阿拉瑞林加7-甲异炔诺酮治疗子宫内膜异位症

目的探讨促性腺激素释放激素激动剂(GnRHa)———国产阿拉瑞林与进口高舍瑞林(Zoladex),对子宫内膜异位症(内异症)的治疗作用,7-甲异炔诺酮(利维爱)在反加疗法中的应用。方法采用随机对照研究,将36例内异症患者分为两组:①阿拉瑞林组,分为HRTO组(单用阿拉瑞林)和HRT1组(加用利维爱);②高舍瑞林组,分为HRT’0组(单用高舍瑞林)和HRT’1组(加用17β-E2和MPA)。结果两组患者征象明显改善,超声检查卵巢巧克力囊肿缩小或消失,血清学指标CA125、AEmAb阳性率下降。阿拉瑞林与高舍瑞林两种药物疗效无显著性差异。HRT0与HRT’0组出现低雌激素综合征,HRT0组2例腰椎骨密度降低。HRT’1组低雌激素征象明显减轻,HRT1组未出现低雌激素征象,两反加组无腰椎骨密度降低,未影响GnRHa的疗效。阿拉瑞林组、高舍瑞林组停药后6月内妊娠率分别为53.3%、41.7%。结论国产药物阿拉瑞林与进口药物高舍瑞林具有相同的疗效。反加疗法能减轻GnRHa的不良反应而不影响疗效。小剂量利维爱用于反加疗法,与其它反加方案组比更具优越性。

Alarelin plus Tibolone in the treatment of endometriosis

Objective To study the efficacy of GnRHa (Alarelin and Zoladex)in the treatment of endometriosis and to determine whether the add-back therapy or not would prevent the side reaction,while maintaining the efficacy of GnRHa,and to investigate the role of low dose Tibolone.Methods Thirty-six patients with endometriosis were divided into2groups:one was administrated with Alarelin,the other with Zoladex.The patients in Alarelin group were given Alarelin alone(group HRT0)or Alarelin plus Tibolone(group HRT1).The patients in Zoladex group were given Zoladex alone(group HRT'0)or Zoladex plus17β-E 2 and MPA (group HRT'1).Results Patients showed improvement in both clinical symptoms and signs of the two groups.The size of ovary chocolate cysts decreased or disappeared.The positive rates of serum AEmAb and CA 125 dropped.There was no significant difference of the efficacy between Alarelin and Zoladex.hypoestrogenic syndrome occurred in groups received GnRHa alone and in2cases of Zoladex alone group suffered from bone density loss of the lumber vertebrae(2-4).Add-back therapy with17β-E 2 and MPA provided effective relieves of vasomotor symptoms and decrease of bone density loss.The patients in Tibolone group experienced no hypoestrogenic side reaction and bone loss,for Tibolone was given with the commencement of GnRHa therapy.Pregnancy rate within6month s after the therapy was53.3%in Alarelin group and41.7%in Zoladex group.Conclusion GnRHa are potent therapeutic agents for endometriosis.Alarelin is as same effective as Zoladex.The efficacy of GnRHa can be preserved while overcoming side reaction with the use of appropriate add-back therapy.Low dose Tibolone is a better option than other estrogen and progestin therapy.