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1.
目的探讨促性腺激素释放激素激动剂(GnRHa)———国产阿拉瑞林与进口高舍瑞林(Zoladex),对子宫内膜异位症(内异症)的治疗作用,7-甲异炔诺酮(利维爱)在反加疗法中的应用。方法采用随机对照研究,将36例内异症患者分为两组:①阿拉瑞林组,分为HRTO组(单用阿拉瑞林)和HRT1组(加用利维爱);②高舍瑞林组,分为HRT’0组(单用高舍瑞林)和HRT’1组(加用17β-E2和MPA)。结果两组患者征象明显改善,超声检查卵巢巧克力囊肿缩小或消失,血清学指标CA125、AEmAb阳性率下降。阿拉瑞林与高舍瑞林两种药物疗效无显著性差异。HRT0与HRT’0组出现低雌激素综合征,HRT0组2例腰椎骨密度降低。HRT’1组低雌激素征象明显减轻,HRT1组未出现低雌激素征象,两反加组无腰椎骨密度降低,未影响GnRHa的疗效。阿拉瑞林组、高舍瑞林组停药后6月内妊娠率分别为53.3%、41.7%。结论国产药物阿拉瑞林与进口药物高舍瑞林具有相同的疗效。反加疗法能减轻GnRHa的不良反应而不影响疗效。小剂量利维爱用于反加疗法,与其它反加方案组比更具优越性。 相似文献
2.
目的探讨促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist,GnRHa)在子宫内膜异位症的应用情况,并比较不同GnRHa的疗效。方法利用医院计算机处方管理系统提取2018年1月1日-2019年1月1日门诊药房调配含有GnRHa的处方信息,分析和讨论亮丙瑞林、戈舍瑞林、曲普瑞林用于治疗子宫内膜异位症的比例,并研究不同GnRHa对子宫异常出血、内膜厚度及CA125的影响。结果亮丙瑞林、戈舍瑞林、曲普瑞林在子宫内膜异位症的使用比例分别为29.45%,46.52%,24.03%;不同GnRHa用药前后子宫内膜厚度、子宫体积和CA125无显著性差异;子宫不规则出血病例数曲普瑞林最多,亮丙瑞林最少。结论不同GnRHa疗效无明显差异,使用比例不同可能与药物的安全性、经济性,医师的地域性、使用习惯有关。 相似文献
3.
目的:探讨促性腺激素释放激素激动剂(GnRHa)对子宫内膜异位症术后复发和生活质量的影响。方法:将2010年1月至2012年1月期间我院收治的子宫内膜异位症患者82例按数字随机法分为观察组和对照组,每组患者41例。对照组接受常规的子宫内膜异位手术及术后抗感染治疗,观察组在对照组的基础上于术后月经来潮第2天皮下注射曲普瑞林(3.75 mg,每28天1次,共治疗3次)。比较两组疗效、复发情况以及生活质量。结果:观察组疗效显著的患者比例和治疗有效率分别为58.54%和97.56%,均显著高于对照组。观察组治疗后6个月、1年和2年的复发率分别为2.44%、2.44%和4.88%,均显著低于对照组。两组治疗后躯体功能和社会功能2个维度和11个因子的生活质量评分得分均提高,且观察组得分较对照组提高。差异都有统计学意义。结论:GnRHa用于子宫内膜异位症术后辅助治疗疗效显著,可有效减少术后复发,并提高患者的生活质量,值得临床推广使用。 相似文献
4.
