促性腺激素释放激素激动剂对乳腺癌术后辅助化疗患者卵巢的保护作用

摘要

目的 观察促性腺激素释放激素激动剂(GnRHa)对乳腺癌术后辅助化疗患者卵巢的保护作用.方法 将21例术后需要辅助全身化疗的乳腺癌患者随机分为两组,对照组11例常规化疗;观察组10例常规化疗同时肌注达菲林3.75 mg,其后每隔28 d注射1次,直至化疗结束.在化疗过程中及停药后,定期监测患者的性激素水平及月经情况.结果 对照组在治疗过程中有8例出现闭经,平均在第3个疗程出现;停药后有3例恢复月经,恢复月经的时间为停药后的30 ～90 d,平均73 d.观察组在第一次使用达菲林后均出现闭经;停药后仅1例出现月经紊乱,其他9例恢复正常月经,恢复时间为37 ～46 d,平均40 d.两组停药后月经恢复情况及恢复时间比较,P均＜0.05.停药时,对照组闭经者雌二醇(E2)、促卵泡生成素(FSH)和黄体生成素(LH)高于观察组(P均＜0.05),未闭经者的FSH高于治疗前水平(P＜0.05),LH也高于治疗前水平,但P均＞0.05.两组月经恢复者FSH、LH、E2水平比较,P均＞0.05.结论 乳腺癌术后常规化疗可导致患者卵巢功能损害,化疗同时应用GnRHa可保护患者的卵巢功能.%Objective To investigate the effect of GnRHa in preventing chemotherapy-induced ovarian failur. Methods 21 cases of postoperative adjuvant systemic chemotherapy in breast cancer were randomly divided into two groups: 11 cases of the control group were treated with conventional chemotherapy; 10 cases of the study group were treated with conventional chemotherapy and Diphereline 3.75 mg im q28d every month subsequently until the end of chemotherapy, regular monitoring of the patient's sex hormone levels and menstrual. Results 8 cases of patients had amenorrhoea at three chemotherapy courses in the control, 3 cases restored menstrual after stopping treatment, the time required to restore the menstrual with 30-90 d, an average of about 73 d. All of patients in the study group had amenorrhoea in the first period of chemotherapy, 9 cases recovered menstrual flow after chemotherapy, only 1 case had menstrual disorders, the time required to restore the menstrual with 37-46 d, an average of about 40 d. The menstruation recovery rate and recovery time were different in two groups after stopping ( P ＜ 0.05). The level of FSH, LH and E2 in the control group were higher than those in the study group when the chemotherapy stopped (P ＜ 0.05 ). When the chemotherapy was stopped, the FSH level of those who were not amenorrhoea was higher than those of before treatment ( P ＜ 0.05 ) , but the level of E2 and LH had no significant differences (P ＞ 0.05). Conclusion Chemotherapy can lead to ovarian function damage in breast cancer patients, while chemotherapy combined with GnRHa was one of the effective means to protect ovarian function.