CAJ | 학술논문

目的探讨长效曲普瑞林(3.75 mg)剂量减半后治疗子宫内膜异位症(EM)的疗效与不良反应.方法前瞻性分析186例中重度EM患者保守性手术后辅助注射半量或全量曲普瑞林6个月的疗效及不良反应.将治疗对象分为3组,半量组(99例):每次1.875 mg;退缩组(52例):第1次3.75 mg,以后每次1.875 mg;全量组(35例):每次3.75 mg;均每隔28 d用药1次.结果 3组患者在第2次用药后均闭经；半量组、退缩组及全量组每次用药后28 d血清雌二醇(E2)水平分别有99％、100％和99.0％处于不刺激异位内膜生长的“阈值窗(110 ～ 146 pmol/L)”内及以下的有效治疗水平,差异无统计学意义(P＞0.05),其中E2＜ 37 pmol/L占E2＜ 110 pmol/L的比例在第1次半量和全量用药后差异无统计学意义(71％比73％,P＞0.05),在第2～5次用药后半量组(69％)低于退缩组(79％)及全量组(85％),差异有统计学意义(P＜0.01)；3组月经首次恢复时盆腔疼痛缓解率及术后1年复发率比较,差异均无统计学意义(均P＞ 0.05)；半量组围绝经症状及严重围绝经症状的发生率均低于退缩组及全量组,差异均有统计学意义(均P＜0.01)；半量组6次用药完成率高于退缩组及全量组,因严重围绝经症状6次用药未完成率低于退缩组及全量组,差异均有统计学意义(均P＜0.05).结论曲普瑞林剂量减半后治疗EM有效,减少围绝经症状的发生,降低治疗费用,增加患者治疗的依从性.
목적 탐토장효곡보서림(3.75 mg)제량감반후치료자궁내막이위증(EM)적료효여불량반응.방법 전첨성분석186례중중도EM환자보수성수술후보조주사반량혹전량곡보서림6개월적료효급불량반응.장치료대상분위3조,반량조(99례):매차1.875 mg;퇴축조(52례):제1차3.75 mg,이후매차1.875 mg;전량조(35례):매차3.75 mg;균매격28 d용약1차.결과 3조환자재제2차용약후균폐경；반량조、퇴축조급전량조매차용약후28 d혈청자이순(E2)수평분별유99％、100％화99.0％처우불자격이위내막생장적“역치창(110 ～ 146 pmol/L)”내급이하적유효치료수평,차이무통계학의의(P＞0.05),기중E2＜ 37 pmol/L점E2＜ 110 pmol/L적비례재제1차반량화전량용약후차이무통계학의의(71％비73％,P＞0.05),재제2～5차용약후반량조(69％)저우퇴축조(79％)급전량조(85％),차이유통계학의의(P＜0.01)；3조월경수차회복시분강동통완해솔급술후1년복발솔비교,차이균무통계학의의(균P＞ 0.05)；반량조위절경증상급엄중위절경증상적발생솔균저우퇴축조급전량조,차이균유통계학의의(균P＜0.01)；반량조6차용약완성솔고우퇴축조급전량조,인엄중위절경증상6차용약미완성솔저우퇴축조급전량조,차이균유통계학의의(균P＜0.05).결론 곡보서림제량감반후치료EM유효,감소위절경증상적발생,강저치료비용,증가환자치료적의종성.
Objective To evaluate the efficacy and adverse effects of half-dose depot long-acting triptorelin in the therapy of endometriosis.Methods The efficacy and adverse effects of routine-dose or halfdose triporelin in postoperative endometriosis patients were prospectively observed.A total of 186 postoperative patients with moderate or severe endometriosis received an intramuscular injection of triporelin every 28 days for 6 times.They were randomly divided into 3 groups,i.e.half-dose group (n =99):1.875 mg each time; "draw-back"group (n =52):3.75 mg first time,then 1.875 mg each time; and routine-dose group (n =35):3.75 mg each time.Results Amenorrhea was effectively induced in all patients after the second injection.There was no significant difference in the rate of serum E2 level at Day 28 of every injection below the upper limit of " estrogen threshold (110-146 pmol/L)" not stimulating ectopic endometrium proliferation among half-dose group,"draw-back" group and routine-dose group (99％ vs 100％ and 99.0％,P ＞ 0.05),the percentage of E2 ＜ 37 pmol/L in E2 ＜ 110 pmol/L in half-dose group was significantly lower than that in "draw-back" and routine-dose groups after 2-5th injection (69％ vs 79％ and 85％,P ＜0.01),but there was no significant difference after first half-dose and routine-dose injection (71％ vs 73％,P ＞0.05).No significant difference existed in the rate of pelvic pain relief during the first returning menstruation and the recurrence rate of endometriosis within 1 year postoperation among three groups (both P ＞ 0.05).However,the incidences of menopausal syndrome and severe menopausal syndrome in half-dose group were significantly lower than those in "draw-back" and routine-dose groups (both P ＜0.01).And the incompletion rate of six-time drug for severe menopause syndrome was also significantly lower (P ＜ 0.05) while the completion rate of six-time drug use in half-dose group was significantly higher (P ＜0.05).Conclusion As a postoperarive adjuvant,half-dose depot triptorelin therapy is efficacious for endometriosis.It reduces menopausal syndrome and treatment cost and enhances patient compliance.