目的 研究促性腺激素释放激素激活剂(GnRHa)联合中成药坤泰胶囊与GnRHa减量治疗子宫内膜异位症的疗效与安全性.方法 选择2010年1月~2012年1月在枣庄市妇幼保健院就诊的子宫内膜异位症患者40例,均经腹腔镜手术确诊并系rAFS分期为Ⅲ~Ⅳ期,手术治疗1个月内,随机分为联合用药组(A组)与减量组(G组).A组手术后第3天或月经周期的第1天予曲普瑞林3.75 mg深部肌内注射,隔28 d注射1次,共注射6次.同时从第3次注射开始口服坤泰胶囊,至治疗结束.G组手术后第3天或月经周期第1天予曲普瑞林1.875 mg深部肌内注射,隔28 d注射1次,共注射6次.所有研究对象于治疗前后进行VAS疼痛评分及Kupperman评分,并抽取外周血测定FSH及E2水平,随访月经恢复情况、妊娠情况及VAS疼痛评分.结果 治疗末,各组患者血清FSH、E2水平均降低;患者疼痛症状明显减轻,减量组低雄激素症状相对较轻,且潮热症状发生率较低,用药期间患者E2水平位于雌激素治疗窗口范围,联合用药组疼痛减轻明显,E2平均水平低于减量组.结论 GnRHa使用1月后即可出现低雌激素症状,加用具有类雌激素活性的中成药可减轻更年期症状,治疗有效.GnRHa减量治疗可以达到使患者闭经的效果,并因其对雌激素的抑制作用相对弱而使低雌激素症状减轻,从而提高患者的生活质量. 相似文献
5.
《Expert opinion on pharmacotherapy》2013,14(3):291-305
Introduction: Endometriosis is a common disease that causes pain symptoms and/or infertility in women in their reproductive years. The disease is characterised by the presence of endometrium-like tissue – glands and stroma – outside the uterine cavity. Different treatment options exist for endometriosis including medical and surgical treatments or a combination of the two approaches. The most commonly used medications are non-steroidal anti-inflammatory drugs, GnRH agonists, androgen derivatives such as danazol, combined oral contraceptive pills, progestogens and more recently the levonorgestrel intrauterine system. Areas covered: The authors review current medical treatments used for symptomatic endometriosis and also discuss new treatment approaches. The authors conducted a literature search for randomised controlled trials related to medical treatments of endometriosis in humans, searched the Cochrane library for reviews and also searched for registered trials that have not yet been published on ClinicalTrials.gov. Expert opinion: The medical treatment of endometriosis is effective at treating pain and preventing recurrence of disease after surgery. Remarkably, the oral contraceptive pill taken continuously is as effective as GnRH-a, while causing far less side-effects. Conversely, no treatment currently exists for enhancing fecundity in women whose infertility is associated with endometriosis. As all existing therapies of endometriosis are contraceptive, great efforts should be targeted at researching novel products that reduce the disease expression without shuttering ovulation. 相似文献
6.
目的探讨腹腔镜保守手术后应用曼月乐以及GnRHa联合治疗子宫内膜异位症的疗效。方法 40例EMs患者随机分配到对照组和观察组,各20例。对照组接受GnRHa治疗,观察组接受GnRHa和曼月乐联合治疗,通过观察两组患者的疼痛程度、CA125水平来评定治疗效果。结果对照组与观察组中,术后半年、术后1年的VAS评分低于手术前(P〈0.05);对照组术后1年的VAS评分高于观察组(P〈0.05)。对照组与观察组中,术后半年、术后1年的CA125水平低于手术前(P〈0.05);对照组术后1年的CA125水平高于观察组(P〈0.05)。结论曼月乐和GnRHa联合治疗EMs的效果显著,可长时间缓解患者的疼痛,值得推广。 相似文献
7.
目的分析卵巢子宫内膜异位囊肿接受腹腔镜保守治疗,术后辅助使用与不用促性腺激素释放激素激动剂(gonadotropin-releasing-hormoneagonist,GnRHa)的近期、远期复发率和妊娠率。方法收集2008年1月一2011年7月在我院妇科行腹腔镜保守手术治疗并经病理证实为卵巢子宫内膜异位囊肿症的患者,按术后辅助使用GnRHa与否,分为单纯手术组和联合用药组。随访截止到2012年12月,比较两组患者的复发率和妊娠率。结果共有195例患者接受治疗,最后183例患者纳入分组,为单纯手术组59例,联合用药组124例。单纯手术组总妊娠率、6月和1年妊娠率分别为45.8%、22.0%和39.0%;联合用药组为55.6%、9.7%和29.0%,两组6月妊娠率差异有统计学意义,其余差异无统计学意义。单纯手术组总复发率、6月和1年复发率分别为10.2%、5.1%和6.8%;联合周药组为11.3%、1.6%和6.5%,两组差异无统计学意义。结论对于卵巢子宫内膜异位囊肿症患者,在腹腔镜手术治疗以及术后辅助GnRHa相比较能降低复发率和有益于妊娠率的提高。 相似文献
8.
