醋酸戈舍瑞林缓释植入剂对妇科肿瘤术后化疗患者卵巢功能影响的临床研究
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摘要
目的:探讨醋酸戈舍瑞林缓释植入剂在妇科肿瘤术后化疗患者中的应用效果及对卵巢功能的影响。方法:选择2014年8月-2015年7月本科室收治的妇科肿瘤术后化疗患者152例,按照随机数字表法分为对照组(n=76例)和观察组(n=76例)。对照组采用常规方法化疗,观察组在对照组基础上联合醋酸戈舍瑞林缓释植入剂治疗。采用免疫化学发光法测定两组手术前后卵泡雌激素(FSH)、雌二醇(E_2)及黄体生成素水平;采用彩色多普勒超声诊断仪对两组治疗前、后卵巢动脉血流指标PI、RI及S/D水平进行测定,记录并统计两组化疗后月经生育及绝经相关症状;记录并统计两组治疗后潮热出汗、易激动、失眠及性交痛发生率,比较两组临床疗效及对卵巢功能的影响。结果:观察组治疗6周期后FSH、E2及LH水平,均低于治疗前(P<0.05);对照组治疗6周期后FSH和LH水平,均高于治疗前(P<0.05);对照组治疗6周期后E_2水平,低于治疗前(P<0.05);观察组治疗6周期后FSH、E_2及LH水平,均低于对照组(P<0.05);观察组治疗6周期后卵巢血流学参数PI、RI及S/D水平,均低于对照组(P<0.05);观察治疗6周期后月经复潮天数为(35.41±7.25)d,短于对照组的(102.53±4.28)d(P<0.05)。观察组治疗6周期后月经稀发、经量减少及闭经发生率,均低于对照组(P<0.05);观察组治疗6周期后潮热出汗、易激动、失眠及性交痛发生率,均低于对照组(P<0.05);观察组与对照组均对保留生育功能者进行随访观察,观察组治疗后2~3年足月娩出率高于对照组(P<0.05);观察组治疗后2~3年自然流产率、异位妊娠率,均低于对照组(P<0.05)。结论:在常规化疗基础上联合醋酸戈舍瑞林缓释植入剂用于妇科肿瘤术后化疗患者中效果理想,有助于改善患者卵巢功能,能降低更年期相关症状,提高化疗后患者的妊娠率,值得推广应用。
Objective:To investigate the effect of Goserelin Acetate Sustained-release Depo on postoperative chemotherapy in gynecologic oncology and its effect on ovarian function.Method:A total of 152 patients undergoing gynecologic oncology postoperative chemotherapy were selected from August 2014 to July 2017.Acording to randomized numerical methods they were divided into control group(n=76) and observation group(n=76).The control group was treated with conventional chemotherapy.The observation group was treated with Goserelin Acetate Sustained-release Depo on the basis of the control group.The levels of follicular-derived estrogen(FSH),estradiol(E_2) and luteinizing hormone(LH) in two groups before and after operation were measured by immunochemical chemiluminescence.The color Doppler echocardiography was used to measure the changes of ovarian arterial blood flow index,RI and S/D levels.The symptoms of menopause and menopause after 2 cycles of chemotherapy were recorded and statistically analyzed.The incidence of hot flashes,irritability,insomnia and pain after hot flashes,efficacy and ovarian function of two groups were recorded and statistically compared. Result:The levels of FSH,E_2 and LH in the observation group after 6 cycles were lower than those of before treatment(P<0.05).The levels of FSH and LH in the control group after 6 cycles were higher than those of before treatment(P<0.05).The levels of FSH,E_2 and LH in the observation group after 6 cycles of treatment were lower than those of the control group(P<0.05).After 6 cycles of treatment,the ovarian blood flow parameters PI,RI and S/D levels were lower than those of the control group(P<0.05).After 6 weeks of treatment,the days of menstrual cramps were(35.41±7.25)d,shorter than those of the control group(102.53 ± 4.28)d(P<0.05).After 6 weeks of treatment,the observation group had less menstrual flow,decreased menstruation and amenorrhea,which were lower than those of the control group(P<0.05).The incidences of hot flashes,irritability,insomnia and painful sexual intercourse after 6 cycles of treatment in the observation group were lower compared with the control group(P<0.05).The observation group and the control group were followedup observation of those who retained fertility,the full-term delivery rate of 2 to 3 years after treatment in the observation group was higher than that in the control group(P<0.05).The spontaneous abortion rate and ectopic pregnancy rate in 2-3 years after treatment of the observation group were lower than those in the control group(P<0.05).Conclusion:Based on routine chemotherapy,combined with Goserelin Acetate Sustained-release Depo,the results of postoperative chemotherapy in gynecologic oncology patients are good,which will help to improve the ovarian function and reduce the symptoms related to menopause.It is worth of popularizing and applying.
