长间隔的GnRHa方案在重度子宫内膜异位症患者中的应用

目的探讨延长促性腺激素释放激素激动剂（GnRHa）注射间隔期的治疗方案在重度子宫内膜异位症（EM）患者（r-AFSⅢ、Ⅳ期）腹腔镜手术后应用的疗效及安全性。方法选取经腹腔镜手术治疗的重度EM患者32例分为两组,观察组（n=15）每隔6周皮下注射1次长效GnRHa制剂（曲普瑞林3.75mg）,共4次;对照组（n=17）每隔4周皮下注射1次长效GnRHa制剂,共6次;疗程均为24周。比较GnRHa治疗过程中两组患者间性激素水平变化、绝经期症状出现情况及腰椎骨密度（DXA法,L2-L4）变化,评价两种GnRHa治疗方案的近期疗效及安全性并随访患者至术后2年。结果 GnRHa治疗过程中,两组患者促卵泡激素（FSH）、黄体生成素（LH）、雌二醇（E2）水平均显著降低,与治疗前比较差异有统计学意义（P〈0.05）,且对照组降低更明显,差异有统计学意义（P〈0.05）。治疗12周后,对照组患者绝经期症状出现率（58.8%）显著高于观察组（13.3%）,差异有统计学意义（χ^2=7.036,P〈0.05）。治疗结束时,观察组患者腰椎骨密度无明显改变,而对照组患者较治疗前出现明显下降,差异有统计学意义（P〈0.05）。术后2年,观察组EM复发率为6.7%（1例）,对照组为11.8%（2例）,差异无统计学意义（χ^2=0.244,P〉0.05）。对照组患者术后2年腰椎骨密度为（1.016±0.103）g/cm^2,仍低于GnRHa治疗前的（1.058±0.120）g/cm^2,差异有统计学意义（P〈0.05）。结论延长GnRHa注射间隔期的治疗方案可适度缓解GnRHa对垂体和卵巢的过度抑制,在不降低疗效的前提下,改善近期及远期治疗的安全性,且费用减少。

Development of a GnRHa injection regime for patients with severe endometriosis after laparoscopic surgery

Objective To develop an injection regime of gonadotropin releasing hormone agonist （GnRHa） in patients with severe endometriosis （EM） after laparoscopic surgery. Methods 32 severe EM patients after laparoscopic surgery were administered with Triptorelin 3.75 mg subcutaneously using either a classical regime （control group, n=17, 6 doses with an interval of 4 weeks between two consecutive injections） or a modified regime （observation group,n=15, 4 doses with an interval of 6 weeks between two consecutive injections）. The concentrations of serum follicle-stimulating hormone （FSH）, luteinizing hormone （LH）, estradiol （E2）, and the occurrence rate of menopausal symptoms, changes of lumbar vertebra density during GnRHa therapies were compared. The recurrence rate of EM and recovery of lumbar vertebra density at 2 years after laparoscopic surgery were also compared. Results The levels of FSH, LH, and E2 in both the patients and the control subjects were significantly decreased after the treatment （P〈0.05）. The level of reduction in the observation group was greater than the control group （P〈0.05）. The occurrence rate of menopausal symptoms in the control group was significantly higher than the observation group （58.8% vs 13.3%, χ^2=7.036,P〈0.05） in their second half phases of the treatment. After treatment, the lumbar vertebra density in the observation group did not change obviously, but the lumbar vertebra density of the control group was significantly decreased compare with before treatment （P〈0.05）. The rate of recurrence of EM in the observation group （6.7%, 1 case） was similar to the control group （11.8%, 2 cases） （χ^2=0.244, P〉0.05）. Low lumbar vertebra density was still observed in the control patients two years after surgery. Conclusions The modified GnRHa administration regime with a longer interval of injection was found to be effective. It could relieve the excessive suppression of pituitary and ovary.