子宫内膜异位症根治术后激素替代治疗疗效观察

目的　探讨激素替代治疗Ⅲ～Ⅳ期子宫内膜异位症根治术后 (全子宫及双侧附件切除术后 )的临床疗效与安全性。方法　 2 0 0 1年 3月至 2 0 0 2年 12月将 30例患者随机分成两组 (各 15例 ) :观察组口服戊酸雌二醇0 5～ 1 0mg ,每日 1次。对照组口服利维爱 1 2 5mg ,每日或隔日 1次。治疗前后检查盆腔情况、肝肾功能、体内血清FSH(卵泡刺激素 )、血清E2 (雌二醇 )水平 ,记录治疗期间盆腔痛、性交痛等子宫内膜异位症相关症状和乳房胀痛等不良反应 ,Kupperman评分 (K评分 )每月 1次。 结果　两组用药后围绝经期症状均明显改善 ,无子宫内膜异位症复发表现 ,血浆E2 水平上升 ,治疗前后比较差异有显著性意义 (P <0 0 1)。治疗后E2 水平观察组高于对照组 ,两组比较差异有显著性意义 (P <0 0 1) ,但均在安全范围内。结论　小剂量戊酸雌二醇和利维爱用于Ⅲ～Ⅳ期子宫内膜异位症根治术后患者 ,均能安全、有效地控制围绝经期症状。     

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。     

促性腺激素释放激素激动剂联合反加疗法治疗子宫内膜异位症的临床观察

近年来研究表明 ,应用促性腺激素释放激素激动剂(ＧｎＲＨ ａ)可有效地治疗子宫内膜异位症 (内异症 ) ,但其低雌激素状态引起潮热、阴道干燥及骨密度下降等限制了其长期使用。本研究观察应用ＧｎＲＨ ａ联合结合雌激素、安宫黄体酮反加疗法治疗内异症的疗效及对骨密度的影响。一、资料和方法1.一般资料 :1997年 4月至 2 0 0 0年 10月在我院就诊的内异症患者 3 0例 ,年龄 2 9～ 41岁 ,平均 (3 6± 4)岁 ,随机分成Ａ、Ｂ两组 (各 15例 )。内异症术后复发者 ,Ａ组 4例、Ｂ组 6例 ;内异症术后仍有残留病灶于术后继续药物治疗者 ,Ａ组11例、Ｂ组 …     

雌激素与子宫内膜异位症的研究进展

子宫内膜异位症(简称内异症)是一种常见于育龄妇女的雌激素依赖性疾病,其生物学行为源于雌激素暴露。促进内异症易感和发展的因素很多,本文就雌激素代谢与内异症发生、发展的关系进行综述。     

子宫内膜异位症患者激素治疗的研究进展

目前临床上治疗子宫内膜异位症患者常用的激素类药物有孕激素、雄激素、丹那唑、三苯氧胺、促性腺激素释放激素激动剂、内美通等，这些药物作用机理不同，需针对情况使用。     

重度子宫内膜异位症腹腔镜术后联合GnRHa治疗效果及反加疗法的影响

目的:分析重度子宫内膜异位症患者腹腔镜术后联合GnRHa治疗中,应用反加疗法与否对临床疗效及副反应的影响,探讨短期应用GnRHa联合反加治疗的必要性和时机。方法:回顾分析2003年3月至2006年6月行保守性腹腔镜手术且手术证实为盆腔子宫内膜异位症,部分合并子宫腺肌症、术后应用GnRHa治疗3个月87例患者的临床资料,包括患者疼痛症状、不孕情况、体征、血清CA125、临床病理类型、手术过程、术后用药及随诊情况,根据是否应用反加疗法分成两组。统计分析用药疗效、月经恢复状态、副反应及复发情况。停药后定期随诊,随诊时间为12～28个月,平均18.25个月。结果:34例患者出现明显低雌症状,予以反加治疗(倍美力0.3mg+安宫黄体酮2mg)/d。两组治疗后疼痛VAS评分、体征改善、血清CA125均较治疗前有统计学差异(P<0.05);治疗后两组疗效及月经恢复间隔无统计学差异(P>0.05)。49例不孕患者手术用药后自然妊娠12例,辅助生殖妊娠6例,妊娠率36.74%;自然妊娠时间为停药后2～22个月,平均9.5±5.5个月,自然妊娠率为24.48%。复发平均时间为末次GnRHa用药后12.81±5.5个月;复发23例,1年内复发13例(14.94%),2年累计复发率26.43%。疼痛复发率8/87(9.2%),体征复发率20/87(22.99%)。两组复发率,复发类型及复发间隔无统计学差异(13.8%vs12.6%,P=0.133;12.13±6.15个月vs12.75±5.60个月,P=0.881)。结论:腹腔镜术后辅以GnRHa治疗重度子宫内膜异位症提高了手术成功率,有效抑制了疼痛复发。适时反向添加治疗可缓解用药副反应,不影响疗效及复发。     

子宫内膜异位症手术治疗的现状

子宫内膜异位症(内异症)是生育年龄妇女的常见病。其发病率呈上升趋势，且发病机制不清。目前，内异症的治疗方法主要为手术治疗和药物治疗，现就其手术治疗现状及疗效作一综述。     

