阿拉瑞林对子宫内膜癌裸鼠移植瘤作用的实验研究

目的观察阿拉瑞林对HEC-1B裸鼠移植瘤的抑制作用及对血管内皮生长因子（VEGF）表达的影响。方法将HEC-1B荷瘤鼠随机分为5组：阴性对照组、阿拉瑞林低、中、高剂量组和阳性对照（5-Fu）组。30d后处死裸鼠,称取移植瘤质量,并观察抑瘤率及用免疫组化SABC法检测移植瘤VEGF的表达。结果阿拉瑞林组和5-Fu组平均瘤质量和抑瘤率与阴性对照组比较,差异均有统计学意义（P〈0.05或P〈0.01）。低、中剂量阿拉瑞林组VEGF阳性率与阴性对照组比较,差异有统计学意义（P〈0.05）;高剂量阿拉瑞林组、5-Fu组VEGF阳性率与阴性对照组比较,差异有统计学意义（P〈0.01）。结论阿拉瑞林有一定的抑制子宫内膜癌生长的作用,且不良反应轻微,可能通过对VEGF的表达调控来实现。     

阿拉瑞林联合5-FU对人子宫内膜癌裸鼠移植瘤的抑制作用

目的观察阿拉瑞林对HEC-1B裸鼠移植瘤的抑制作用及对Bcl-2表达的影响。方法将HEC-1B荷瘤鼠随机分为4组：对照组、5-FU组、阿拉瑞林组和联合组。30d后处死裸鼠,称取移植瘤重量,观察抑瘤率,免疫组化SABC法检测移植瘤Bcl-2表达。结果阿拉瑞林组抑瘤率为21.02%,与对照组比较差异有统计学意义（P〈0.01）,免疫组化显示,各治疗组Bcl-2的表达明显下调。结论阿拉瑞林有一定的抑制子宫内膜癌生长的作用,可能通过对Bcl-2的表达调控来实现,且与5-FU有协同作用。     

亮丙瑞林和曲普瑞林治疗子宫内膜异位症术后不良症状的临床疗效观察

目的 比较亮丙瑞林和曲普瑞林治疗子宫内膜异位症(EMs)的近期不良反应与激素水平的下降情况.方法 将80例卵巢子宫内膜异位囊肿剥除术后的患者随机分成2组,进行前瞻性临床观察.术后亮丙瑞林组注射亮丙瑞林3.75 mg,曲普瑞林组注射曲普瑞林3.75 mg,两组均治疗3～6个月,每28～30天1次.观察2组的近期不良反应,同时测定用药第0、7、21天血清卵泡刺激素(FSH)、促黄体激素(LH)和雌二醇(E2)水平.结果 亮丙瑞林组27例与曲普瑞林组33例全程完成了治疗.两组患者均可发生潮热、盗汗,痤疮,肌肉、关节痛,头痛,异常阴道出血等不良反应,痤疮、头痛的发生率两组有显著性差异(P＜0.01,0.05).两组患者用药前基础性激素水平差异无统计学意义;用药治疗7d后血清FSH、LH、E2水平差异均有统计学意义(P＜0.05,0.01);用药治疗21 d后血清FSH、E2水平差异均有统计学意义(P＜0.01).结论 亮丙瑞林与曲普瑞林治疗子宫内膜异位症后其激素水平变化和近期不良反应均不同.亮丙瑞林治疗后激素水平下降缓和,不良反应发生率低.临床上应该根据不同剂型的特点,实施个体化治疗.     

水飞蓟素联用亮丙瑞林对子宫内膜异位症的疗效和安全性

目的考察水飞蓟素联用亮丙瑞林剂量减半法对于治疗子宫内膜异位症的疗效和安全性。方法 105位子宫内膜异位症患者随机分为两组,一组单用亮丙瑞林,另一组水飞蓟素联用亮丙瑞林,在治疗12,24个月后检测相关指标。结果与单用亮丙瑞林相比,联用组经12,24个月治疗,盆骨的慢性疼痛强度和频率减少相当,肝肾功能改善显著(P<0.05)。结论水飞蓟素能有效改善因长期服用亮丙瑞林引起的肝肾功能降低现象,水飞蓟素联用亮丙瑞林剂量减半法对于子宫内膜异位症的治疗具有积极意义。     

