不同药物治疗子宫内膜异位症合并不孕的疗效对比
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摘要
目的观察促性腺激素释放激素激动剂(GnRH-a)和孕三烯酮(GTK)辅助腹腔镜手术,对中重度子宫内膜异位症合并不孕患者妊娠率、实验室指标及不良反应的影响。方法 2015年6月至2017年1月在丽水市中心医院接受治疗的子宫内膜异位症合并不孕女性患者120例为研究对象。将120例患者随机分为对照组40例、GnRH-α组40例和GTK组40例。对照组单纯给予腹腔镜手术,GnRH-α组在对照组的基础上给予GnRH-α,GTK组在对照组的基础上给予GTK治疗。比较3组患者的临床疗效、妊娠率、复发率,采用酶联免疫吸附法检测基质金属蛋白酶-9(MMP-9)、黄体生成素(LH)、卵泡刺激素(FSH)、金属蛋白酶组织抑制因子-1(TIMP-1)、雌二醇(E2)水平及药物不良反应的发生率。结果对照组、GnRH-α组和GTK组,总有效率分别为70.00%(28/40)、92.50%(37/40)、75.00%(30/40),GTK组和对照组有效率显著低于GnRH-α组(Z值分别为-2.56、-2.72,均P<0.05),GTK组和对照组比较差异无统计学意义(P>0.05)。治疗后,GnRH-α组患者LH、FSH、MMP-9、TIMP-1、E2水平显著低于对照组和GTK组,差异均有统计学意义(t=2.90～25.02,均P<0.05),GTK组LH、FSH、MMP-9、TIMP-1、E2水平显著低于对照组,差异均有统计学意义(t值分别为5.26、2.05、20.74、4.66、6.22,均P<0.05)。治疗后试孕6个月对照组累计妊娠率为32.50%(13/40),显著低于GTK组55.00%(22/40)和GnRH-α组60.00%(24/40)(χ~2值分别为6.08、4.11,均P<0.05);治疗后试孕12个月,对照组累计妊娠率为42.50%(17/40),显著低于GTK组65.00%(26/40)和GnRH-α组77.50%(31/40)(χ~2值分别为10.21、4.07,均P<0.05)。治疗后6个月,对照组和GTK组复发率显著高于GnRH-α组(χ~2值分别为6.28、4.11,均P<0.05),治疗后12个月时,对照组和GTK组复发率仍显著高于GnRH-α组(χ~2值分别为9.04、4.50,均P<0.05);3组患者不良反应比较差异无统计学意义(P>0.05)。结论腹腔镜手术联合GnRH-α可作为子宫内膜异位症合并不孕患者的优选方式,患者的妊娠率和治疗有效率较高,且复发率较低,具有较好的安全性,相较于GTK具有较好的疗效。
Objective To observe the effect of gonadotropin releasing hormone agonists(GnRH-α)and pregnancy three ketone(GTK)assisted laparoscopic surgery on pregnancy rate,laboratory index and adverse reactions in patients with moderate to severe endometriosis(EMs)and infertility.Methods One hundred and twenty women with EMs and infertility treated in Lishui Municipal Central Hospital from June 2015 to January 2017 were selected as study subjects,and they were randomly divided into control group,GnRH-αgroup and GTK group with 40 cases in each.The control group was treated with laparoscopic surgery,GnRH-αgroup was given GnRH-αon the basis of the control group,and GTK group was provided with GTK therapy based on the treatment for the control group.The clinical efficacy,pregnancy rate and relapse rate of three groups were compared.Enzymelinked immunosorbent assay(ELISA)was used to detect the levels of matrix metalloproteinase-9(MMP-9),luteinizing hormone(LH),follicle stimulating hormone(FSH),TIMP-1,estradiol(E2)and incidence of adverse drug reactions.Results The total effective rates of the control group,GnRH-αgroup and GTK group were 70.00%(28/40),92.50%(37/40)and 75.00%(30/40),respectively.The effective rate of GTK group and the control group was significantly lower than that of GnRH-αgroup(Z value was-2.56 and-2.72,respectively,both P<0.05),and there was no significant difference between GTK group and the control group(P>0.05).After treatment,the levels of LH,FSH,MMP-9,TIMP-1 and E2 in GnRH-αgroup were significantly lower than those in the control group and GTK group(t value ranged 2.90-25.02,all P<0.05).The levels of LH,FSH,MMP-9,TIMP-1 and E2 in GTK group were significantly lower than those in the control group(t value was 5.26,2.05,20.74,4.66 and6.22,respectively,all P<0.05).The cumulative pregnancy rate of the control group was 32.50%(13/40)at 6 months after treatment,which was significantly lower than 55.00%(22/40)in GTK group and 60.00%(24/40)in GnRH-αgroup(χ~2 value was 6.08 and 4.11,respectively,both P<0.05).After 12 months of trial pregnancy,the cumulative pregnancy rate of the control group was 42.50%(17/40),which was significantly lower than that of GTK group(65.00%,26/40)and GnRH-αgroup(77.50%,31/40)(χ~2 value was 10.21 and 4.07,respectively,both P<0.05).Six months after treatment,the recurrence rate of the control group and GTK group was significantly higher than that of GnRH-αgroup(χ~2 value was 6.28 and 4.11,respectively,both P<0.05).After 12-month treatment,the recurrence rate of the control group and GTK group was still significantly higher than that of GnRH-αgroup(χ~2 value was 9.04 and 4.50,respectively,both P<0.05),and there was no significant difference in adverse reactions among three groups(P >0.05).Conclusion Laparoscopic surgery combined with GnRH-αcan be used as a preferred treatment of EMs with infertility.The pregnancy rate and effective rate of treatment are high,and the recurrence rate is low with good safety.Its effect is superior to that of GTK.