雌激素在子宫内膜异位症中的作用

子宫内膜异位症（以下简称内异症）是雌激素依赖性疾病。内异症患者的在位和异位的子宫内膜细胞内均存在芳香化酶及其ｍＲＮＡ,病灶组织局部呈高雌激素状态,但是,异位的子宫内膜细胞上的雌激素受体不随月经周期而变化,并且功能异常,无与雌激素结合者,说明雌素不是通过与内异症细胞上的雌激素受体来促进增殖。研究发现,雌激素可与各种相前的细胞因子协调参与异位的子宫内膜增殖。     

子宫内膜异位症患者雌激素受体基因的多态性研究

遗传流行病学研究提示 ,子宫内膜异位症 (内异症 )是一种多基因遗传性疾病[1,2 ] 。雌激素与内异症发病、发展有密切的关系 ,我们选择雌激素受体 (ＥＲ)基因为候选基因 ,探讨ＥＲ基因ＰｖｕⅡ、ＸｂａⅠ的多态性与内异症的关系。一、材料和方法1 研究对象 :观察组为 2 0 0 0年 2月～ 2 0 0 1年 8月 ,在复旦大学附属妇产科医院住院治疗 ,经腹腔镜活组织检查 ,并经病理学证实为内异症的患者 ,共 63例 ,年龄为 2 1～ 5 0岁 ,平均为 (3 5± 9)岁。对照组为同期住院患者 ,经腹腔镜或开腹手术证实无内异症 ,且无子宫肌瘤、子宫腺肌病的患者 ,共41…     

GnRH-a治疗子宫内膜异位症对骨密度影响的系统评价

目的:评价促性腺激素释放激素激动剂(GnRH-a)治疗子宫内膜异位症对骨密度影响。方法:检索Cochrane Library、MEDLINE、EMBASE、中国生物医学文献数据库、CBM、CNKI等。纳入GnRH-a治疗子宫内膜异位症的随机对照试验,对其方法学质量进行评价。用RevMan 4.2.10软件进行统计分析。结果:①GnRH-a组骨密度和骨丢失率明显大于反加疗法[RR=0.03,95%CI(0.01,0.06),P<0.05;RR=1.86,95%CI(1.11,2.61),P<0.01]。其余描述性研究支持上述结果,认为两组差异有统计学意义(P<0.05)。GnRH-a组骨密度减少大于孕激素组(P<0.05)。②GnRH-a组药物副反应比反加疗法组大(P<0.05),雌激素水平也比反加疗法组下降多(P<0.01),在缓解疼痛上与反加疗法组差异无统计学意义(P>0.05)。GnRH-a组在缓解疼痛、药物副反应方面同孕激素组差异均无统计学意义。结论:目前研究认为GnRH-a组与反加疗法组、孕激素组在缓解子宫内膜异位症疼痛上效果相同,GnRH-a组所致骨密度下降大于其余两组。反加疗法组能降低GnRH-a...     

Recurrence of endometriosis in women with bilateral adnexectomy (with or without total hysterectomy) who received hormone replacement therapy

OBJECTIVE: To estimate the risk of recurrence after administration of hormone replacement therapy (HRT) among women who have had endometriosis and who underwent bilateral salpingo-oophorectomy (BSO). DESIGN: Prospective randomized trial (115 women receiving HRT and 57 not receiving HRT). SETTING; Public university hospital. PATIENT(S): Women with a histologic diagnosis of endometriosis in whom BSO was performed; 91.8% had a total hysterectomy. INTERVENTION(S): Periodical clinical examination, vaginal ultrasound, and CA-125 levels; surgical evaluation and histologic study. MAIN OUTCOME MEASURE(S): Recurrence rate, prognostic factors, and a mean follow-up time of 45 months. RESULT(S): There was no recurrence among women who did not receive HRT, versus a 3.5% rate (4 out of 115), or 0.9% per year, in women who received HRT. Two recurrences required abdominal surgery. There was one additional patient who required surgery, but the relationship to the endometriosis recurrence was controversial. Among women receiving HRT, the following risk factors were detected: peritoneal involvement > 3 cm (2.4% recurrence per year vs. 0.3%) and incomplete surgery (22.2% per patient vs. 1.9%). CONCLUSION(S): Patients with a history of endometriosis in whom total hysterectomy and bilateral salpingo-oophorectomy have been performed have a low risk of recurrence when HRT is administered. In those patients, HRT is a reasonable option. However, in cases with peritoneal involvement > 3 cm, the recurrence rate makes HRT a controversial option; if HRT is indicated, it should be monitored closely.     