注射用阿拉瑞林的细菌内毒素检查

目的探讨注射用阿拉瑞林的细菌内毒素检查方法。方法按照2000年版《中国药典》(二部)收载的细菌内毒素检查法要求进行。结果对于注射用阿拉瑞林,可用标示灵敏度为0.25 EU/ml的鲎试剂进行细菌内毒素检查。结论注射用阿拉瑞林可使用细菌内毒素检查,方法可行、有效。     

丙氨瑞林对子宫内膜异位症患者骨密度的影响

目的 :探讨丙氨瑞林治疗的子宫内膜异位症患者的骨密度变化情况。方法 :选取 46例子宫内膜异位症患者作为治疗组 ,给予丙氨瑞林 15 0 μg ,sc ,疗程为 3mo。 2 8例月经周期正常的健康妇女及 18例轻度子宫膜异位症的妇女作为对照组。 结果 :治疗组与对照组骨密度均在正常范围。结论 :丙氨瑞林使用 3mo对骨密度无明显影响     

子宫内膜异位症术后应用GnRH-a及反加疗法的临床观察

目的探讨子宫内膜异位症术后应用促性腺激素释放激素激动剂(GnRH-a)联合反加疗法的疗效。方法将行腹腔镜保守治疗后的Ⅲ-Ⅳ期子宫内膜异位症患者36例随机分为A、B两组,A组患者在月经第1~2天给予醋酸亮丙瑞林3.75 mg皮下注射,隔28 d注射1次,共6次;B组用法同前,并于注射第2支醋酸亮丙瑞林同时每天口服戊酸雌二醇0.5 mg+地屈孕酮5 mg至治疗结束。比较两组患者治疗前后性激素水平、骨密度变化、EMT症状及低雌激素症状。结果治疗6个月后,A、B两组的VAS评分下降,且组间差异无统计学意义(P>0.05);两组患者的FSH、E2水平较前显著降低,A组E2水平显著低于B组(P<0.05);B组BMD无明显改变,而A组明显降低,显著低于B组(P<0.05);A组治疗后的Kupperman评分显著高于B组(P<0.05)。结论中、重度EMT患者术后采用GnRH-a联合反加疗法能有效缓解内异症的疼痛症状,并能减轻GnRH-a引起的低雌激素症状,维持骨密度。     

人参果总皂苷(SFPG)联合舍曲林治疗高血压病合并抑郁症的疗效及副反应观察

摘要 目的 探讨人参果总皂苷(SFPG)联合舍曲林治疗高血压病合并抑郁症的临床疗效及安全性。方法 选取88例高血压病合并抑郁症患者随机分为SFPG加舍曲林组和舍曲林单用组,在治疗前和用药后2,4,6周用HAMD评分量表评定其疗效,以TESS量表评定并观察两者的副作用。结果 治疗6周末,与舍曲林单用组相比,联合组HAMD评分的减分率有显著性差异,且不良反应明显减少(P<0. 01) ,合用组有效率为93.00%,单用组有效率为77.80%,两比较差异有显著性(P<0. 01)。两组患者用药6周TESS评分比较有显著性差异 (P<0. 01)。结论 SFPG对高血压病合并抑郁症的治疗有显著的辅助作用,副反应较单用舍曲林减少。     

腹腔镜联合醋酸亮丙瑞林治疗子宫内膜异位症的临床观察

目的探讨腹腔镜联合醋酸亮丙瑞林治疗子宫内膜异位症的临床价值。方法选择经腹腔镜手术诊断并治疗的子宫内膜异位症患者68例,术后随机分为2组,腹腔镜术后用药组(35例)为实验组:术后第一次月经来潮第一天皮下注射醋酸亮丙瑞林3.75μg,间隔28 d注射一次,连用3~6个月;未用药组(33例)为对照组。所有患者随访12个月,观察疗效。结果术后联合用醋酸亮丙瑞林组与未用药组有效率分别为88.6%、42.4%;复发率分别为5.7%、30.3%;妊娠率分别为57.1%、21.2%。术后用药药组与未用药组比较差异具有统计学意义(P<0.05),两组均无肝脏损害。结论腹腔镜联合醋酸亮丙瑞林治疗子宫内膜异位症疗效确切,能降低复发率,提高妊娠率。     

