来曲唑联用孕三烯酮与单用孕三烯酮治疗子宫内膜异位症的对比研究

摘要/Abstract

摘要： 目的: 比较来曲唑联用孕三烯酮与单用孕三烯酮治疗子宫内膜异位症的临床效果。方法: 78例子宫内膜异位症患者随机分为两组,来曲唑+孕三烯酮组(LE+GE)38例患者于月经第一天开始口服来曲唑 2.5 mg/d、孕三烯酮 2.5 mg,每周2次。孕三烯酮组(GE)40例患者于月经第一天开始口服孕三烯酮 2.5 mg,每周2次。治疗时间均为6个月。所有患者均在治疗前、停止治疗第一次月经来潮后及治疗结束后6个月进行痛经及盆腔触痛VAS评分,并进行B超检查及癌抗原125(CA125)测定。结果: 治疗6个月后和停药6个月后两组痛经症状都明显缓解,但LE+GE组患者痛经VAS评分下降较GE组更明显(t=2.54, P<0.05;t=3.23,P<0.05)。治疗6个月后两组患者盆腔触痛VAS评分均降低,但LE+GE组较GE组降低更明显(t=2.73, P<0.05);停药6个月后两组患者盆腔触痛VAS评分均回升,差异无统计学意义(t=1.76,P>0.05)。两组患者治疗6个月后 CA125均较治疗前明显下降,但差异无统计学意义(t=1.29, P>0.05)。停药6月后,两组患者CA125均回升,差异无统计学意义(t=1.82, P>0.05)。治疗前后两组卵巢囊肿最大直径改变不明显(t=0.86, P>0.05;t=1.51, P>0.05)。所有患者都未因副反应终止治疗。结论: 来曲唑联用孕三烯酮能更好地减轻子宫内膜异位症患者的痛经症状,但对控制病灶并不优于单用孕三烯酮。

关键词: 子宫内膜异位症, 疼痛, 来曲唑, 孕三烯酮

Abstract: AIM: To compare the efficacy of the aromatase inhibitor letrozole combined with gestrinone versus gestrinone alone in treating endometriosis.METHODS: 78 endometriosis patients were randomly divided into two groups:38 patients in letrozole + gestrinone group(LE+GE)and 40 patients in gestrinone alone group(GE). Letrozole (2.5 mg/day) and gestrinone(2.5 mg,2 times per week) were administered in LE+GE group and gestrinone(2.5 mg,2 times per week) were administered in GE group. The treatment was started on the first day of menstruation and continued for 6 months. Each patient completed visual analogue scale (VAS) of dysmenorrhea and pelvic tenderness before the onset of therapy, at the firs menorrhea and at 6 -month follow-up after the completion of treatment, assayed for serum CA-125 concentration and measured ovrian cyst size by ultrasonography at same time.RESULTS: The intensity of dysmenorrhea were significantly decreased at the first menorrhea and at 6 -month follow-up after the completion of treatment both in LE+GE group and GE group, but the drop VAS scale in LE+GE group was more obvious than that in GE group(t=2.54, P<0.05;t=3.23,P<0.05). At the first menorrhea after the completion of treatment, pelvic tenderness had released in two groups, but VAS score in LE+GE group had more sharply dropped than those in GE group (t=2.73, P<0.05). VAS score of pelvic tenderness pick-up in two groups at 6 -month follow-up after the completion of treatment (t=1.76,P>0.05). The serum CA-125 levels had dropped in two groups at the first menorrhea after the completion of treatment, but diffrentiaton was not signifcant (t=1.29, P>0.05). The serum CA-125 levels pick-up in two groups at 6 -month follow-up after the completion of treatment (t=1.82, P<0.05). Maximum diameter of ovarian cysts did not change significantly in each group after 6 -month treatment (t=0.86, P>0.05;t=1.51, P>0.05). No patients with from the study because of adverse effects.CONCLUSION: Letrozole combined with gestrinone was more effective in reducing dysmenorrhea caused by endometriosis than gestrinone alone, but to inhibit endometriosis lesions was no better than gestrinone alone.