A case of persistent endometriosis after total hysterectomy with both salpingo-oophorectomy managed by radiation therapy

Persistent endometriosis after total hysterectomy and both salpingo-oophorectomy (TH with BSO) is a rare condition and the etiology is uncertain. The exact incidence of persistent endometriosis after definitive surgery is not known. In addition, the treatment of persistent endometriosis after complete surgical excision is controversial. We report a case of persistent endometriosis with vaginal and sigmoid-colonic invasion after TH with BSO. The lesions were not responsive to hormonal therapy. The patient was managed successfully by therapeutic pelvic radiation. Received: 26 October 2000 / Accepted: 12 December 2000     

Low-dose conjugated equine estrogens elevate circulating neurotransmitters and improve the psychological well-being of menopausal women

OBJECTIVE: To assess the effect of low-dose conjugated equine estrogens (E) on circulating neurotransmitters and the efficacy for the treatment of psychological symptoms. DESIGN: Controlled comparative clinical study. SETTING: Endocrine Research Unit, Instituto Mexicano del Seguro Social, Mexico. PATIENT(S): Thirty postmenopausal women received conjugated equine E. Ten women acted as a comparison group. INTERVENTION(S): Conjugated equine E, 0.312 mg/day, for 21 days per cycle during six cycles and added chlormadinone acetate, 2 mg/day, for the last 5 days of each cycle. Green scale for climateric women and Blatt-Kupperman Menopausal Index were used for measuring psychological well-being. MAIN OUTCOME MEASURE(S): Serum levels of dopamine (DA), noradrenaline, serotonin, and beta-endorphin were quantified by specific assays at baseline and at the end of treatment. RESULT(S): Low baseline levels of DA, serotonin, and beta-endorphin increased significantly (P<.001) from 181.9 +/- 47.8 pg/mL to 202.9 +/- 32.8 pg/mL (mean +/- SD); from 206.4 +/- 94.2 ng/mL to 279.2 +/- 67.9 ng/mL; from 11.2 +/- 1.8 pmol/L to 13.8 +/- 2.4 pmol/L, respectively, after conjugated equine E. In parallel, augmented baseline noradrenaline levels diminished significantly (P<.05) from 30.2 +/- 4.7 ng/mL to 24.0 +/- 4.7 ng/mL. All neurotransmitter levels had a significant correlation with 17beta-E(2) concentrations at the end of the study. Alleviation of psychological symptoms was observed in all but eight treated women. CONCLUSION(S): Low-dose conjugated equine E associated with periodic administration of chlormadinone acetate elicited favorable changes in neurotransmitters and relieved psychological symptoms.     

Effects of bilateral ovariectomy and estrogen replacement therapy on serum leptin,sex hormone binding globulin and insulin like growth factor-I levels

Studies evaluating the effect of estrogen replacement therapy (ERT) on leptin levels are contradictory. The aim of this study was to investigate effects of bilateral ovariectomy and ERT on serum leptin levels and anthropometric measurements as well as interaction among leptin, sex hormone binding globulin (SHBG), and insulin like growth factor-I (IGF-I) in premenopausal women after bilateral ovariectomy. Twenty-four premenopausal women who undergo bilateral overiectomy were divided into two groups based on whether they received hormonal treatment postoperatively. The studied parameters were evaluated in both groups preoperatively and during the fourth and eighth weeks postoperatively. Serum leptin, testosterone, prolactin, insulin, IGF-1 levels, BMI, HOMA-IR, and waist-to-hip ratio values did not change in both groups at all times. In the estradiol group, serum SHBG concentrations were significantly higher on weeks 8 compared with control group and basal values (p?=?0.03 and 0.014, respectively). Leptin levels showed a positive linear correlation with BMI in all groups and at all times evaluated (r?=?0.80, p?<?0.01 for controls and r?=?0.62, p?<?0.01 for women treated with 17β-estradiol) and with insulin in estradiol group on weeks 4 (r?=?0.755, p?<?0.05). No correlation was found between leptin and estradiol, testosterone, prolactin, SHBG, IGF-1 levels, and anthropometric variables at all times. Leptin levels do not show modification 8 weeks after bilateral ovariectomy and under ERT, suggesting that estrogens do not have a stimulatory action on leptin in humans. Although needing confirmation by a longer study, our findings suggest that IGF-I system and SHBG did not regulate leptin and vice versa and ERT do not have any effect on leptin, SHBG, and IGF-I.     

Effects of estrogen therapy on microalbuminuria in healthy post-menopausal women

Objective. To evaluate the impact of estrogen therapy on microalbuminuria levels in healthy post-menopausal women.

Methods. Sixty post-menopausal women were evaluated in a prospective, randomised, double-blind, placebo-controlled study. The patients were randomly allocated to one of two groups to take one pill orally per day containing either 1 mg of 17β-estradiol (E₂ group) or placebo (placebo group). Prior to initiating treatment and at the end of the sixth treatment month, microalbumin was measured in a 12-h urine sample, and lipid profile (total cholesterol, HDL, LDL and triglycerides) and fasting glucose were evaluated. Comparative intra- and inter-group analyses between the initial and final laboratory parameters were performed using the t-test for paired samples and for independent samples, respectively.

Results. Microalbuminuria levels remained within normal limits throughout the study and no statistically significant differences were found in the intra- or inter-group analyses. With respect to lipid profile, alterations characteristically encountered during use of estrogen replacement therapy were found. No statistically significant variation in glucose levels occurred during the study period.

Conclusion. Estrogen replacement therapy had no significant effect on microalbuminuria levels in healthy post-menopausal patients.