Taskin O, Buhur A, Birincioglu M, Burak F, Atmaca R, Yilmaz I, Wheeler J M
Department of Obstetrics and Gynecology, Inonu University Medical School, Malatya, Turkey.
J Am Assoc Gynecol Laparosc. 1998 May;5(2):119-24. doi: 10.1016/s1074-3804(98)80076-5.
To investigate the effects of gonadotropin-releasing hormone (GnRH) analog pretreatment on endometrial Na+, K+-adenosine triphosphatase (ATPase) pump function and peripheral blood vasopressin levels, and their role in fluid absorption and mechanisms of hyponatremia in patients undergoing hysteroscopic endometrial ablation.
Prospective, randomized, placebo-controlled study (Canadian Task Force classification I).
University-affiliated hospital.
Seventeen women with dysfunctional uterine bleeding.
Nine women received a GnRH analog and eight received saline approximately 6 to 8 weeks before hysteroscopic ablation by electrosurgery.
Both before randomization and immediately before surgery, endometrial biopsy samples were obtained and numbered consecutively without patient identification. Operative hysteroscopy was performed with glycine 1.5% mixed with 2% alcohol. The amount of irrigant and irrigant deficit; blood levels of albumin and ethanol; hematocrit and hemoglobin; changes in sodium levels; and central venous pressure were compared. The Na+, K+-ATPase pump activity was significantly increased in the GnRH analog group compared with the saline group and correlated with decreased estradiol levels (0.4 +/- 0.08 vs 0.26 +/- 0.06 micro mol/min/ml). Vasopressin levels were significantly lower in the GnRH group (3.2 +/- 0.9 vs 7.6 +/- 1.7 micro mol/L). Mean volume of irrigant used and operating time were similar in both groups. Volume deficit, decrease in protein, and hematocrit were less in GnRH than in the saline group. Blood ethanol levels, decrease in sodium, and irrigant deficit were significantly lower in GnRH group.
Pretreatment with GnRH analogs may prevent the adverse effects of estradiol on endometrial Na+, K+-ATPase and creates a protective mechanism against iatrogenic hyponatremia, which is more critical in women than men in case of absorption of irrigating fluid. Moreover, created hypoestrogenism may enhance Na+, K+-ATPase activity in brain as well as endometrium, thus decreasing women's susceptibility to hyponatremic complications and brain damage. Suppressed vasopressin levels may be protective against fluid absorption in GnRH analog-treated patients.
探讨促性腺激素释放激素（GnRH）类似物预处理对宫腔镜子宫内膜切除术患者子宫内膜钠钾 - 三磷酸腺苷酶（ATP酶）泵功能及外周血血管加压素水平的影响，及其在液体吸收和低钠血症发生机制中的作用。
前瞻性、随机、安慰剂对照研究（加拿大工作组分类I级）。
大学附属医院。
17例功能失调性子宫出血的女性。
9例女性在宫腔镜电切术前约6至8周接受GnRH类似物治疗，8例接受生理盐水治疗。
在随机分组前及手术即将开始前，获取子宫内膜活检样本并连续编号，患者不知情。采用1.5%甘氨酸与2%乙醇混合液进行宫腔镜手术。比较灌洗液用量及灌洗量差值、血白蛋白和乙醇水平、血细胞比容和血红蛋白、钠水平变化及中心静脉压。与生理盐水组相比，GnRH类似物组钠钾 - ATP酶泵活性显著升高，且与雌二醇水平降低相关（0.4±0.08对0.26±0.06微摩尔/分钟/毫升）。GnRH组血管加压素水平显著降低（3.2±0.9对7.6±1.7微摩尔/升）。两组的平均灌洗液用量和手术时间相似。GnRH组的灌洗量差值、蛋白质减少量和血细胞比容均低于生理盐水组。GnRH组的血乙醇水平、钠减少量和灌洗量差值显著更低。
GnRH类似物预处理可预防雌二醇对子宫内膜钠钾 - ATP酶的不良影响，并建立针对医源性低钠血症的保护机制，在灌洗液吸收方面女性比男性更易发生低钠血症。此外，产生的低雌激素状态可能增强大脑及子宫内膜中的钠钾 - ATP酶活性，从而降低女性发生低钠血症并发症和脑损伤的易感性。GnRH类似物治疗患者中血管加压素水平受抑制可能对液体吸收具有保护作用。
