Bulletti C, Flamigni C, Polli V, Giacomucci E, Albonetti A, Negrini V, Galassi A, Morselli-Labate A M
Unit of Special Pelvic Surgery, Operative Laparoscopy and Hysteroscopy, First Institute of Obstetrics and Gynecology, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy.
J Am Assoc Gynecol Laparosc. 1996 Aug;3(4):495-501. doi: 10.1016/s1074-3804(05)80157-4.
To establish the crude effects of danazol and gonadotropin-releasing hormone (GnRH) analogs in the management of endometriosis.
Prospective case-control study.
Unit of the Pathophysiology of Reproduction outpatient department.
Two groups of 110 women each with endometriosis (American Fertility Society score 1-3) who received danazol and GnRH analogs, and a control group who did not receive any drugs.
Women in the treatment groups received danazol 200 mg every 8 hours for 6 months, or a different GnRH agonist at standard dosages for 6 months. Laparoscopy was performed twice, at the time of diagnosis and just before the end of treatment (or no therapy for controls). Surgical treatment of the implants was performed at the second laparoscopy.
Samples of both eutopic and ectopic endometrium were collected during both laparoscopies. Both danazol and GnRH agonists were useful in reducing the AFS scores to inactive endometriotic implants, and there were no significant differences between the effects (p <0.001). Fibrosis was found after 6 months of observation in the implants in one control woman (0.9%), in 20 patients (18.2%) treated with danazol (p <0.001 vs controls), and in 4 patients (3.6%) treated with GnRH agonists (NS vs controls). A correlation between a clinical diagnosis of AFS score zero and histologic features of fibrosis in the ectopic specimens after therapies was observed in 28% of women, with poor agreement (k = 0.07).
Fibrosis, which represent the absence of endometrial cells within the specimens of endometriotic lesions or eutopic endometrium, did not appear in eutopic endometria but it was found in some endometriotic implants. Danazol and GnRH agonists reduced the clinical AFS scores of endometriosis, but their histologic effects in completely and permanently eliminating endometriotic implants were unacceptable.
确定达那唑和促性腺激素释放激素（GnRH）类似物在子宫内膜异位症治疗中的初步疗效。
前瞻性病例对照研究。
生殖病理生理学门诊科室。
两组各110例患有子宫内膜异位症的女性（美国生育协会评分1 - 3分），分别接受达那唑和GnRH类似物治疗，另有一组为未接受任何药物治疗的对照组。
治疗组女性接受达那唑，每8小时200毫克，持续6个月，或接受不同的GnRH激动剂标准剂量治疗6个月。在诊断时和治疗结束前（对照组不进行治疗）各进行一次腹腔镜检查。在第二次腹腔镜检查时对植入物进行手术治疗。
在两次腹腔镜检查期间均采集了在位内膜和异位内膜样本。达那唑和GnRH激动剂均有助于将美国生育协会评分降低至非活动期的子宫内膜异位植入物，且二者疗效无显著差异（p<0.001）。在一名对照女性（0.9%）的植入物中、20名接受达那唑治疗的患者（18.2%）（与对照组相比，p<0.001）以及4名接受GnRH激动剂治疗的患者（与对照组相比无统计学差异）的植入物中，观察到6个月后出现纤维化。在28%的女性中观察到治疗后异位标本中美国生育协会临床评分为零与纤维化组织学特征之间存在相关性，但一致性较差（k = 0.07）。
纤维化表现为子宫内膜异位病变或在位内膜标本中无子宫内膜细胞，在位内膜中未出现，但在一些子宫内膜异位植入物中发现。达那唑和GnRH激动剂降低了子宫内膜异位症的临床美国生育协会评分，但其在完全和永久消除子宫内膜异位植入物方面的组织学效果并不理想。
