黑升麻在中重度子宫内膜异位症GnRH-a反加治疗中的疗效评估

目的:比较黑升麻和替勃龙在中重度子宫内膜异位症腹腔镜术后GnRH-a反加治疗中的疗效。方法:前瞻性随机对照比较中重度子宫内膜异位症腹腔镜术后患者90例,分为戈舍瑞林+黑升麻组、戈舍瑞林+替勃龙组、戈舍瑞林组,各30例,分析各组用药3个月后血清雌二醇(E2)、促卵泡激素(FSH)水平;子宫内膜厚度;Kupperman(KMI)评分;视觉疼痛症状评分法(VAS)评分;血清骨钙素(BGP);CA125、肝肾功能、血脂等变化。结果:戈舍瑞林+替勃龙组血清E2水平显著高于戈舍瑞林+黑升麻组及戈舍瑞林组(P均<0.05),FSH显著低于戈舍瑞林+黑升麻组及戈舍瑞林组(P均<0.05),戈舍瑞林+黑升麻组和戈舍瑞林组间无差异(P>0.05);戈舍瑞林组KMI评分明显高于戈舍瑞林+替勃龙组和戈舍瑞林+黑升麻组(P<0.05),而戈舍瑞林+替勃龙组和戈舍瑞林+黑升麻组间无差异(P>0.05);戈舍瑞林+替勃龙组血清BGP浓度显著低于戈舍瑞林组和戈舍瑞林+黑升麻组(P均<0.05),而戈舍瑞林组和戈舍瑞林+黑升麻组间无差异(P>0.05)。各组间EM、VAS评分、CA125、肝肾功能及血脂等均无明显差异(P>0.05)。结论:黑升麻是中重度子宫内膜异位症腹腔镜术后GnRH-a反加治疗安全有效的选择之一。

Assessment of efficacy of Black cohosh in addback therapy on GnRH-a treatment for severe endometriosis

Objective:To compare the efficacy of Black cohosh and Tibolone in addback therapy on Gonadotropin releasing hormone analogues treatment for severe endometriosis after laparoscopic surgery.Methods:90 cases of severe endometriosis patients who underwent GnRH-a treatment after laparoscopic surgery were retrospectively analyzed.They were randomly divided into three groups:GnRH-a +Black cohosh group(n=30),GnRH-a +Tibolone group(n=30),and GnRH-a group(n=30).Three months later,the degree of pain was measured according to a visual analog scale(VAS),the menopausal symptoms were assessed with the Kupperman Menopausal Index(KMI).Serum E2,FSH,BGP,CA125,Lipid,electrolytes,Liver and kidney function were measured respectively.Endometrial thickness was detected by Ultrasound.Results:The level of serum E2 in Tibolone group was significantly higher than that in Black cohosh group and GnRH-a group(P<0.05);and the level of serum FSH in Black cohosh group and GnRH-a group was significantly lower than that in Tibolone group(P<0.05).The score of KMI significantly increased in GnRH-a group(P<0.05),but there was no significant differences between Tibolone group and Black cohosh group(P>0.05).The serum of BGP significantly decreased in Tibolone group(P<0.05),but there was no significant difference between GnRH-a group and Black cohosh group(P>0.05).The score of VAS,endometrial thickness,serum CA125,lipid,liver and kidney function were all similar in three groups(P>0.05).Conclusion:Black cohosh add-back therapy can relieve the side effect of GnRH-a,and it may be a better choice for add-back therapy in GnRH-a treatment for severe endometriosis after laparoscopic surgery.