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。

GnRHa and add-back therapy with low dose tibolone in the treatment of endometriosis

Objective:To study the roles of GnRHa (Alarelin and Zoladex) in the treatment of endometriosis and to determine whether tibolone add-back therapy would prevent the hypoestro-genic effects.Methods: Patients with endometriosis were randomized to receive Alarelin or Zoladex for 6 month. The patients in Alarelin group were randomized to receive Alarelin 150μg/d alone (Group HRTO, n = 10) or Alrelin 150μg/d plus tibolone 1.25mg/d at the same time (Group HRT1 ,n= 10). The patients in Zoladex group were randomized to receive Zoladex 3. 6mg/4week alone ( Group HRT' 0, n = 10) or Zoladex 3. 6mg/4week plus tibolone 1.25mg/d at the same time. Results:Serum FSH,LH,E2 levels in all groups were suppressed by GnRHa within the first month,E2 levels fell into postmenopausal range. Patients showed significant improvement in clinical symptoms and signs,the efficacy rate was 90.0% .The sizes of ovary chocolate cysts decreased, the efficacy rate was 80.0% - 90.0% .The positive rates of serum AEMAb and CA125 dropped.There was no significant difference of efficacy between Alarelin and Zoladex (P > 0.05). Hypoestrogenic effects occurred to groups who received GnRHa alone. The patients with tibolone add-back therapy experienced no hy-poestrogenic effects.Conclusions:GnRHa is potent therapeutic agent for endometriosis. Alarelin is as effective as Zoladex.Tibolone is an effective and safe agent in relieving side effects induced by Gn- RHa.GnRHa with tibolone add-back therapy is an ideal regimen for endometriosis.