GnRH-a联合反加疗法治疗子宫内膜异位症的临床观察

发布时间：2018-05-24 19:55

本文选题：促性腺激素释放激素激动剂 + 反加疗法　；参考：《新疆医科大学》2014年硕士论文

【摘要】：目的：探讨促性腺激素释放激素激动剂(GnRH-a)联合反加疗法对子宫内膜异位症(内异症)患者内分泌激素水平、低雌激素症状及骨质丢失的影响。方法：选择2012年4月至2013年12月经腹腔镜手术确诊为子宫内膜异位症患者64例且手术治疗限于两月内,随机分为分为A、B两组,A组患者于月经第1-2天或手术后3-5天内予诺雷德3.6mg皮下注射,隔28天注射一次,共6次；B组用法同前,并于注射第2支诺雷德同时每天口服药物替勃龙(2.5mmg/天)连续服用至疗程结束。治疗1个月后及治疗结束后记录改良库珀曼法(Kupperman)评分及疼痛视觉模拟评分(VAS),监测卵泡刺激素(FSH)、黄体生成激素(LH)、雌二醇(E2)、血清骨钙素(BGP)水平并随访治疗后两组患者首次月经复潮时间、疼痛视觉模拟评分。结果：A、B两组治疗6月末的血清FSH、LH和E2水平均较前显著降低,差异有统计学意义(P0.01)；B组治疗末E2水平高于A组(P0.01)；血清骨钙素治疗结束后与治疗1个月后比较差异无统计学意义；治疗结束后患者Kupperman评分及疼痛视觉模拟评分均较治疗1个月后降低,差异有统计学意义(P0.01)。A、B两组疼痛总分、盆腔痛、性交痛三项评分均较治疗1个月后显著下降,差异均有统计学意义(P0.05)；月经来潮后,两组疼痛总分、盆腔痛、性交痛评分较治疗6个月末时略有上升或下降,但差异均无统计学意义,两组患者痛经评分均较治疗1个月后下降(P0.01)。结论：GnRH-a联合替勃龙能有效减轻使用GnRH-a引起的低雌激素症状、降低骨转化保护骨量,并能有效缓解内异症的疼痛症状,是一种安全、有效、提高患者依从性的治疗方案。
[Abstract]:Objective: to investigate the effects of gonadotropin releasing hormone agonist (GnRH-a) combined with reverse adduct therapy on endocrine hormone levels, hypoestrogen symptoms and bone loss in patients with endometriosis (endometriosis). Methods: 64 patients with endometriosis diagnosed by laparoscopic surgery from April 2012 to December 2013 were selected and the operative treatment was limited to two months. Patients in group A were randomly divided into group A and group A were subcutaneously injected with Norred 3.6mg on day 1-2 of menstruation or within 3-5 days after operation, and were injected once every 28 days. The second dose of Norred was administered at the end of the course of treatment with oral tibolone 2.5 mmg / day. A month after treatment and one month after treatment, the modified Kupperman( Kupperman) score and pain visual analogue score (VASA) were recorded, follicle stimulating hormone (FSH), luteinizing hormone (LHN), estradiol (E _ 2), serum osteocalcin (BGP) were monitored and the two groups were followed up after treatment. The first time of menorrhagia, Visual analogue score of pain. Results at the end of 6 months after treatment, the serum levels of FSHLH and E2 in the two groups were significantly lower than those in the control group (P 0.01), the level of E 2 in group B was higher than that in group A at the end of treatment, and there was no significant difference in serum osteocalcin between the end of treatment and one month after treatment. The scores of Kupperman and visual analogue of pain in patients after treatment were significantly lower than those after one month treatment. The difference was statistically significant. The total score of pain, pelvic pain and sexual intercourse pain in two groups were significantly lower than those after one month treatment. After menarche, the total score of pain, pelvic pain and sexual intercourse pain score in the two groups were slightly increased or decreased compared with those at the end of 6 months, but there was no significant difference between the two groups at the end of 6 months. The scores of dysmenorrhea in both groups were lower than that after 1 month treatment (P 0.01). ConclusionTwo GnRH-a combined with tibolone can effectively alleviate the symptoms of low estrogen induced by GnRH-a, reduce the bone mass of bone transformation, and relieve the pain symptoms of endometriosis. It is a safe, effective and effective therapy for improving the compliance of patients with endometriosis.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.71

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