In the past, the primary approach for the treatment of endometriosis was represented by surgery; however, after the introduction of non-invasive diagnosis of endometriosis with the development of imaging technologies, medical treatment became the preferred approach, particularly in young patients. Hormonal drugs, by blocking menstruation, are the most effective for the treatment of endometriosis-related pain, independently of phenotype (ovarian, deep, or superficial endometriosis).Gonadotropin-releasing hormone analogs and oral antagonists act on hypothalamus-pituitary-ovary axis inducing iatrogenic menopause, thus reducing dysmenorrhea and all pain symptoms. The side effects, such as hot flushes and bone loss, may be reduced by an add-back therapy. However, the cost in terms of women's health remains high in view of a long-term treatment.Progestins are considered the first-line treatment, highly effective, and with reduced side effects. In addition to the well-known and largely used Norethisterone acetate and Medroxyprogesterone acetate, recently Dienogest has become one of the most used drugs in all endometriosis phenotypes for long-term treatment. Besides, Intrauterine levornogestrel or subcutaneous etonogestrel are valid alternative for long-term treatment. 相似文献
9.
BACKGROUND: Endometriosis is a painful, chronic disease affecting 5.5 million women and girls in the United States and Canada and millions more worldwide. The usual age range of women diagnosed with endometriosis is 20 to 45 years. Endometriosis has an estimated prevalence of 10% among women of reproductive age, although estimates of prevalence vary greatly. Endometriosis is the most common gynecological cause of chronic pelvic pain, but published information on its associated medical care costs is scarce. OBJECTIVE: The aim of this study was to determine (1) the prevalence of endometriosis in the United States, (2) the amount of health care services used by women coded with endometriosis in a commercial medical claims database during 1999 to 2003, and (3) the endometriosis-related costs for 2003, the most recent data available at the time the study was performed. METHODS: This study was a retrospective review of administrative data for commercial payers, which included enrollment, eligibility, and claims payment data contained in the Medstat Marketscan database for approximately 4 million commercial insurance members. All claims and membership data were extracted for each woman aged 18 to 55 years who had at least 1 medical or hospital claim with a diagnosis code for endometriosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 617.00-617.99) for 1999 through 2003. Claims data from 1999 through 2003 were used to determine prevalence and health care resource utilization (i.e., annual admission rate, annual surgical rate, distribution of endometriosis-related surgeries, and prevalence of comorbid conditions). The cost analysis was based on claims from 2003 only. Cost was defined as the payer-allowed charge, which equals the net payer cost plus member cost share. RESULTS: The prevalence of women with medical claims (inpatient and/or outpatient) containing ICD-9-CM codes for endometriosis was 1.1% for the age band of 30 to 39 years and 0.7% over the entire age span of 18 to 55 years. The medical costs per patient per month (PPPM) for women with endometriosis were 63% greater ($706 PPPM) than those of the average woman per member per month ($433) in 2003; inpatient hospital costs accounted for 32% of total direct medical costs. Between 1999 and 2003, these women with endometriosis who were identified by either inpatient and/or outpatient claims had high rates of hospital admission (53% for any reason; 38% for an endometriosis-related reason) and a high annual surgical procedure rate (64%). Additionally, women with endometriosis frequently suffered from comorbid conditions, and these conditions were associated with greater PPPM costs of 15% to 50% for women with an endometriosis diagnosis code, depending on the condition. Interstitial cystitis was associated with 50% greater cost ($1,061 PPPM); depression, 41% ($997 PPPM); migraine, 40% ($988 PPPM); irritable bowel syndrome, 34% ($943 PPPM); chronic fatigue syndrome, 29% ($913 PPPM); abdominal pain, 20% ($846 PPPM); and infertility, 15% ($813 PPPM). CONCLUSIONS: Women with endometriosis have a high hospital admission rate and surgical procedure rate and a high incidence of comorbid conditions. Consequently, these women incur total medical costs that are, on average, 63% higher than medical costs for the average woman in a commercially insured group. 相似文献
10.