子宫内膜异位症术后应用戈舍瑞林疗效观察

目的：探讨戈舍瑞林用于子宫内膜异位症术后辅助治疗的疗效及安全性。方法：比较术后应用戈舍瑞林及未用药组的复发率。结果：戈舍瑞林组复发率2．94％，低于未用药组29．41％（P〈0．05）。结论：戈舍瑞林用于子宫内膜异位症半根治术后辅助治疗与未用药组相比复发率低。     

GnRHa联合反加疗法治疗保守性手术后中重度子宫内膜异位症的临床分析

目的比较中重度子宫内膜异位症患者保守性手术后辅助促性腺激素释放激素激动剂(gonadotrop in-re-leasing homone agonists,GnRHa)治疗中,联合结合型雌激素(CEE)和安宫黄体酮(MPA)反加疗法与否对治疗效果及副反应的影响,分析应用GnRHa联合反加治疗的必要性和时机。方法 将63例保守性手术后中重度子宫内膜异位症(en-dometriosis,EMT)患者随机分为2组:反加组(31例)术后皮下注射诺雷德,每4周1次,连续3次,于用药第2个月起加用倍美力0.625mg/d+安宫黄体酮4mg/d,连续2个月;单药组(32例)术后单用诺雷德治疗,比较两组治疗前后症状、体征、性激素水平、CA125、副反应、复发率和不孕患者的妊娠率。结果反加组、单药组临床疗效总有效率为93.55%、93.75%,复发率分别为9.68%、9.38%,两组复发都发生在停药后1～2年,两组临床疗效总有效率、复发率及复发间隔无统计学差异(P>0.05);两组患者在GnRHa治疗后1个月,FSH、LH、E2水平与治疗前比较均显著下降,E2降至绝经期水平,单药组比反加组下降更明显(P<0.05),停药后3个月均与用药前比较差异无显著性差异(P>0.05);两组血清学指标CA125阳性率均明显下降;反加组13例不孕患者中妊娠率为53.85%,单药组15例不孕患者中妊娠率则为53.33%,两组比较无显著性差异(P>0.05)。潮热等副反应发生率,单药组为87.50%,反加组仅25.00%,都在用药后1～2个月出现。结论 GnRHa联合反加疗法治疗保守性手术后中重度子宫内膜异位症可以缓解GnRHa的副反应,不影响疗效及复发,是治疗内异症较理想的方案,建议GnRHa用药后1月反向添加。     

仙灵骨葆胶囊在药物性卵巢去势反加疗法中的临床观察

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。     

促性腺激素释放激素激动剂对子宫内膜异位症术后复发和生活质量的影响

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。     

Emerging drugs for endometriosis

Medical treatment of endometriosis relies on drugs that suppress ovarian steroids and induce an hypoestrogenic state that causes atrophy of ectopic endometrium. Gonadotrophin-releasing hormone (GnRH) analogues, danazol, progestogens and oestrogen-progestin combinations have all proven effective in relieving pain and reducing the extent of endometriotic implants. However, symptoms often recur after discontinuation of therapy and hypoestrogenism-related side effects limit the long-term use of most medications. Furthermore, these therapies are of limited value in patients with a desire to become pregnant because they inhibit ovulation. An important target for current research is to identify effective therapies that can be safely administered in the long term. GnRH analogues with add-back therapy, progestogens and continuous oral contraceptive are options available for a medium or long-term systemic treatment. Mifepristone, an antiprogestogen, may constitute an alternative if encouraging preliminary data on its effectiveness and tolerability are confirmed. A very appealing area of interest is the possibility of treating endometriosis without suppressing ovarian function. Aromatase inhibitors might have such characteristics as they have been shown to inhibit oestrogen production selectively in endometriotic lesions, without affecting ovarian function; the clinical role of these drugs in the treatment of endometriosis is under evaluation. Levonorgestrel medicated intrauterine device has proven effective in relieving dysmenorrhoea associated with endometriosis, as well as pain associated with rectovaginal endometriosis. Although a systemic absorption is present determining side effects, this approach is promising in the long-term management of this condition. A fundamental objective of research in endometriosis treatment is to develop new therapeutic approaches based on the findings from experimental studies on the aetiopathogenesis of the disease; current research is focusing on anti-inflammatory drugs and modulators of the immune system. TNF-binding protein-1 and IL-12 have proved effective in reducing endometriotic lesions in animal models, while pentoxifylline and INF-alpha 2b have shown encouraging results in clinical studies. This area may be of paramount importance in the near future in order to develop a therapy that could prevent or eradicate endometriosis rather than merely relieving the symptoms.     

