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目的:研究比较GnRHa联合经皮雌激素及口服安宫黄体酮反加治疗与单用GnRHa治疗子宫内膜异位症对腰椎骨量的影响。方法:选择子宫内膜异位症患者28例,均经腹腔镜手术确诊并手术治疗两个月内,随机分为单用GnRHa组(A组)和反加组(B组)。A组患者于月经周期的第2天或于术后3～5天予诺雷德3.6 mg皮下注射,隔28天注射1次,共3次;B组患者于月经周期的第2天或于术后3～5天予诺雷德3.6 mg皮下注射,隔28天注射1次,共3次,于注射第1次同时每周1/2片松奇贴剂贴于腹部皮肤,并每晚口服安宫黄体酮6 mg至治疗结束。于治疗前测量患者腰椎骨密度,同时抽取外周静脉血测量E2水平,检测血清BGP水平;治疗3月后再次检测上述各项指标。结果:①A组L1～L4骨密度治疗3月后较治疗前显著降低(P<0.01),而B组虽较治疗前也有降低趋势,但差异无统计学意义(P=0.201);治疗后A组血清BGP较治疗前显著升高(P<0.01),而B组虽较治疗前也有升高趋势,但差异无统计学意义。②治疗3月后,两组患者血清E2水平均较治疗前显著降低(P<0.01),而B组E2显著高于A组(P<0.01)。结论:反加组L1～L4骨密度虽较治疗前也有降低趋势,但骨量丢失少于单用GnRHa组,血清BGP水平变化与腰椎骨密度变化呈负相关,提示该研究的反加方案能减少骨量的丢失,对骨密度起到一定的保护作用。
OBJECTIVE: To study the effect of GnRHa combined with transdermal estrogen and oral anti-endometriosis progesterone plus lumbar vertebrae on endometriosis with GnRHa alone. Methods: Twenty - eight patients with endometriosis were selected. All cases were diagnosed by laparoscopic surgery and were treated with GnRHa alone (group A) and anti - add group (group B) within two months after operation. A group of patients on the second day of the menstrual cycle or 3 to 5 days after surgery to Nuodeid 3.6 mg subcutaneously injected once every 28 days, a total of 3 times; B group of patients in the menstrual cycle of the first two days or 3 to 5 days after surgery to Nuodeid 3.6 mg subcutaneously injected once every 28 days, a total of 3 times, at the same time injection of the first 1 at the same time each week 1/2 Songzi patch affixed to the abdomen skin and nightly Oral medroxyprogesterone 6 mg to the end of treatment. The BMD of lumbar vertebrae was measured before treatment, E2 level in peripheral venous blood was measured at the same time, serum BGP level was measured. After 3 months of treatment, the above indexes were detected again. Results: ① The BMD of L1 ~ L4 in group A was significantly lower than that before treatment (P <0.01) after 3 months of treatment, while it was lower in group B than that before treatment, but the difference was not statistically significant (P = 0.201) Serum BGP levels were significantly higher than those before treatment (P <0.01), while those in group B were higher than those before treatment, but the difference was not statistically significant. ② After 3 months of treatment, serum E2 levels in both groups were significantly lower than those before treatment (P <0.01), while E2 in group B was significantly higher than that in group A (P <0.01). Conclusion: The bone mineral density of L1 ~ L4 in reverse addition group also decreased compared with that before treatment, but the bone loss was less than that of GnRHa alone group. The change of serum BGP level was negatively correlated with the BMD of lumbar spine, suggesting that the anti- Reduce the loss of bone mass, play a protective role on bone density.