發(fā)布時(shí)間：2018-05-24 19:55

  本文選題：促性腺激素釋放激素激動(dòng)劑 + 反加療法　； 參考：《新疆醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：探討促性腺激素釋放激素激動(dòng)劑(GnRH-a)聯(lián)合反加療法對(duì)子宮內(nèi)膜異位癥(內(nèi)異癥)患者內(nèi)分泌激素水平、低雌激素癥狀及骨質(zhì)丟失的影響。方法：選擇2012年4月至2013年12月經(jīng)腹腔鏡手術(shù)確診為子宮內(nèi)膜異位癥患者64例且手術(shù)治療限于兩月內(nèi),隨機(jī)分為分為A、B兩組,A組患者于月經(jīng)第1-2天或手術(shù)后3-5天內(nèi)予諾雷德3.6mg皮下注射,隔28天注射一次,共6次；B組用法同前,并于注射第2支諾雷德同時(shí)每天口服藥物替勃龍(2.5mmg/天)連續(xù)服用至療程結(jié)束。治療1個(gè)月后及治療結(jié)束后記錄改良庫(kù)珀曼法(Kupperman)評(píng)分及疼痛視覺(jué)模擬評(píng)分(VAS),監(jiān)測(cè)卵泡刺激素(FSH)、黃體生成激素(LH)、雌二醇(E2)、血清骨鈣素(BGP)水平并隨訪治療后兩組患者首次月經(jīng)復(fù)潮時(shí)間、疼痛視覺(jué)模擬評(píng)分。結(jié)果：A、B兩組治療6月末的血清FSH、LH和E2水平均較前顯著降低,差異有統(tǒng)計(jì)學(xué)意義(P0.01)；B組治療末E2水平高于A組(P0.01)；血清骨鈣素治療結(jié)束后與治療1個(gè)月后比較差異無(wú)統(tǒng)計(jì)學(xué)意義；治療結(jié)束后患者Kupperman評(píng)分及疼痛視覺(jué)模擬評(píng)分均較治療1個(gè)月后降低,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。A、B兩組疼痛總分、盆腔痛、性交痛三項(xiàng)評(píng)分均較治療1個(gè)月后顯著下降,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)；月經(jīng)來(lái)潮后,兩組疼痛總分、盆腔痛、性交痛評(píng)分較治療6個(gè)月末時(shí)略有上升或下降,但差異均無(wú)統(tǒng)計(jì)學(xué)意義,兩組患者痛經(jīng)評(píng)分均較治療1個(gè)月后下降(P0.01)。結(jié)論：GnRH-a聯(lián)合替勃龍能有效減輕使用GnRH-a引起的低雌激素癥狀、降低骨轉(zhuǎn)化保護(hù)骨量,并能有效緩解內(nèi)異癥的疼痛癥狀,是一種安全、有效、提高患者依從性的治療方案。
[Abstract]:Objective: to investigate the effects of gonadotropin releasing hormone agonist (GnRH-a) combined with reverse adduct therapy on endocrine hormone levels, hypoestrogen symptoms and bone loss in patients with endometriosis (endometriosis). Methods: 64 patients with endometriosis diagnosed by laparoscopic surgery from April 2012 to December 2013 were selected and the operative treatment was limited to two months. Patients in group A were randomly divided into group A and group A were subcutaneously injected with Norred 3.6mg on day 1-2 of menstruation or within 3-5 days after operation, and were injected once every 28 days. The second dose of Norred was administered at the end of the course of treatment with oral tibolone 2.5 mmg / day. A month after treatment and one month after treatment, the modified Kupperman( Kupperman) score and pain visual analogue score (VASA) were recorded, follicle stimulating hormone (FSH), luteinizing hormone (LHN), estradiol (E _ 2), serum osteocalcin (BGP) were monitored and the two groups were followed up after treatment. The first time of menorrhagia, Visual analogue score of pain. Results at the end of 6 months after treatment, the serum levels of FSHLH and E2 in the two groups were significantly lower than those in the control group (P 0.01), the level of E 2 in group B was higher than that in group A at the end of treatment, and there was no significant difference in serum osteocalcin between the end of treatment and one month after treatment. The scores of Kupperman and visual analogue of pain in patients after treatment were significantly lower than those after one month treatment. The difference was statistically significant. The total score of pain, pelvic pain and sexual intercourse pain in two groups were significantly lower than those after one month treatment. After menarche, the total score of pain, pelvic pain and sexual intercourse pain score in the two groups were slightly increased or decreased compared with those at the end of 6 months, but there was no significant difference between the two groups at the end of 6 months. The scores of dysmenorrhea in both groups were lower than that after 1 month treatment (P 0.01). ConclusionTwo GnRH-a combined with tibolone can effectively alleviate the symptoms of low estrogen induced by GnRH-a, reduce the bone mass of bone transformation, and relieve the pain symptoms of endometriosis. It is a safe, effective and effective therapy for improving the compliance of patients with endometriosis.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R711.71

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