不同促排卵方法在卵巢储备功能下降患者中的应用

目的:探讨卵巢储备功能下降患者的促排卵优选方案。方法:GnRH-a/hMG/rFSH(Gn)长方案促排卵(A组)共39个周期,GnRH-a/hMG/rFSH(Gn)短方案促排卵(B组)46个周期,GnRH-A/hMG/rFSH(Gn)促排卵(C组)共35个周期,比较3组临床用药和临床结局情况。结果:A组Gn所用天数(12.4±1.51d)显著高于B组(9.5±1.7d)、C组(10.7±3.2),P<0.05,且Gn(75IU/支)所用支数(41.5±8.6支)也明显多于B组(34.7±9.7支)和C组(33.4±16.2支)(P<0.05)。B组Gn所用天数要少于C组(P<0.05),Gn所用总量与C组间无统计学差异(P>0.05)。hCG注射日的血清LH水平A组(1.20±1.02IU/L)显著低于B组(3.17±1.58IU/L)和C组(2.15±1.8IU/L)(P<0.05),B组与C组之间无统计学差异(P>0.05)。A组与C组注射hCG日的血清E2值(7958±4586pmol/L,6022±7852pmol/L)均低于B组(10145±5503pmol/L)(P<0.05)。3组种植率、临床妊娠率均无显著性差异。3组间hCG注射日内膜厚度、受精率、卵裂率均无统计学差异(P>0.05)。结论:短方案更适合于卵巢功能减退患者的促排卵治疗,长方案与GnRH-A方案促排卵也是可行方法。     

标准剂量和半量缓释型达必佳在体外受精-胚胎移植中治疗效果的比较

目的 :探索一种在体外受精 -胚胎移植 ( IVF-ET)超排卵方案中既能使垂体降调节又不至于过度抑制卵巢功能的达必佳有效剂量。方法 :比较 2 4位接受 IVF-ET助孕者的治疗效果 ,一组 1 4例( A组 )皮下注射半支 ( 1 .88mg)达必佳缓释型 ;一组 1 0例 ( B组 )接受缓释型达必佳标准剂量 3 .75mg/支。结果 :B组在使用促性腺激素 ( Gn)前及绒毛膜促性腺激素 ( h CG)注射日的黄体生成素( LH)水平明显低于 A组 ( 1 .1 6± 0 .45 IU/L vs 2 .3 8± 0 .79IU/L,P<0 .0 1 ;0 .84± 0 .60 IU/L vs2 .1 4± 0 .71 IU/L,P<0 .0 1 )。 Gn用量及用药时间大于 A组 ( 4 0 .9± 1 2 .7支 vs 3 0 .9± 4.2支 ,P<0 .0 5 ;1 4.2± 3 .0 d vs 1 1 .4± 1 .6d,P<0 .0 1 ) ,二组的 h CG注射日雌二醇 ( E2 )水平、获卵数、受精率、卵裂率、妊娠率均无统计学差异 ( P>0 .0 5 )。二组均无内源性 LH峰出现。结论 :半量达必佳能获得与全量达必佳相同的治疗结果、且能减少 Gn用量及缩短疗程     

两种剂量达必佳在体外受精-胚胎移植中治疗效果的比较

目的:探讨在体外受精- 胚胎移植(IVF-ET)中达必佳的最适剂量。方法:　将接受IVF-ET助孕,采用长方案的患者84例随机分为观察组和对照组,观察组44例,每日皮下注射达必佳1/3支(0.03　mg),对照组40 例,每日皮下注射达必佳1 支(0.1　mg),比较其治疗效果。结果:　观察组促性腺激素(Gn)用量明显少于对照组　(27.5±4.5支vs　36.6±7.5支,P　<0.05);Gn用药时间少于对照组(9.10±2.52　d　vs　11.67±3.31　d),但无统计学意义;使用Gn前及hCG注射日血LH水平明显高于对照组(3.89±0.41　IU/L　vs　1.25±0.32　IU/L,P　<0.001;3.27±0.98IU/L　vs　1.01±0.21　IU/L,　P　<0.001),而使用Gn前血E2水平、hCG注射日的血P、E2水平、获卵数、受精率、优质胚胎率、妊娠率两组间均无显著性差异。两组均无内源性LH峰出现。结论:1/3剂量达必佳即可达到降调节的作用,且能减少Gn的用量,获得与标准剂量达必佳相同的临床效果。     