Medical management of endometriosis: a systematic review 总被引:9,自引:0,他引:9
Endometriosis is an important clinical problem in routine practice. Besides the problems of dysmenorrhea, dyspareunia and chronic abdominal pain, women with endometriosis are often infertile. We performed a systematic literature review on two issues: firstly, we clarified which medical treatment options have been investigated in prospective, randomized studies. Secondly, potential future treatments, still being preclinically investigated, were examined. A meta-analysis was not possible as the studies varied too much in their protocols and inclusion and exclusion criteria, as well as in the drugs and doses administered. Gonadotropin-releasing hormone (GnRH) agonists, progestins and oral contraceptives all appear to offer certain advantages for endometriosis patients. GnRH agonists appear to be the most effective but they are expensive and long-term treatment is not possible because of loss of bone mineral density. Estrogen add-back may offer some benefit for the clinical complaints of patients, but it may reduce the efficacy of GnRH agonists. Progestins have the best clinical profile and a good cost-effectiveness balance; however, most studies found that they were not as effective as GnRH agonists. Oral contraceptives are only effective during treatment and have a high relapse rate after therapy is completed. Future options may include the use of GnRH agonists, selective estrogen receptor modulators (SERMs) and anti-estrogens, as well as immunomodulators. 相似文献
11.
目的探讨仙灵骨葆胶囊对药物性卵巢去势所带来的骨质丢失的治疗效能和机制。方法选取子宫内膜异位症术后病理确诊并促性腺激素释放激素激动剂(GnRHa)治疗患者120例,于术后初次月经第1天给予GnRHa,用药3周后复诊超声测量子宫内膜厚度,抽血测雌二醇浓度,及检测骨密度。之后按就诊顺序随机分为3组,对照组:维生素E 100 mg,1次/d,反加组:倍美力0.3 mg+安宫黄体酮4 mg,1次/d,观察组:仙灵骨葆胶囊1.5 g,2次/d,并于GnRHa注射后112 d重复测量上述指标。结果GnRHa治疗3周后,血清雌二醇水平显著降低进入绝经状况,并一直持续。至治疗4个周期后,对照组骨密度下降,而反加组及观察组骨密度无明显改变。但反加组血清雌二醇浓度较对照组明显升高(P〈0.05),对照组及观察组血清雌二醇浓度无明显改变,故子宫内膜厚度2组均无明显变化。但反加组子宫内膜厚度轻度增加,且5例患者出现阴道不规则出血。结论仙灵骨葆胶囊可对药物性卵巢去势引起的骨密度下降起到有效的预防和治疗作用,且不改变血清雌二醇浓度,不作用于子宫内膜。 相似文献
12.
Endometriosis, which may be defined as the presence and proliferation of endometrial tissue outside the uterine cavity, causes pain and infertility for millions of women worldwide. Studies suggest a prevalence of 0.5 to 5% in fertile and 25 to 40% in infertile women. The most widely accepted aetiological theory is that retrograde flow of menstrual fluid through the Fallopian tubes deposits viable endometrial tissue, which implants on the peritoneal surface. Increasingly, the aetiology of endometriosis is being studied at the immunological and genetic levels. The aim of treatment of endometriosis is to remove or diminish disease deposits. This may be attempted through medical or surgical means. It has long been recognised that endometriotic glands are hormonally sensitive. Medical therapies work by inducing a hypoestrogenic, anovulatory state to induce atrophy within the glandular tissue. Conception is generally not possible during medical therapy and has not been demonstrated to increase afterwards. Medical treatment of endometriosis should be discouraged when infertility is the primary problem. In this situation surgery or an assisted reproduction treatment such as in vitro fertilisation may be more appropriate. Medical treatment of pain caused by endometriosis is generally effective. There is little difference in efficacy between the different medications but their adverse effect profiles differ greatly. It appears that gonadotropin-releasing hormone agonists, particularly when used with add-back estrogen, may be more acceptable to women than other treatments. Laparoscopic surgical treatment of minimal and mild endometriosis has been demonstrated to increase fecundity. Surgical treatment has also been shown to decrease pain scores compared with expectant management. Ongoing and future research examining the aetiology of endometriosis at the immunological and genetic levels should usher in new treatments directed at the actual cause of the disease. More randomised trials examining the role of surgery, and comparing surgical and medical treatments, are also required and are necessary if we are to continue in our attempts to adopt an evidence-based approach to treatment. 相似文献
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14.
