Gnoth C H, Gödtke K, Freundl G, Godehardt E, Kienle E
Department of Gynecology and Obstetrics, Academic Hospital of the University of Düsseldorf, Düsseldorf-Benrath, Germany.
Gynecol Obstet Invest. 1999;47(1):37-41. doi: 10.1159/000010059.
Treatment of endometriosis with gonadotropin-releasing hormone agonists (GnRHa) is limited to 6 months because of possible adverse effects on bone metabolism. We designed a randomized, double-blind, placebo-controlled, prospective study of 27 patients with endometriosis who were given GnRHa with or without hormone add-back therapy (+ 20 microg of ethinyl estradiol with 0.15 mg desogestrel) designed to suppress the adverse effects of hypoestrogenism while preserving the efficacy of GnRHa. Both regimens showed significant improvements in endometriosis, dysmenorrhea, and pelvic pain; effects were significantly better in the GnRHa + placebo group. The GnRHa + placebo group had significantly higher serum calcium levels and a significantly higher loss of lumbar spine bone mineral density (BMD). Urinary levels of pyridinium crosslinks increased significantly in the GnRHa + placebo group, and declined to normal in the GnRHa + add-back group. The add-back therapy protects women taking GnRHas from severe loss of BMD and accelerated bone collagen resorption, but reduces the efficacy of the GnRHa.
由于促性腺激素释放激素激动剂（GnRHa）可能对骨代谢产生不良影响，子宫内膜异位症的GnRHa治疗通常限制在6个月以内。我们设计了一项随机、双盲、安慰剂对照的前瞻性研究，纳入27例子宫内膜异位症患者，给予GnRHa治疗，部分患者同时接受激素补充治疗（20微克炔雌醇加0.15毫克去氧孕烯），旨在抑制低雌激素血症的不良反应，同时保留GnRHa的疗效。两种治疗方案均使子宫内膜异位症、痛经和盆腔疼痛有显著改善；GnRHa + 安慰剂组的效果显著更佳。GnRHa + 安慰剂组的血清钙水平显著更高，腰椎骨密度（BMD）损失显著更大。GnRHa + 安慰剂组的尿吡啶交联水平显著升高，而GnRHa + 补充治疗组则降至正常水平。补充治疗可保护接受GnRHa治疗的女性避免严重的骨密度损失和加速的骨胶原吸收，但会降低GnRHa的疗效。