改良超长方案在卵巢储备功能低下高龄患者中的应用

目的:探讨改良超长方案行体外受精-胚胎移植(IVF-ET)助孕的高龄(年龄≥40岁)且卵巢储备功能低下(窦卵泡3~7个)患者的治疗结局。方法:采用随机对照前瞻研究的方法,将行IVF-ET的120例高龄且卵巢储备功能低下患者随机分成:改良超长方案组(A组,n=55)和拮抗剂方案组(B组,n=65),比较A、B组间IVF-ET结局。结果:A组的Gn使用总量(3 955.2±1194.3 IU)、Gn使用天数(11.7±1.9 d)、hCG注射日E2水平(2 452.7±1 285.6 pg/ml),hCG注射日子宫内膜厚度(12.1±2.3 mm)均明显高于B组(分别为2 022.5±610.1 IU、9.1±1.7 d、1 257.7±696.0 pg/ml、11.3±2.0 mm),P<0.05;周期取消率、优质胚胎率、妊娠率、着床率、流产率、宫外孕发生率组间均无统计学差异(P>0.05)。A组hCG注射日LH水平(1.0±0.5 mIU/ml)及P/E2值(0.3±0.2)明显低于B组(3.4±2.4 mIU/ml及0.5±0.2),P<0.05。结论:改良超长方案经过GnRHa的预处理,使患者充分降调节,hCG注射日可以获得良好的LH水平、P/E2值及内膜厚度;而hMG的使用,既可降低患者费用,又可以适当补充LH,提高子宫内膜容受性。因此,对于高龄且卵巢储备功能低下的患者,改良超长方案是一个经济有效的治疗选择。     

短效达必佳两种降调节方案在控制性超排卵中的效果比较

目的:比较短效达必佳2种降调节方案在控制性超排卵(COH)中的效果。方法:回顾性分析比较本中心接受COH降调节方案的261个周期,根据达必佳用量及用法的不同分成A组:部分半量方案,95个周期;B组:半量方案,166个周期,比较组间的超促排卵情况及妊娠结局。结果:A组Gn用量(75IU/支)、Gn总天数、IVF受精率和优质胚胎率均较B组高(P<0.05);Gn启动日FSH水平和hCG注射日LH水平较B组低(P<0.05);着床率、临床妊娠率、继续妊娠率A组与B组比差异无统计学意义(P<0.05),但有增高趋势。结论:黄体中期短效达必佳0.1mg/d×14d降调节效果比0.05mg/d降调节好。     

小剂量GnRHa在IVF-ET促超排卵中的探讨

目的:探讨在体外受精-胚胎移植(IVF-ET)超排卵方案中GnRHa降调节的最低有效剂量。方法:回顾分析采用长方案的148个IVF周期,分为1/2剂量组(A组)42例,每日皮下注射短效曲普瑞林1/2支(0.05mg/d);1/3剂量组(B组)44例,一次性皮下注射曲普瑞林缓释型1.25mg;小剂量组(C组)62例,每日皮下注射短效曲普瑞林1/2支(0.05mg/d)至月经来潮d3减量至1/4支(0.025mg/d),比较其治疗效果。结果:C组促性腺激素(Gn)用量、用药时间明显少于A组(P<0.05)和B组(P<0.01),hCG注射日血LH水平明显高于其他两组(P<0.05)。三组降调后E2、hCG注射日E2水平、受精率、优质胚胎率、临床妊娠率均无显著性差异(P>0.05)。三组均无内源性LH峰出现。结论:小剂量短效GnRHa的应用能减少Gn用量及缩短疗程,且不影响IVF结局,与缓释型GnRHa制剂相比还有能灵活调整使用剂量的优点。     

应用不同剂量长效GnRHa(达菲林)降调节的临床效果分析

目的:探讨IVF中GnRHa(达菲林)降调节的合适剂量。方法:回顾性分析采用黄体期长方案进行控制性超排卵临床妊娠病例147例,根据所用达菲林的剂量分为4组,分别为A组0.93-1.12mg(31例)、B组1.31mg(30例)、C组1.50mg(50例)和D组1.69-1.87mg(36例),比较各组间的治疗指标。结果:各组间垂体降调节时间、促性腺激素(Gn)使用时间、降调节后给予Gn前血清LH、取卵日血清P、ET日血清PRL水平均无显著性差异(P>0.05)。各组患者年龄、使用Gn总量、hCG注射日血清E2、取卵日血清E2、募集卵泡数、获卵数、MII卵数均有显著性差异(P<0.05)。结论:应根据患者的卵巢基础状态给予不同剂量的GnRHa行垂体降调节;高龄妇女及卵巢储备功能较差的患者,进行辅助生殖治疗中,长效GnRHa0.93mg(1/4支)已可达到控制性超排卵的垂体调节和抑制LH峰早现的作用。     

