Long Qi-qi, Zhang Shao-fen, Han Yi, Chen Hang, Li Xue-lian, Hua Ke-qin, Hu Wei-guo
Department of Gynecology, Obstetris and Gynecology Hospital, Fudan University, Shanghai 200011, China.
Zhonghua Fu Chan Ke Za Zhi. 2010 Apr;45(4):247-51.
To compare clinical effect of gonadotropin releasing hormone agonist (GnRH-a) alone and GnRH-a combined with low-dose dydrogesteronea and estradiol valerate on sex hormone, hypoestrogenic symptoms, quality of life and bone mineral density (BMD) in treatment of endometriosis.
Seventy patients with moderate or severe endometriosis, who were diagnosed by laparotomy or laparoscopic surgery within two months, were randomly assigned into two groups. 35 patients in GnRH-a group were treated by goserelin (3.6 mg) for three months, and 35 patients in add-back group were treated by goserelin (3.6 mg) combined with estradiol valerate 0.5 mg and dydrogesteronea 5 mg daily. Before and after the treatment, clinical parameters were recorded and analyzed, including visual analog scale (VAS), medical outcomes survey short form 36 (SF-36), Kupperman menopausal index (KMI), BMD, the serum level of follicle stimulating hormone (FSH), estradiol (E2) and bone gla-protein (BGP). The first menstruation and VAS were also followed up after treatment.
Every 3 cases in two groups lost follow-up. (1) Reproductive hormone: the level of E2 in add-back group [(94+/-71) pmol/L] was significantly higher than (54+/-52) pmol/L in GnRH-a group (P<0.01). The level of FSH in add-back group [(3.0+/-1.9) U/L] was significantly lower than (5.7+/-2.9) U/L in GnRH-a group (P<0.05). (2) VAS: after treatment, VAS in both group decreased significantly when compared with that before treatment (P<0.05), and remained until menstruated. (3) KMI: KMI in add back-group (10+/-8)was significantly lower than (14+/-6) in GnRH-a group (P<0.05). (4) BMD: compared with that before treatment, BMD decreased significantly after treatment in GnRH-a group (P<0.05), no remarkable difference of BMD was observed before and after treatment in add-back group. Before treatment, serum BGP in both groups did not show statistical difference. After treatment, the level of BGP in GnRH-a group [(7932+/-5206) ng/L] was significantly higher than (5419+/-2917) ng/L in add-back group (P<0.05).
GnRH-a combined with estrogen-progesterone regimen could relieve pain from endometriosis as effectively as GnRH-a alone and reduce hypoestrogenic symptoms and bone loss. Therefore, it is a safe and effective treatment.
比较促性腺激素释放激素激动剂（GnRH-a）单独使用以及GnRH-a联合小剂量地屈孕酮和戊酸雌二醇对子宫内膜异位症患者性激素、低雌激素症状、生活质量及骨密度（BMD）的影响。
选取70例中重度子宫内膜异位症患者，均在2个月内行剖腹手术或腹腔镜手术确诊，随机分为两组。GnRH-a组35例，采用戈舍瑞林（3.6mg）治疗3个月；反向添加组35例，采用戈舍瑞林（3.6mg）联合戊酸雌二醇0.5mg及地屈孕酮5mg每日治疗。治疗前后记录并分析临床参数，包括视觉模拟评分（VAS）、医学结局简明量表36项（SF-36）、库珀曼绝经指数（KMI）、BMD、血清卵泡刺激素（FSH）、雌二醇（E2）及骨钙素（BGP）水平。治疗后随访首次月经及VAS。
两组各失访3例。（1）生殖激素：反向添加组E2水平为（94±71）pmol/L，显著高于GnRH-a组的（54±52）pmol/L（P<0.01）。反向添加组FSH水平为（3.0±1.9）U/L，显著低于GnRH-a组的（5.7±2.9）U/L（P<0.05）。（2）VAS：治疗后两组VAS均较治疗前显著降低（P<0.05），且持续至月经来潮。（3）KMI：反向添加组KMI为（10±8），显著低于GnRH-a组的（14±6）（P<0.05）。（4）BMD：GnRH-a组治疗后BMD较治疗前显著降低（P<0.05），反向添加组治疗前后BMD无显著差异。治疗前两组血清BGP无统计学差异。治疗后，GnRH-a组BGP水平为（7932±5206）ng/L，显著高于反向添加组的（5419±2917）ng/L（P<0.05）。
GnRH-a联合雌孕激素方案缓解子宫内膜异位症疼痛的效果与GnRH-a单独使用相当，且可减轻低雌激素症状及骨质流失。因此，是一种安全有效的治疗方法。