The incidence, pathogenesis, staging, and treatment of endometriosis are reviewed, with an emphasis on pharmacologic management of this condition. Endometriosis--the presence of ectopic endometrial tissue--can be found in 15-25% of infertile women and may be found in 1-5% of all women between menarche and menopause. Although the pathogenesis of endometriosis is uncertain, the most tenable etiologic theory is a combination of celomic metaplasia and retrograde menstruation. Staging is based on the American Fertility Society classification scheme, with stage I being the mildest and stage IV the most severe form of the disease. The management of endometriosis depends on the extent of the disease, the severity of the symptoms, the age of the patient, and the patient's desire for future fertility. Treatment modalities include expectant management, surgery, induction of a pseudopregnancy state with hormonal therapy (e.g., oral contraceptives), or induction of a pseudomenopausal state. The induction of a pseudomenopausal state with the use of oral danazol gained widespread favor in the 1970s as the treatment of choice in patients with endometriosis, but therapy is often associated with unpleasant adverse effects. Gonadotropin-releasing hormone (GnRH) agonists may provide a safe and clinically effective alternative to danazol therapy in patients with endometriosis. Results of a multicenter study comparing nafarelin with danazol for treatment of endometriosis indicated no significant differences between treatment groups with respect to improvements in disease state and symptomatology. The most common adverse effect associated with nafarelin therapy is hot flashes. The GnRH agonist nafarelin is as effective as danazol or oral contraceptives for the treatment of endometriosis and causes fewer adverse reactions. GnRH agonists may replace danazol as the treatment of choice in patients with endometriosis. 相似文献
15.
INTRODUCTION: Current therapies for endometriosis cannot completely cure the disease, and patients present with high recurrence rates. Novel medical approaches are, therefore, needed. AREAS COVERED: In endometriosis, aromatase was long thought to be involved in the in situ formation of estrogens, leading to a positive feedback loop favoring estrogens, themselves inducing prostaglandin production and inflammation. This hypothesis led to aromatase inhibitors (AIs) being proposed as the new medical therapy for endometriosis, as reported in all the studies reviewed here. Recent findings nevertheless indicate that aromatase may be less implicated in endometriosis than previously postulated. More than 10 years after the first successful treatment of a rare and severe case of postmenopausal endometriosis with an AI, there are only three small randomized controlled trials in the literature. EXPERT OPINION: Until recently, AIs were thought to be an alternative to current medical therapies for endometriosis. However, recent findings question their real utility in clinical practice in the context of this disease. Because there is no strong evidence of their efficacy or benefit compared to other molecules in existing clinical trials, AIs need to be investigated further in well-designed studies to confirm/disprove their hypothetical impact on endometriotic lesions. 相似文献
16.
《Expert opinion on pharmacotherapy》2013,14(9):1399-1413
The use of tamoxifen among women with breast cancer or at high risk of the disease has greatly expanded over the past several decades. Tamoxifen has a complex effect on the female reproductive tract and several tamoxifen-associated changes have been described among tamoxifen users. These include endometrial thickening, cervical and endometrial polyps, endometrial hyperplasia, endometrial adenocarcinoma, uterine sarcoma, increase in the size of uterine leiomyomata, exacerbation of endometriosis and ovarian cysts. The most common uterine change associated with tamoxifen is endometrial polyps. The annual incidence of endometrial cancer among women on tamoxifen is 2 per 1000 and seems to be related to the cumulative tamoxifen dose. It is not clear whether endometrial cancer occurring among women on tamoxifen is of worse prognosis than endometrial cancer occurring among women not receiving tamoxifen. Tamoxifen is associated with several sonographic changes which make the use of ultrasound in surveillance of these patients difficult. There is no indication to implement routine screening for endometrial cancer among all women on tamoxifen. However, endometrial biopsy, preferably via hysteroscopy, should be considered in women with uterine bleeding. 相似文献
17.