促性腺激素释放激素激动剂长、短方案在体外受精-胚胎移植中的比较性研究

目的　探讨促性腺激素释放激素激动剂（GnRH-a）长、短方案控制性超排卵在体外受精-胚胎移植（IVF-ET）中的疗效。方法　将2000年1～5月进行IVF和单精子卵胞浆注射（ICSI）助孕的不孕患者，按病历奇、偶数编号分为GnRH-a长方案组（55例）和短方案组（54例）。长方案组从使用促性腺激素（Gn）治疗周期前的黄体中期开始使用GnRH-a0.9mg/d，至垂体完全降调节后，加用Gn；短方案组从月经第2天开始使用GnRH-a0.45mg/d，同时加用Gn。两组均在优势卵泡达18mm时，肌内注射人绒毛膜促性腺激素（hCG），36h后取卵行IVF及ICSI。结果　长方案组较短方案组，使用Gn前血清促卵泡激素（FSH）和黄体生成素（LH）水平降低［（4.4±1.2）IU/L比（6.3±1.7）IU/L,（2.7±1.5）IU/L比（4.4±2.8）IU/L,P<0.01］；注射hCG前血清雌二醇（E2）和LH水平降低［（7119±3584）pmol/L比（9523±3587）pmol/L，（1.0±1.0）IU/L比（4.0±3.4）IU/L,P<0.01］；每个卵子E2水平降低［（610±315）pmol/L比（935±450）pmol/L,P<0.01］；Gn用量增多［（28.0±8.6）支比（23.4±8.7）支,P<0.01］，用药时间增长［（11.1±1.2）d比（10.1±1.5）d,P<0.01］；两组平均获卵数、第2次成熟分裂中期卵子数、受精卵数、卵裂数、优质胚胎数及妊娠率无显著差异。结论　在IVF-ET，GnRH-a长、短方案能获得相同的控制性超排卵效果，且GnRH-a短方案能减少Gn用量和缩短治疗时间。     

基础FSH/LH比值及晚卵泡期LH水平对体外受精-胚胎移植结局的影响

目的:探讨患者基础FSH/LH比值及控制性超促排卵(COH)时降调后hCG注射日血清LH水平对IVF-ET结局的影响及与COH各参数的关系。方法:回顾性分析首次进行IVF/ICSI-ET助孕、应用GnRH-a长方案降调节的不孕妇女,共427个周期。结果:ROC曲线显示FSH/LH比值与IVF-ET临床妊娠率无明显相关性;FSH/LH≥2与FSH/LH<2组间虽然临床妊娠率无差异,但FSH/LH≥2组Gn用量增加,获卵数少,优质胚胎数少,存在统计学差异(P<0.05)。hCG注射日血清LH≥0.65IU/L者妊娠率(55.8%)明显高于LH<0.65IU/L者(24.6%)。结论:基础FSH/LH比值增高能较早反映卵巢储备功能并指导超排方案及Gn用量;降调节后卵泡晚期(hCG注射日)的LH水平过低(<0.65IU/L),将会导致临床妊娠率下降。     

