摘要
目的探讨应用促性腺激素释放激素激动剂(GnRH-a)联合反向添加不同剂量戊酸雌二醇治疗子宫内膜异位症后血清雌二醇(E2)升高情况及反添加治疗的个体化意义。方法子宫内膜异位症患者39例,于确诊后或手术后的月经第1天肌肉注射GnRH-a,此后根据病情每28天注射1次。随访期间,每4周测一次血清E2浓度,当血清E2<110pmol/L或出现围绝经期症状时给予反向添加戊酸雌二醇至疗程结束,根据血清E2水平调整剂量,控制血清E2于110-165pmol/L。统计每増加1mg戊酸雌二醇患者血清E2升高的程度,观察血清E2升高程度与体重指数(BMI)及体表面积的关系。结果 (1)39例患者中,34例(87.2%)肌肉注射GnRH-a 8周后血清E2降至低于110pmol/L。(2)为维持血清E2浓度在110-165pmol/L,33例补充戊酸雌二醇患者中,12例需补充0.5mg;3例需补充0.75mg;15例需补充1mg;2例需补充1.5mg;1例需补充2mg。(3)每添加1mg戊酸雌二醇,血清E2值升高幅度<50pmol/L者6例,50pmol/L～者7例,100pmol/L～者10例,150pmol/L～者9例,≥200pmol/L者1例。(4)添加戊酸雌二醇后,血清E2升高幅度与个体BMI及体表面积无明显线性关系。结论反向添加治疗时间及药物剂量需根据应用GnRH-a后血清E2水平施行个体化治疗。
Objective To study the significance of individualized treatment with add-back therapy with estradiol valerate in the patients with endometrosis undergoing gonadotropin-releasing hormone agonist（GnRH-a） treatment. Methods GnRH-a treatment was performed in 39 patients with endometrosis, which was injected intramuscularly on the 1st day of menstruation after diagnosis or operation,and then once every 28 days according to the severity of disease. Serum level of E2 was detected every 4 weeks. To keep E2 in 110-165 pmol/L, estradiol valerate was given as add-back therapy when E2~l10 pmol/L or occurrence of perimenopausal symptoms. The increase of E2 level was calculated after estradiol valerate 1 mg was added. The correlation between elevated E2 level and body mass index（BMI） or body surface area（BSA） was observed as well. Results Of 39 cases,E2 was lower than 110 pmol/L in 34 cases after GnRH-a treatment for 8 weeks. To keep E2 in 110-165 pmol/L in 33 cases, add-back therapy with estradiol valerate 0. 5 mg was needed in 12 cases, 0. 75 mg in 3 cases,1 mg in 15 cases, 1.5 mg in 2 cases,and 2 mg in 1 case. After estradiol valerate 1 mg was added, the amplitude in the increase of sertLrn E2 was 〈50 pmol/L in 6 cases, 50-99 pmol/L in 7 cases, 100-149 pmol/L in 10 cases,150-199 pmol/L in 9 cases, and ≥200 pmol/L in 1 case. After estradiol valerate was added, the increase of the amplitude of serum E2 had no significant linear relationship with BMI or BSA. Conclusion The time and dosage of add-back therapy with estradiol valerate should be individualized according to serum levels of E2 during the treatment of GnRH-a.
出处
《江苏医药》
CAS
北大核心
2014年第14期1670-1672,共3页
Jiangsu Medical Journal