Objective To observe the effect of gonadotropin releasing hormone agonists(GnRH-α)and pregnancy three ketone(GTK)assisted laparoscopic surgery on pregnancy rate,laboratory index and adverse reactions in patients with moderate to severe endometriosis(EMs)and infertility.Methods One hundred and twenty women with EMs and infertility treated in Lishui Municipal Central Hospital from June 2015 to January 2017 were selected as study subjects,and they were randomly divided into control group,GnRH-αgroup and GTK group with 40 cases in each.The control group was treated with laparoscopic surgery,GnRH-αgroup was given GnRH-αon the basis of the control group,and GTK group was provided with GTK therapy based on the treatment for the control group.The clinical efficacy,pregnancy rate and relapse rate of three groups were compared.Enzymelinked immunosorbent assay(ELISA)was used to detect the levels of matrix metalloproteinase-9(MMP-9),luteinizing hormone(LH),follicle stimulating hormone(FSH),TIMP-1,estradiol(E2)and incidence of adverse drug reactions.Results The total effective rates of the control group,GnRH-αgroup and GTK group were 70.00%(28/40),92.50%(37/40)and 75.00%(30/40),respectively.The effective rate of GTK group and the control group was significantly lower than that of GnRH-αgroup(Z value was-2.56 and-2.72,respectively,both P<0.05),and there was no significant difference between GTK group and the control group(P>0.05).After treatment,the levels of LH,FSH,MMP-9,TIMP-1 and E2 in GnRH-αgroup were significantly lower than those in the control group and GTK group(t value ranged 2.90-25.02,all P<0.05).The levels of LH,FSH,MMP-9,TIMP-1 and E2 in GTK group were significantly lower than those in the control group(t value was 5.26,2.05,20.74,4.66 and6.22,respectively,all P<0.05).The cumulative pregnancy rate of the control group was 32.50%(13/40)at 6 months after treatment,which was significantly lower than 55.00%(22/40)in GTK group and 60.00%(24/40)in GnRH-αgroup(χ~2 value was 6.08 and 4.11,respectively,both P<0.05).After 12 months of trial pregnancy,the cumulative pregnancy rate of the control group was 42.50%(17/40),which was significantly lower than that of GTK group(65.00%,26/40)and GnRH-αgroup(77.50%,31/40)(χ~2 value was 10.21 and 4.07,respectively,both P<0.05).Six months after treatment,the recurrence rate of the control group and GTK group was significantly higher than that of GnRH-αgroup(χ~2 value was 6.28 and 4.11,respectively,both P<0.05).After 12-month treatment,the recurrence rate of the control group and GTK group was still significantly higher than that of GnRH-αgroup(χ~2 value was 9.04 and 4.50,respectively,both P<0.05),and there was no significant difference in adverse reactions among three groups(P >0.05).Conclusion Laparoscopic surgery combined with GnRH-αcan be used as a preferred treatment of EMs with infertility.The pregnancy rate and effective rate of treatment are high,and the recurrence rate is low with good safety.Its effect is superior to that of GTK.
引文
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[8]Almada M,Cunha S,Fonseca B M,et al.Anandamide interferes with human endometrial stromal-derived cell differentiation:an effect dependent on inhibition of cyclooxygenase-2 expression and prostaglandin E2 release[J].Biofactors,2016,42(3):277-286.
[9]陈继明,吴洁,浦丹华,等.子宫内膜异位症术后GnRH-a治疗与黑升麻制剂的使用[J].中国妇幼健康研究,2014,25(2):344-347.
[2]Yang X H,Ji F,Aili A,et al.Effects of laparoscopic ovarian endometriosis cystectomy combined with postoperative GnRH-a therapy on ovarian reserve,pregnancy,and outcome recurrence[J].Clin Exp Obstet Gynecol,2014,41(3):272-275.
[3]Okamoto M,Nasu K,Abe W,et al.Enhanced miR-210expression promotes the pathogenesis of endometriosis through activation of signal transducer and activator of transcription 3[J].Hum Reprod,2015,30(3):632-641.
[4]邱铸敏,谈勇.子宫内膜异位症合并不孕术后的中西医治疗进展[J].北京中医药,2013,32(2):154-156.
[5]赖娟.腹腔镜联合孕三烯酮治疗卵巢子宫内膜异位囊肿的疗效观察[J].中国医刊,2013,48(2):75-76.
[6]Mathyk B,Adama N,Young S L.Endometrial receptivity:lessons from systems biology and candidate gene studies of endometriosis[J].Minerva Ginecol,2017,69(1):41-56.
[7]Singh S S,Suen M W.Surgery for endometriosis:beyond medical therapies[J].Fertil Steril,2017,107(3):549-554.
[8]Almada M,Cunha S,Fonseca B M,et al.Anandamide interferes with human endometrial stromal-derived cell differentiation:an effect dependent on inhibition of cyclooxygenase-2 expression and prostaglandin E2 release[J].Biofactors,2016,42(3):277-286.
[9]陈继明,吴洁,浦丹华,等.子宫内膜异位症术后GnRH-a治疗与黑升麻制剂的使用[J].中国妇幼健康研究,2014,25(2):344-347.