小剂量达必佳用于体外受精-胚胎移植卵巢反应欠佳患者的临床研究

目的:探讨小剂量达必佳在体外受精-胚胎移植(IVF-ET)卵巢反应欠佳患者中的应用效果。方法:选择接受IVF-ET治疗应用常规长方案促排卵获卵数4~6个,因治疗失败,3月后进行第2次IVF助孕的患者62例,第1个治疗周期每日皮下注射达必佳1支(0.1mg),第2治疗周期达必佳用量为每日1/3支(0.03mg),自身对照比较促性腺激素(Gn)用量、获卵数、受精卵数、冷冻胚胎数。结果:第2周期Gn用量明显少于第1周期(38.46±10.13支vs 44.50±13.10支,P<0.05);使用Gn前血黄体生成素(LH)水平高于第1周期(2.89±0.41IU/L vs 1.20±0.31IU/L,P<0.001);绒毛膜促性腺激素(HCG)注射日血LH、雌二醇(E2)水平高于第1周期(3.39±0.98IU/L vs 1.25±0.29IU/L,P<0.001;6032.11±1011.3pmol/L vs 4299.81±1122.40pmol/L,P<0.05);获卵数多于第1周期(6.7±0.32个vs 5.0±0.68个,P<0.05);受精卵数多于第1周期(4.9±0.85个vs 3.49±0.35个,P<0.05);冷冻胚胎数多于第1周期(2.1±0.42个vs 0.97±0.65个,P<0.05);而Gn用药时间、降调节后血E2、HCG注射日血孕酮(P)、优质胚胎率等在2个治疗周期间无统计学差异,62例患者第2个IVF周期21例妊娠。结论:对卵巢反应欠佳患者应用1/3剂量达必佳即可达到降调节的效果,且在减少Gn用量的同时,获得满意的妊娠效果。     

Comparison of leuprolide acetate and triptorelin in assisted reproductive technology cycles: a prospective,randomized study

OBJECTIVE: To compare the use of two depot GnRH-a, leuprolide and triptorelin, in long-suppression GnRH-a protocols. DESIGN: Prospective, randomized study. SETTING: An IVF unit of an academic medical center.Fifty-two women who underwent controlled ovarian hyperstimulation and IVF. INTERVENTION(S): Patients were prospectively randomized to receive 3.75 mg depot formulations of either leuprolide or triptorelin on days 21-23 of the menstrual cycle. Stimulation with gonadotropins was initiated after pituitary desensitization was achieved. MAIN OUTCOME MEASURE(S): The stimulation pattern and cycle outcomes were compared between the two groups. RESULT(S): Twenty-six patients were included in each group. No significant differences were observed in the patient age, estrogen, and P levels on day of hCG administration, gonadotropin dosage, number of oocytes retrieved, fertilization rate, percentage of high-quality embryos, and number of embryos transferred. However, significantly higher clinical implantation and pregnancy rates were found in the leuprolide group compared with the triptorelin group. CONCLUSION(S): A depot preparation of leuprolide is associated with higher implantation and pregnancy rates than a depot preparation of triptorelin when it is used in the midluteal phase as part of the long-suppression GnRH-a protocol in IVF.     

Comparison of GnRH agonists and antagonists in unselected IVF/ICSI patients treated with different controlled ovarian hyperstimulation protocols: a matched study

OBJECTIVES: To evaluate the results of the use of GnRH antagonist (GnRHant) and GnRH analog (GnRHa) in two matched groups of unselected IVF/ICSI patients in a retrospective matched pair analysis. STUDY DESIGN: Patients (n=52) were stimulated with human menopausal gonadotropin (hMG) and/or recombinant FSH (rFSH). In Group I (n=26) a daily dose of 0.25mg of Cetrorelix (GnRHant) was administered when follicles reached a diameter of > or = 14 mm. Patients in Group II (n=26) were first desensitized with GnRHa triptorelin long protocol, which was continued during the gonadotropins treatment until the induction of ovulation. RESULTS: In both groups, serum LH levels remained low during the stimulation. The mean length of stimulation, and the dose of FSH required per patient were similar in both groups. The mean E2 level on day of hCG administration was significantly higher in the patients of Group II (2076+/-1430 versus 1145+/-605 pg/ml), however, a progressive increase in serum E2 concentration during the cycle was noted in both groups. A median of 5.38 and 6.34 mature oocytes per patient was obtained, and the fertilization rate was 59.3% in Group I and 63.6% in Group II. Pregnancy rate (PR) were better in Group II (15 versus 5%), and no severe or moderate ovarian hyperstimulation syndrome (OHSS) occurred. CONCLUSIONS: GnRHant and GnRHa provide comparable results in unselected patients, while GnRHant allows a higher flexibility in the treatment.     

