清心消癥汤联合GnRH-α对中重度子宫内膜异位症保守性手术治疗后的观察分析

摘要

Objective:To compare the different clinical efficacy between the therapy of gonadotropin-releasing hormone agonist (GnRH-α) combined with Qingxin Xiaozheng decoction and the therapy of GnRH-α combined with Tibolone,after conservative surgery for moderate and severe endometriosis(EMT).Methods:40 patients were randomly assigned into the TCM group (n =20) and the hormone group (n =20),both groups were injected with GnRH-α (Zoladex,3.6mg,once per 28 days,six times) on the second day after surgery.When the symptoms of peri-menopausal period occurred,the TCM group was treated with Qingxin Xiaozheng decoction(three months at least);whereas the hormone group was given Tibolone(1.25 mg/d),the dosage was adjusted according to estradiol(E2) level.The treatment lasted for more than six months.Kupperman score(KIM),serum levels of E2 and cancer antigen125 (CA125),as well as the degree of menalgia and menstrual recovery time were observed in the two groups.Results:In terms of KIM score,it was higher in the TCM group after the 4th injection compared to the hormone group,with statistical significance(P ＜0.05);after the 6th injection,there was no statistical difference between the two groups (P ＞ 0.05).In terms of E2 level,there was statistical difference after the 6th injection between the two groups (P ＜ 0.05).In terms of CA125 level,there was no statistical difference between the two groups(P ＞ 0.05).In terms of menalgia degree and menstrual recovery time,there was no significant difference between the two groups after the treatment(P ＞ 0.05).Conclusions:The therapy of GnRH-α combined with Qingxin Xiaozheng decoction can increase serum level of E2,and it can achieve similar effect as hormone,but can avoid the disadvantages of hormone,when treating EMT after laparoscopy surgery.%目的:使用促性腺激素释放激素激动剂(gonadotropin-releasing hormon agonist,GnRH-α)联合清心消癥汤与GnRH-α联合激素两种不同疗法对中重度子宫内膜异位症(Endometriosis,EMT)(卵巢型)保守术后患者的疗效差异.方法:选择符合纳入标准经手术的40例OEM患者,随机分成中药组、激素组,每组20例,均于术后月经第2天皮下注射诺雷得(3.6 mg,28天/次,共6次).出现围绝经期症状后,中药组开始服用清心消癥汤(至少3个月);激素组加用替勃龙(利维爱,1.25 mg/d),依据每次注射前检测的雌二醇(E2)含量调整用量.连续观察6个月以上.分别观察两组患者改良Kupperman评分;血清E2、血清CA125变化;痛经程度评分;月经恢复时间.结果:1)与激素组比较,中药组在第4针注射时KIM评分较高,且有统计学意义(P＜0.05);2)第6针时,两组KIM评分无统计学差异(P＞0.05),但第6针注射时两组E2水平有差异,且有统计学意义(P＜0.05),治疗后两组患者血清CA125水平变化无明显差异(P＞0.05):3)两组患者痛经程度比较无明显差异(P＞0.05);4)两组患者月经恢复时间比较无明显差异(P＞0.05).结论:腹腔镜术后OEM患者,使用清心消癥汤联合GnRH-α治疗,可升高E2,在改善围绝经期症状方面可达到与激素相同的效果,但避免了应用激素的不良反应.