Hormonal drugs for the treatment of endometriosis

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.     

Cardiovascular effects of tibolone: a selective tissue estrogenic activity regulator

Traditionally, it was accepted that long-term hormone replacement therapy (HRT) has a cardiovascular beneficial effect in postmenopausal women with and without coronary artery disease (CAD). However, randomized trials in postmenopausal women have not shown any benefit in either primary or secondary prevention of cardiovascular events. Therefore, these findings have raised the question of whether traditional HRT (i.e., estrogen and progesterone) has a cardioprotective effect in women at risk for or with established CAD. Concerns about the use of conventional HRT have led to a search for alternatives. Tibolone is a synthetic compound with estrogenic, androgenic, and progestogenic properties that relieves climacteric symptoms and prevents postmenopausal bone loss. Tibolone possesses a tissue-selective mechanism of action that differs from that of estrogen and/or progestogen. Unlike these compounds, tibolone's metabolites play a central role in its mode of action. Tibolone is widely used for HRT. However, its clinical impact on cardiovascular disease is still under study. The current review focuses on the effects of tibolone on the cardiovascular system and discusses clinical investigations with this compound in postmenopausal women.     

Beneficial aspect of oral estriol as hormone replacement therapy: consideration on bone and lipid metabolism

To improve the quality of life of elderly people in Japanese society where women have the longest life expectancy in the world, osteoporosis, and hyperlipidemia are among the major targets of medical treatment. To differentiate two types of regimens for hormone replacement therapy (HRT), we tried to evaluate the efficacy on lipid and bone metabolism. With informed consent, 34 postmenopausal women of more than 2 years were assigned to receive 1 of 2 types of HRT (the HRT group) for 12 months observation: one with a combination of conjugated equine estrogen (CEE) 0.625 mg/day and medroxyprogesterone acetate (MPA) 2.5 mg/day (the CEE group), and the other with oral estriol (E3) 2 mg/day (the E3 group). Parameters of serum lipid were measured, as well as those of bone metabolism with bone mineral density (BMD) by dual-energy X-ray absorptiometry (DEXA) using QDR-2000. In HRT groups, lipid and bone metabolism were confirmed to be improved. Whereas, an increase of triglycerides (TG) observed in the CEE group was not observed in the E3 group. Thus, in the clinical management of postmenopausal women, oral E3 preparation as an alternative regimen for HRT for CEE might be efficacious.     

Therapeutic effects of leuprorelin microspheres on endometriosis and uterine leiomyomata

Uterine leiomyomata and endometriosis are two common hormone-dependent pathologies effecting women of reproductive age. Prior to the introduction of gonadotropin releasing hormone agonists (GnRHa), there was no effective medical therapy for leiomyomata, and the most effective pharmaceutical intervention for endometriosis had unacceptable side effects. Early intranasal and non-depot formulations of GnRHa were effective treatments for these diseases but patient acceptance and compliance was poor. The introduction of depot microspheres of leuprorelin (leuprolide) acetate has provided efficacious and safe medical management of both endometriosis and uterine leiomyomata which is well tolerated by most patients.     

腹腔镜手术联合GnRHa治疗卵巢子宫内膜异位症的预后分析摘要

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。     

妇产科手术切口子宫内膜异位症的治疗及致病原因分析

目的 针对妇产科手术切口子宫内膜异位症的致病原因及针对性治疗措施的效果进行分析.方法 回顾性分析60例行妇产科手术且引发子宫内膜异位症患者的临床资料,根据治疗方案将患者分为常规组和实验组,每组30例.常规组给予常规药物治疗,实验组给予一次性病灶清除术联合药物治疗.分析妇产科手术切口子宫内膜异位症的致病原因,并对比两组患...