Use of GnRH analogs for functional protection of the ovary and preservation of fertility during cancer treatment in adolescents: a preliminary report

OBJECTIVE: Recent success in polychemotherapy (PCT) in adolescent female cancer patients has become a source of concern for specialists who also strive to preserve fertility. We studied whether gonadotropin-releasing hormone (GnRH) analogs could prevent the early onset of ovarian insufficiency postchemotherapy and protect fertility. METHODS: The patients were divided into three groups: Control group 1 (Group A), premenarchal patients aged 3 to 7.5 years (n = 5), were not given GnRH analogs administered prior to PCT. Postmenarchal patients (Group B), aged 14.7 to 20 years (n = 12) with normal menstrual rhythm and ovulatory cycles, received treatment with GnRH analogs prior to PCT. Control group 2 (Group C), postmenarchal patients aged 15.9 to 20 years (n = 4), received PCT but no GnRH analog protection. All groups received the PCT regimens CAVPE, CVPP, ABVD, TAMO, ARA-C, and MTT. In group B, leuprolide acetate inhibition was obtained with a depot injection administered each month before and during treatment with PCT. To accelerate the timing of ovarian regression, a subcutaneous injection (0.2 mg) was administered simultaneously. RESULTS: In Group A, patients had spontaneous menarche between the ages of 12 and 17.9 years, followed by normal menstruation and ovulatory cycles. Three patients became pregnant. After GnRH analog withdrawal, Group B patients continued with normal ovulatory cycles. Two patients became pregnant. Group C patients presented hypergonadotrophic hypoestrogenic amenorrhea. CONCLUSION: GnRH analog treatment before and during PCT enhances ovarian function and preserves adolescent fertility. The results must be confirmed in a larger study.     

来曲唑/FSH促排卵中GnRHa与hCG诱发卵泡成熟效果的比较

目的:比较曲普瑞林和hCG在来曲唑(LE)/FSH促排卵行IVF-ET治疗中诱发卵泡成熟的效果。方法:391个IVF-ET治疗周期随机分成促性腺激素激动剂(GnRHa)组(n=267)和hCG组(n=124),所有患者均采用LE/FSH促排卵方案,当主导卵泡平均直径达18～20mm时,GnRHa组患者采用达菲林0.1mg诱导卵泡成熟,hCG组采用hCG10000IU诱导卵泡成熟,比较组间的获卵数、MII卵率、受精率、卵裂率、优胚率、临床妊娠率和中-重度卵巢过度刺激综合症(OHSS)发生率。同时比较两组患者诱导日(d0)、取卵日(d2)、胚胎移植前日(d4)和胚胎移植后第4日(d9)的血清E2、P、LH水平。结果:hCG组Gn使用总量、MII卵率、卵裂率、中-重度OHSS发生率显著高于GnRHa组(P<0.05)。Gn使用天数、获卵数、受精率、种植率、临床妊娠率、流产率组间无统计学差异(P>0.05)。GnRHa组d0LH、d2LH、d9LH水平显著高于hCG组(P<0.05),而d2P、d4E2、d4P、d4LH、d9E2、d9P水平显著低于hCG组(P<0.05)。结论:在LE/FSH促排卵方案中可以用GnRHa替代hCG诱导卵泡成熟,而不影响IVF结局,并显著降低OHSS发生率。GnRHa诱导卵泡成熟的IVF周期其黄体期存在黄体功能不全,需适当补充外源性hCG加强黄体支持。     

Prospective Randomized Comparison of Ovarian Blockade with Nafarelin Versus Leuprolide During Ovarian Stimulation with Recombinant FSH in an ICSI Program

Purpose: A prospective study was conducted to compare the efficiency of ovarian blockade with nafarelin versus leuprolide in a population whose indication for assisted reproduction was the male factor. Methods: A total of 238 patients were assigned at random to two types of treatment: Group I (119 aspirations), nafarelin (Synarel, Searle), 200 g by the nasal route twice a day, and Group II (119 aspirations), leuprolide acetate (Lupron, Abbott), 0.5 mg by the subcutaneous route once a day. Both types of blockade were started during the 2nd phase (21st day of the menstrual cycle) and were continued until the day of HCG (5,000–10,000 IU). All patients received a fixed dose of recombinant FSH for 7 days and on the 8th day of stimulation the doses started to be adapted according to ovarian response. Results: Patients' age did not differ (p = 0.93) between Group I (34.1 ± 3.79) and Group II (34 ± 4.64). The number of oocytes retrieved from Group I (10.5 ± 5.93) was also similar (p = 0.57) to that retrieved from Group II (10.2 ± 6.36). In addition, there was no difference (p = 0.58) in the number of oocytes retrieved at Metaphase II between Group I (8.2 ± 4.61) and Group II (7.9 ± 5.2). Fertilization rates and embryo scores were similar (p = 0.81 and p = 0.25, respectively) for Group I (67.5% ± 21.3 and 34.4% ± 14.4) and Group II (68.1% ± 23 and 32.2% ± 14.7, respectively). In addition, pregnancy rates per puncture and per embryo transfer and implantation rates were similar for Group I (30.2, 31.3, and 16.2%, respectively) then compared with Group II (24.4, 25.2, and 12.6%, respectively) (p = 0.38, p = 0.37, and p = 0.22, respectively). Conclusions: Implantation and pregnancy rates per puncture and per embryo transfer are not statistically significant in the nafarelin group when compared with leuprolide group.     