Objective:To investigate the effect of Goserelin Acetate Sustained-release Depo on postoperative chemotherapy in gynecologic oncology and its effect on ovarian function.Method:A total of 152 patients undergoing gynecologic oncology postoperative chemotherapy were selected from August 2014 to July 2017.Acording to randomized numerical methods they were divided into control group(n=76) and observation group(n=76).The control group was treated with conventional chemotherapy.The observation group was treated with Goserelin Acetate Sustained-release Depo on the basis of the control group.The levels of follicular-derived estrogen(FSH),estradiol(E_2) and luteinizing hormone(LH) in two groups before and after operation were measured by immunochemical chemiluminescence.The color Doppler echocardiography was used to measure the changes of ovarian arterial blood flow index,RI and S/D levels.The symptoms of menopause and menopause after 2 cycles of chemotherapy were recorded and statistically analyzed.The incidence of hot flashes,irritability,insomnia and pain after hot flashes,efficacy and ovarian function of two groups were recorded and statistically compared. Result:The levels of FSH,E_2 and LH in the observation group after 6 cycles were lower than those of before treatment(P<0.05).The levels of FSH and LH in the control group after 6 cycles were higher than those of before treatment(P<0.05).The levels of FSH,E_2 and LH in the observation group after 6 cycles of treatment were lower than those of the control group(P<0.05).After 6 cycles of treatment,the ovarian blood flow parameters PI,RI and S/D levels were lower than those of the control group(P<0.05).After 6 weeks of treatment,the days of menstrual cramps were(35.41±7.25)d,shorter than those of the control group(102.53 ± 4.28)d(P<0.05).After 6 weeks of treatment,the observation group had less menstrual flow,decreased menstruation and amenorrhea,which were lower than those of the control group(P<0.05).The incidences of hot flashes,irritability,insomnia and painful sexual intercourse after 6 cycles of treatment in the observation group were lower compared with the control group(P<0.05).The observation group and the control group were followedup observation of those who retained fertility,the full-term delivery rate of 2 to 3 years after treatment in the observation group was higher than that in the control group(P<0.05).The spontaneous abortion rate and ectopic pregnancy rate in 2-3 years after treatment of the observation group were lower than those in the control group(P<0.05).Conclusion:Based on routine chemotherapy,combined with Goserelin Acetate Sustained-release Depo,the results of postoperative chemotherapy in gynecologic oncology patients are good,which will help to improve the ovarian function and reduce the symptoms related to menopause.It is worth of popularizing and applying.
引文
[1]陈文慧,柯晓燕,潘敏.醋酸戈舍瑞林缓释植入剂对妇科肿瘤术后化疗患者卵巢功能的影响[J].广东医学院学报,2015,33(6):673-675.
[2]Giannaki C D,Sakkas G K,Karatzaferi C,et al.Combination of exercise training and dopamine agonists in dialysis patients with RLS:A randomized double-blind placebo controlled study[J].Asaio Journal,2015,61(6):738.