The use of tamoxifen among women with breast cancer or at high risk of the disease has greatly expanded over the past several decades. Tamoxifen has a complex effect on the female reproductive tract and several tamoxifen-associated changes have been described among tamoxifen users. These include endometrial thickening, cervical and endometrial polyps, endometrial hyperplasia, endometrial adenocarcinoma, uterine sarcoma, increase in the size of uterine leiomyomata, exacerbation of endometriosis and ovarian cysts. The most common uterine change associated with tamoxifen is endometrial polyps. The annual incidence of endometrial cancer among women on tamoxifen is 2 per 1000 and seems to be related to the cumulative tamoxifen dose. It is not clear whether endometrial cancer occurring among women on tamoxifen is of worse prognosis than endometrial cancer occurring among women not receiving tamoxifen. Tamoxifen is associated with several sonographic changes which make the use of ultrasound in surveillance of these patients difficult. There is no indication to implement routine screening for endometrial cancer among all women on tamoxifen. However, endometrial biopsy, preferably via hysteroscopy, should be considered in women with uterine bleeding. 相似文献
18.
R L Barbieri 《Drugs》1990,39(4):502-510
Endometriosis is an extremely common gynaecological disease, affecting between 1 and 5% of women of reproductive age. Women with endometriosis typically present for medical care with one of more of the following problems: pelvic pain, infertility, or a large adnexal mass (an endometrioma). The primary treatment for an endometrioma is surgical. However, long term postoperative hormone therapy may be necessary to prevent new endometriomas from developing. There is no evidence that hormonal therapy of endometriosis will improve fecundability in women with endometriosis and infertility. Pelvic pain due to endometriosis can be successfully treated with hormonal agents in the majority of patients. Four basic hormonal regimens are currently available for the treatment of endometriosis: (a) danazol; (b) gonadotrophin-releasing hormone (GnRH) [luteinising hormone-releasing hormone (LHRH); gonadorelin] agonists; (c) progesterones (progestins); and (d) combined estrogens and progesterones. Randomised, controlled, clinical trials suggest that danazol and the GnRH agonists are equally effective in the treatment of endometriosis. However, the side effects caused by danazol and the GnRH agonists are markedly different. Danazol produces androgenic side effects including weight gain, hirsutism, acne, oily skin and deepening of the voice. GnRH agonists produce side effects due to hypoestrogenism, including hot flushes, osteoporosis and dry vagina. The ideal drug regimen for the treatment of endometriosis remains to be developed. 相似文献
19.
目的建立子宫内膜异位症的种植动物模型,了解正常在位子宫内膜、腺肌症的子宫内膜及卵巢巧克力囊肿内壁组织在裸鼠体内的生长的差异。方法将正常子宫内膜、子宫腺肌症患者的内膜及卵巢巧克力囊肿内壁分别注射到裸鼠腹腔内,观察生长情况,留取标本行病理及免疫组化检查。结果3种种植物中以卵巢巧克力囊肿内壁最易种植成功,其次是子宫腺肌症患者的内膜,正常子宫内膜种植成功率低于前两者。免疫组化结果提示3组种植成功的腺上皮上均有雌激素受体表达,孕激素受体弱表达或不明显,血管上皮生长因子表达明显。结论腺肌症的子宫内膜及卵巢巧克力囊肿内壁组织在裸鼠体内更易生长,与正常内膜有差异;裸鼠体内种植腺体上皮及基质均见明显血管上皮生长因子表达。裸鼠子宫内膜异位症的动物模型成功建立,为研究子宫内膜异位症的发病机理和药物治疗提供了实验动物模型。 相似文献