Does oestriol add to the beneficial effect of combined hormonal prophylaxis against early postmenopausal osteoporosis?

Sixty-nine healthy women in the early menopause were assessed in terms of calcium metabolism, coronary risk factors, Kupperman index, and various serum hormones before and during replacement therapy with 17 beta-oestradiol plus oestriol and norethisterone acetate. The patients were followed for 1 year, and the daily doses used were: 17 beta-oestradiol: 2 mg from day 1 to day 22, 1 mg from day 23 to day 28; oestriol: 1 mg from day 1 to day 22, 0.5 mg from day 23 to day 28; and norethisterone acetate: 1 mg from day 13 to day 22. Group A (n = 22) received 17 beta-oestradiol and norethisterone acetate; group B (n = 20) received 17 beta-oestradiol plus oestriol and norethisterone acetate and group C (n = 23) received a placebo. The responses in groups A and B were similar with no significant difference between the two therapy regimens. The results suggest that in the dose given, oestriol does not add significantly to the beneficial effect of combined hormonal prophylaxis against early postmenopausal osteoporosis.     

Efficacy and renal toxicity of one daily dose of amikacin versus conventional dosage regime

This study assessed the efficacy and renal toxicity of one daily dose of amikacin versus several doses in infected full-term newborns. A clinical trial was conducted with 120 patients who were divided into two groups: group A (n = 60), infants who received amikacin 20 mg/kg/d in one dose; and group B (n = 60), infants who received amikacin 10 mg/kg/d every 12 hours. Both groups also received ampicillin 100 mg/kg/day. Blood levels of amikacin, urinary beta(2)-microglobulin (beta(2)-m), serum creatinine (SCr), and glomerular filtration rate (GFR) were measured in each patient. No significant difference was found in demographic characteristics as well as in their beta(2)-m, SCr, and GFR levels. Infection was resolved in 96% for infants of group A and 91% for group B ( P = 0.254). Renal toxicity was present in 20 versus 31.6%, respectively ( P = 0.211). In both groups no significant difference was found in peak amikacin levels, whereas trough levels were higher for group B ( P = 0.004). No significant difference was found in efficacy or renal toxicity in either group. We recommend using amikacin in one daily dose. It could diminish the manipulation of intravenous access, reducing the risk of nosocomial infections.     

GnRHa与小剂量利维爱反加疗法在治疗子宫内膜异位症中的应用

目的:探讨促性腺激素释放激素类似物(GnRHa)对子宫内膜异位症(内异症)的治疗作用,比较国产药物阿拉瑞林与进口药物高舍瑞林的疗效;探讨小剂量利维爱反加疗法的应用价值。方法:随机将内异症40例分为两组。研究组20例予以阿拉瑞林治疗,150μg/d,连用6个月,再随机分为HRTO组(10例,单用GnRHa)和HRT1组(10例,同时加用利维爱1.25mg/d)。对照组20例,予以高舍瑞林治疗,3.6mg/4周,也随机分为HRT’0组(10例,单用GnRHa)和HRT’1组(10例,同时加用利维爱1.25mg/d)。结果:治疗1月各组患者血清FSH、LH水平均降低,E2降至绝经期水平;患者的自觉症状明显改善,异位症的体征减少或消失,有效率为90.0％;卵巢巧克力囊肿缩小或消失,有效率为80.0％～90.0％;血清学指标CA125、AEMAb阳性率明显下降。各组疗效无显著性差异(P>0.05)。单用GnRHa组几乎均出现低雌激素症状。反加疗法组未出现低雌激素症状或症状很轻。结论:GnRHa能有效治疗内异症,阿拉瑞林与高舍瑞林具有相同的疗效。反加疗法能减轻GnRHa的副作用而不影响其疗效。GnRHa与利维爱反加疗法联合应用是治疗内异症较为理想的方案。     