[3]郑婧,关崇丽,王惠玲,等.Gn RHa对妇科恶性肿瘤患者化疗中卵巢功能保护作用[J].中国现代药物应用,2017,11(16):189-190.
[4]Gao Y,Wu X,Zhou L,et al.A Sweet Polydopamine Nanoplatform for Synergistic Combination of Targeted ChemoPhotothermal Therapy[J].Macromolecular Rapid Communications,2015,36(10):916-922.
[5]孔守芳,袁汇,孙选,等.中药对妇科恶性肿瘤术后化疗患者骨髓抑制的影响[J].中国中医药科技,2015,22(6):730-731.
[6]Morioka N,Sugimoto T,Sato K,et al.The induction of Per1 expression by the combined treatment with glutamate,5-hydroxytriptamine and dopamine initiates a ripple effect on Bmal1 and Cry1 m RNA expression via the ERK signaling pathway in cultured rat spinal astrocytes[J].Neurochemistry International,2015,90(3):9-19.
[7]黄真,莫钦国.化疗对乳腺癌围绝经期患者卵巢功能的影响[J/OL].实用妇科内分泌电子杂志,2015,2(11):34-35.
[8]Pivonello C,Rousaki P,Negri M,et al.Effects of the single and combined treatment with dopamine agonist,somatostatin analog and m TOR inhibitors in a human lung carcinoid cell line:an in vitro study[J].Endocrine,2017,56(3):1-18.
[9]普小芸,李力,刘强,等.化疗对卵巢恶性生殖细胞肿瘤术后患者卵巢功能的影响[J].中国性科学,2017,26(8):34-37.
[10]Hao F,Wang S,Zhu X,et al.PharmacokineticPharmacodynamic Modeling of the Anti-Tumor Effect of Sunitinib Combined with Dopamine in the Human Non-Small Cell Lung Cancer Xenograft[J].Pharmaceutical Research,2017,34(2):408-409.
[11]郭玮,刁海丹.保妇康栓治疗妇科恶性肿瘤术后并发阴道炎的效果[J].实用临床医药杂志,2017,21(7):152-154.
[12]普铁炜炜,葛芬芬.微波或LEEP术后保妇康栓辅助治疗的临床效果观察[J].中国计划生育学杂志,2015,23(7):486-489.
[13]冯鹏才,杨金煜,唐明杰,等.进展期中低位直肠癌新辅助放化疗后肿瘤部位及手术方式对患者预后的影响[J].中国普通外科杂志,2015,24(6):895-898.
[14]梅雅琪,杨娅娟,苏丹,等.乳腺癌术后化疗患者的疾病感知及相关因素[J].中国心理卫生杂志,2015,29(8):567-569.
[15]孙兴国,Curtis,Hightower,等.心肺运动试验评价食管癌患者化疗后整体功能变化的临床研究[J].中国全科医学,2016,19(17):2046-2052.
[16]王丹青,李清丽,尹如铁.Gn RH类似物对化疗患者卵巢功能保护的研究进展[J].实用妇产科杂志,2016,32(10):727-729.
[17]余晖,张宗泽,王焱林,等.腹腔肿瘤患者行细胞减灭术联合腹腔热灌注化疗后早期认知功能的影响因素分析[J].临床麻醉学杂志,2016,32(7):638-641.
[18]郭文利,黄建棋,陆建菊.乳腺癌根治术后早期化疗对患者临床预后的影响[J].中国普通外科杂志,2017,26(5):666-670.
[19]Kurman R J,Iem S.The Dualistic Model of Ovarian Carcinogenesis:Revisited,Revised,and Expanded[J].American Journal of Pathology,2016,186(4):733.
[20]Sawaya G F,Kulasingam S,Denberg T D,et al.Cervical Cancer Screening in Average-Risk Women:Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians[J].Annals of Internal Medicine,2015,162(12):851.
[2]Giannaki C D,Sakkas G K,Karatzaferi C,et al.Combination of exercise training and dopamine agonists in dialysis patients with RLS:A randomized double-blind placebo controlled study[J].Asaio Journal,2015,61(6):738.
