CAJ | 학술논문

目的：探讨术后促性腺激素释放激素激动剂（GnRHa）联合反向添加治疗中、重度子宫内膜异位症（EMS）的临床效果。方法选取采用保守性手术治疗的中、重度 EMS 患者96例，随机分成治疗组和对照组。治疗组患者予GnRHa 联合反向添加治疗，对照组患者予单一 GnRHa 治疗。比较两组患者血清性激素水平、骨代谢生化指标（血钙、血磷和碱性磷酸酶水平）、腰椎骨密度（L - VMD）水平，并观察比较两组患者经临床治疗后病情缓解情况。结果较治疗前相比，两组患者血清性激素水平均有所降低；治疗组患者治疗后血清性激素水平稍低于对照组，但差异无统计学意义（ P >0.05）。治疗后治疗组患者血清中骨代谢生化指标（钙、磷、碱性磷酸酶）和腰椎骨密度的水平明显优于对照组，差异具有统计学意义（ P <0.05）。治疗组的临床缓解率高于对照组，而恶心、呕吐等不良反应发生率明显低于对照组，差异均具有统计学意义（ P <0.05）。结论中、重度 EMS 保守性手术后 GnRHa 联合反向添加治疗效果明显，可克服单一GnRHa 治疗的弊端，优化治疗效果。
목적：탐토술후촉성선격소석방격소격동제（GnRHa）연합반향첨가치료중、중도자궁내막이위증（EMS）적림상효과。방법선취채용보수성수술치료적중、중도 EMS 환자96례，수궤분성치료조화대조조。치료조환자여GnRHa 연합반향첨가치료，대조조환자여단일 GnRHa 치료。비교량조환자혈청성격소수평、골대사생화지표（혈개、혈린화감성린산매수평）、요추골밀도（L - VMD）수평，병관찰비교량조환자경림상치료후병정완해정황。결과교치료전상비，량조환자혈청성격소수평균유소강저；치료조환자치료후혈청성격소수평초저우대조조，단차이무통계학의의（ P >0.05）。치료후치료조환자혈청중골대사생화지표（개、린、감성린산매）화요추골밀도적수평명현우우대조조，차이구유통계학의의（ P <0.05）。치료조적림상완해솔고우대조조，이악심、구토등불량반응발생솔명현저우대조조，차이균구유통계학의의（ P <0.05）。결론중、중도 EMS 보수성수술후 GnRHa 연합반향첨가치료효과명현，가극복단일GnRHa 치료적폐단，우화치료효과。
Objective To discuss the clinical results after the gonadotropin - releasing hormone agonist(GnRHa)add - back therapy combined with moderate to severe endometriosis(EMS). Methods 96 cases of severe endometriosis(EMS)were randomly divided into treat-ment group and control group. The treatment group were treated with gonadotropin releasing hormone agonist(GnRHa)combined with reverse ad-dition treatment. The control group was treated with single gonadotropin releasing hormone agonist(GnRHa)treatment. Serum sex hormone levels were compared in patients with bone metabolic markers(serum calcium,phosphorus,and alkaline phosphatase levels). The lumbar spine bone mineral density(L - VMD)levels were observed between the two groups of patients after clinical remission situation. Results The serum levels of sex hormones of previous treatment decreased compared two groups of patients. The serum sex hormone levels were slightly lower than in the con-trol group after treatment,but the difference was not statistically significant( P > 0. 05). After treatment,the bone metabolic markers(calcium, phosphorus,alkaline phosphatase)and lumbar spine bone mineral density in the treatment group was significantly better than the control group. The difference was statistically significant( P < 0. 05). Clinical remission rate was higher than the treatment group. The nausea,vomiting,and other adverse events was significantly lower than those of the control group,the differences were statistically significant( P < 0. 05). Conclusion The effect of EMS after conservative operation of gonadotropin releasing hormone agonist(GnRHa)combined with add back therapy is obvious, which can overcome the drawbacks of single GnRHa treatment,optimization of treatment effect.