West C P, Lumsden M A, Hillier H, Sweeting V, Baird D T
Department of Obstetrics and Gynaecology, University of Edinburgh, UK.
Hum Reprod. 1992 Mar;7(3):328-32. doi: 10.1093/oxfordjournals.humrep.a137643.
Twenty women with symptomatic uterine fibroids were treated with the luteinizing hormone-releasing hormone (LHRH) agonist goserelin (Zoladex) combined with medroxyprogesterone acetate (MPA) in an open pilot study comparing two protocols. Ten women received goserelin 3.6 mg monthly combined with oral MPA 15 mg daily for 6 months. The mean uterine volume (497 cm3) measured by ultrasound fell by only 18% after 3 months, with no further reduction at 6 months. The other 10 women received goserelin alone for the initial 3 months, followed by combined treatment for 3 months. The mean uterine volume (557 cm3) fell by 39% after 3 months with no significant regrowth by 6 months. At 6 months post-treatment, uterine volume had not returned to pretreatment size. MPA significantly reduced the frequency of vasomotor side-effects. There were no differences in plasma oestradiol, luteinizing hormone or follicle stimulating hormone concentrations between the protocols and good symptomatic relief was experienced by both groups. Two years after completion, three women in each group have requested surgical treatment. The results indicate that MPA may be a useful adjunct to LHRH analogues in women with fibroids, reducing side-effects and possibly prolonging the response, although positive effects on bone density have yet to be confirmed. The optimum regimen of administration remains to be clarified as the clinical results were the same with both protocols.
在一项比较两种方案的开放性初步研究中，20名有症状的子宫肌瘤女性接受了促黄体生成素释放激素（LHRH）激动剂戈舍瑞林（Zoladex）联合醋酸甲羟孕酮（MPA）的治疗。10名女性每月接受3.6毫克戈舍瑞林联合每日15毫克口服MPA治疗，持续6个月。超声测量的平均子宫体积（497立方厘米）在3个月后仅下降了18%，6个月时没有进一步减少。另外10名女性在最初3个月单独接受戈舍瑞林治疗，随后3个月接受联合治疗。3个月后平均子宫体积（557立方厘米）下降了39%，6个月时没有明显再生长。治疗后6个月，子宫体积未恢复到治疗前大小。MPA显著降低了血管舒缩副作用的频率。两种方案之间血浆雌二醇、促黄体生成素或促卵泡生成素浓度没有差异，两组均有良好的症状缓解。完成治疗两年后，每组有3名女性要求手术治疗。结果表明，MPA可能是子宫肌瘤女性LHRH类似物的有用辅助药物，可减少副作用并可能延长反应时间，尽管对骨密度的积极影响尚未得到证实。由于两种方案的临床结果相同，最佳给药方案仍有待明确。
