patients and significant pain relief in nine out of 10 patients who had not responded previously to currently available treatments. On this basis, letrozole should be a candidate for the medical management of endometriosis.
确定芳香化酶抑制剂来曲唑在治疗患有子宫内膜异位症及相关慢性盆腔疼痛的育龄妇女中的作用。
2期、开放标签、非随机概念验证研究。
门诊三级医疗中心。
10例子宫内膜异位症患者，均曾接受药物和手术治疗，但效果不佳。
通过活检诊断子宫内膜异位症，并在开始治疗前1个月内进行的初次诊断性腹腔镜检查中进行评分。每天口服来曲唑（2.5毫克）、孕激素醋酸炔诺酮（2.5毫克）、枸橼酸钙（1250毫克）和维生素D（800国际单位），持续6个月。治疗结束后1至2个月内，进行二次腹腔镜检查以对子宫内膜异位症进行评分和活检。
美国生殖医学学会（ASRM）子宫内膜异位症评分的变化、通过视觉模拟量表评估的盆腔疼痛、血清激素水平（促卵泡生成素、促黄体生成素、雌二醇[E2]和雌酮[E1]）以及骨密度（双能X线吸收法扫描）。
在二次腹腔镜检查中，所有患者均未发现组织学上可证实的子宫内膜异位症。治疗后ASRM和盆腔疼痛评分显著降低。总体而言，未检测到骨密度有显著变化。治疗对促性腺激素水平无显著影响，尽管循环中的E2和E1水平有所降低，但下降无统计学意义。
来曲唑和醋酸炔诺酮联合使用使所有10例患者腹腔镜可见且经组织学证实的子宫内膜异位症显著减少，10例之前对现有治疗无反应的患者中有9例疼痛明显缓解。在此基础上，来曲唑应成为子宫内膜异位症药物治疗的候选药物。