曲普瑞林治疗子宫肌瘤的临床疗效及安全性研究

目的 观察曲普瑞林治疗子宫肌瘤的临床疗效及安全性。方法 采用多中心的前瞻性随机对照临床研究,于2002年12月—2004年3月,将确诊的125例子宫肌瘤患者随机分为研究组,63例,接受臀部肌内注射曲普瑞林3．75mg治疗;和对照组,62例,接受前臂皮下注射亮丙瑞林3．75mg治疗。两组均为每28d注射药物1次,共治疗3个月。观察月经情况、子宫与子宫肌瘤体积以及血清雌二醇水平等变化。结果 125例均完成治疗。两组治疗前子宫及最大子宫肌瘤体积比较,差异均无统计学意义(P＞0．05)。但两组治疗后子宫及最大子宫肌瘤体积较治疗前均明显缩小,两组组内治疗前后比较,差异均有统计学意义(P＜0．01)。研究组和对照组治疗后子宫体积较治疗前分别平均缩小51％(中位数,下同)和49％,最大子宫肌瘤体积分别平均缩小50％,和48％,两组间比较,差异均无统计学意义(P＞0．05)。研究组和对照组治疗后血清雌二醇达到去势水平(＜183pmol／L)的比例均为94％(59／63,58／62)。研究组和对照组治疗3个月时的闭经率分别为97％(61／63)和95％(59／62)。患者治疗后痛经、非经期下腹痛和压迫症状等均迅速缓解,两组比较,差异均无统计学意义(P＞0．05)。两组药物副反应总的发生率均为71％(45／63,44／62);主要副反应为注射药物后2周左右发生阴道出血及低雌激素症状;研究组和对照组分别有9例和6例因症状明显给予替勃龙1．25～2．50mg／d口服治疗。结论 曲普瑞林治疗子宫肌瘤3个月的临床疗效确切,无严重副反应。     

A prospective randomized study comparing endocrinological and clinical effects of two types of GnRH agonists in cases of uterine leiomyomas or endometriosis

OBJECTIVE: In order to assess the endocrinological changes associated with 2 types of low-dose GnRH agonists depot as well as their clinical efficacy, we performed a randomized prospective comparison study of patients having uterine leiomyomas or endometriosis. METHODS: A prospective randomized study involving 67 patients with uterine leiomyomas or endometriosis was carried out. These patients were randomly administered either buserelin MP 1.8 mg (Group B, n = 34) or leuprolide 1.88 mg (Group L, n = 33). In each group we evaluated the symptoms of genital bleeding and hot flashes during GnRHa treatment, as well as the levels of serum LH, FSH, and estradiol 8 weeks after the start of treatment. In addition, the endometrial thickness was measured by transvaginal ultrasonography, and changes in the volume of the uterine leiomyoma or endometrial cyst at the end of treatment. The GnRHa depot was administered from 3 to 8 times, 28 days apart, in both groups. RESULTS: The incidence of menstruation-like genital bleeding 8 weeks after treatment was significantly (p < 0.01) higher in Group B. However this difference disappeared by 12 weeks after treatment. The climacteric symptom of hot flashes was found to be significantly (p < 0.01) more severe in Group L, and this tendency continued until 20 weeks after treatment. The 2 groups did not differ significantly with regard to the levels of the serum LH, FSH, and estradiol at 8 weeks after treatment or in the endometrial thickness at the end of the GnRHa treatment. In both groups, the volumes of the uterine leiomyomas were significantly (p < 0.01) lower after the treatment. In contrast, the volumes of the endometrial cysts did not decrease after administration of GnRHa in both groups. CONCLUSION: Leuprolide 1.88 induced pituitary down regulation more rapidly than buserelin MP. However the hypoestrogenic symptoms such as hot flashes were more severe in cases treated with leuprolide 1.88 than in those treated with buserelin MP. Our data confirm that the therapeutic efficacy of buserelin MP and leuprolide 1.88 are similar, with both being sufficient to treat uterine leiomyomas and endometriosis.