[3]郑婧,关崇丽,王惠玲,等.Gn RHa对妇科恶性肿瘤患者化疗中卵巢功能保护作用[J].中国现代药物应用,2017,11(16):189-190.
[4]Gao Y,Wu X,Zhou L,et al.A Sweet Polydopamine Nanoplatform for Synergistic Combination of Targeted ChemoPhotothermal Therapy[J].Macromolecular Rapid Communications,2015,36(10):916-922.
[5]孔守芳,袁汇,孙选,等.中药对妇科恶性肿瘤术后化疗患者骨髓抑制的影响[J].中国中医药科技,2015,22(6):730-731.
[6]Morioka N,Sugimoto T,Sato K,et al.The induction of Per1 expression by the combined treatment with glutamate,5-hydroxytriptamine and dopamine initiates a ripple effect on Bmal1 and Cry1 m RNA expression via the ERK signaling pathway in cultured rat spinal astrocytes[J].Neurochemistry International,2015,90(3):9-19.
[7]黄真,莫钦国.化疗对乳腺癌围绝经期患者卵巢功能的影响[J/OL].实用妇科内分泌电子杂志,2015,2(11):34-35.
[8]Pivonello C,Rousaki P,Negri M,et al.Effects of the single and combined treatment with dopamine agonist,somatostatin analog and m TOR inhibitors in a human lung carcinoid cell line:an in vitro study[J].Endocrine,2017,56(3):1-18.
[9]普小芸,李力,刘强,等.化疗对卵巢恶性生殖细胞肿瘤术后患者卵巢功能的影响[J].中国性科学,2017,26(8):34-37.
[10]Hao F,Wang S,Zhu X,et al.PharmacokineticPharmacodynamic Modeling of the Anti-Tumor Effect of Sunitinib Combined with Dopamine in the Human Non-Small Cell Lung Cancer Xenograft[J].Pharmaceutical Research,2017,34(2):408-409.
[11]郭玮,刁海丹.保妇康栓治疗妇科恶性肿瘤术后并发阴道炎的效果[J].实用临床医药杂志,2017,21(7):152-154.
[12]普铁炜炜,葛芬芬.微波或LEEP术后保妇康栓辅助治疗的临床效果观察[J].中国计划生育学杂志,2015,23(7):486-489.
[13]冯鹏才,杨金煜,唐明杰,等.进展期中低位直肠癌新辅助放化疗后肿瘤部位及手术方式对患者预后的影响[J].中国普通外科杂志,2015,24(6):895-898.
[14]梅雅琪,杨娅娟,苏丹,等.乳腺癌术后化疗患者的疾病感知及相关因素[J].中国心理卫生杂志,2015,29(8):567-569.
[15]孙兴国,Curtis,Hightower,等.心肺运动试验评价食管癌患者化疗后整体功能变化的临床研究[J].中国全科医学,2016,19(17):2046-2052.
[16]王丹青,李清丽,尹如铁.Gn RH类似物对化疗患者卵巢功能保护的研究进展[J].实用妇产科杂志,2016,32(10):727-729.
[17]余晖,张宗泽,王焱林,等.腹腔肿瘤患者行细胞减灭术联合腹腔热灌注化疗后早期认知功能的影响因素分析[J].临床麻醉学杂志,2016,32(7):638-641.
[18]郭文利,黄建棋,陆建菊.乳腺癌根治术后早期化疗对患者临床预后的影响[J].中国普通外科杂志,2017,26(5):666-670.
[19]Kurman R J,Iem S.The Dualistic Model of Ovarian Carcinogenesis:Revisited,Revised,and Expanded[J].American Journal of Pathology,2016,186(4):733.
[20]Sawaya G F,Kulasingam S,Denberg T D,et al.Cervical Cancer Screening in Average-Risk Women:Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians[J].Annals of Internal Medicine,2015,162(12):851.