Key words: Endometriosis, Pain, Letrozole, Gestrinone

中图分类号:

R711.71

石少权, 洪婷, 姜芳芳, 王桂荣, 王峰. 来曲唑联用孕三烯酮与单用孕三烯酮治疗子宫内膜异位症的对比研究[J]. 中国临床药理学与治疗学, 2013, 18(11): 1275-1279.

SHI Shao-quan, HONG Ting, JIANG Fang-fang, WANG Gui-rong, WANG Feng. Letrozole combined with gestrinone compared with gestrinone alone in the treatment of endometriosis[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2013, 18(11): 1275-1279.

参考文献

[1] Hudelist G, Czerwenka K, Keckstein J, et al.Expression of aromatase and estrogen sulfotransferase in eutopic and ectopic endometrium: evidence for unbalanced estradiol production in endometriosis[J].Reprod Sci, 2007,14(8):798-805.
[2] Ferrero S, Venturini PL, Ragni N, et al. Pharmacological treatment of endometriosis: experience with aromatase inhibitors[J]. Drugs, 2009, 69(8):943-952.
[3] Ferrero S, Venturini PL, Gillott DJ, et al. Letrozole and norethisterone acetate versus letrozole and triptorelin in the treatment of endometriosis related pain symptoms: a randomized controlled trial[J]. Reprod Biol Endocrinol, 2011,21(9):88.
[4] Kelly AM. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain[J]. Emerg Med J, 2001,18(3):205-207.
[5] Ferrero S, Gillott DJ, Venturini PL, et al. Use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic review[J]. Reprod Biol Endocrinol, 2011,21(9):89.
[6] Nieto A, Tacuri C, Serra M, et al. Long-term follow-up of endometriosis after two different therapies (Gestrinone and Buserelin) [J]. Clin Exp Obstet Gynecol, 1996,23(4):198-204.
[7] Razzi S, Fava A, Sartini A, et al.Treatment of severe recurrent endometriosis with an aromatase inhibitor in a young ovariectomised woman[J]. BJOG, 2004,111(2):182-184.
[8] Ferrero S, Camerini G, Seracchioli R, et al. Letrozole combined with norethisterone acetate compared with norethisterone acetate alone in the treatment of pain symptoms caused by endometriosis[J]. Human Reproduction,2009,24(12): 3033-3041.
[9] Ramos IM, Podgaec S, Abrão MS, et al. Evaluation of CA-125 and soluble CD-23 in patients with pelvic endometriosis: a case-control study [J]. Rev Assoc Med Bras, 2012, 58(1):26-32.
[10] Remorgida V, Abbamonte HL, Ragni N, et al. Letrozole and norethisterone acetate in rectovaginal endometriosis[J]. Fertil Steril, 2007,88(3):724-726.
[11] Remorgida V, Abbamonte LH, Ragni N, et al. Letrozole and desogestrel-only contraceptive pill for the treatment of stage IV endometriosis[J]. Aust N Z J Obstet Gynaecol ,2007, 47(3):222-225.
[12] Langoi D, Pavone ME, Gurates B, et al. Aromatase inhibitor treatment limits progression of peritoneal endometriosis in baboons[J]. Fertil Steril, 2013, 99(3):656-662.
[13] Ceyhan ST, Onguru O, Fidan U, et al. Comparison of aromatase inhibitor (letrozole) and immunomodulators (infliximab and etanercept) on the regression of endometriotic implants in a rat model[J]. Eur J Obstet Gynecol Reprod Biol, 2011,154(1):100-104.
[14] Bilotas M, Meresman G, Stella I, et al. Effect of aromatase inhibitors on ectopic endometrial growth and peritoneal environment in a mouse model of endometriosis[J]. Fertil Steril,2010,93(8):2513-2518.
[15] Carlson RW, Theriault R, Schurman CM, et al. Phase II trial of anastrozole plus goserelin in the treatment of hormone receptor-positive, metastatic carcinoma of the breast in premenopausal women[J]. J Clin Oncol, 2010,28(25):3917-3921