莫如冰　黄少雅　关棱

【摘要】 目的：分析GnRH-a與反向添加疗法联合治疗子宫内膜异位症的效果观察及安全性。方法：选取2013年2月-2016年2月于本院治疗的92例子宫内膜异位症患者，入院完善相关检查后，行保守性手术治疗，术后随机分成两个组，每组各46例。观察组予GnRH-a加反向添加疗法联合治疗，对照组采用单纯GnRH-a治疗。观察比较两组患者临床治疗效果、术前与术后血清性激素水平、血清CA125、治疗前后血清骨代谢指标、骨密度变化情况、类绝经症状。结果：两组患者经GnRH-a治疗后临床疼痛症状均有所好转，观察组患者疼痛减轻程度要高于对照组，两组患者治疗后血清性激素水平均低于正常值，但是观察组高于对照组更接近于正常水平，观察组骨代谢明显弱于对照组，骨密度明显高于对照组，观察组患者出现绝经症状的情况明显少于对照组（P<0.05）。结论：GnRH-a与反向添加疗法联合治疗子宫内膜异位症，相比单纯GnRH-a治疗子宫内膜异位症，可以提高临床疗效，降低GnRH-a引起的临床副作用，值得临床进一步推广应用。

【关键词】 子宫内膜异位症； 促性腺激素释放激素； 反向添加疗法； 临床疗效

The Observation of Effect and Safety Analysis of GnRH-a Combined with Reverse Addition Therapy in the Treatment of Endometriosis/MO Ru-bing，HUANG Shao-ya，GUAN Leng.//Medical Innovation of China，2017，14（19）：045-048

【Abstract】 Objective：To analyze the efficacy and safety of GnRH-a combined with reverse addition therapy in the treatment of endometriosis.Method：92 patients with endometriosis from February 2013 to February 2016 in our hospital were slected，they were given hospital related examinations after conservative surgery，after surgery，they were randomly divided into two groups，46 cases in each group.The observation group was treated with GnRH-a plus add back therapy，the control group was given GnRH-a treatment alone.The clinical treatment effect，serum sex hormone levels，serum CA125，serum bone metabolic index，bone mineral density and menopausal symptoms of two groups were observed and compared before and after treatment.Result：After treatment of GnRH-a，the clinical pain symptoms of two groups were improved，the pain relief degree in observation group was higher than that of control group，serum sex hormone levels in two groups after treatment were lower than normal，but the observation group of that more close to the normal level than the control group，the bone metabolism in observation group was weaker than the control group，the bone the density was significantly higher than the control group，the observation group patients with menopausal symptoms were significantly less than the control group（P<0.05）.Conclusion：GnRH-a and addback therapy in the treatment of endometriosis，compared with GnRH-a in the treatment of endometriosis can improve the clinical curative effect，reduce the clinical side effect caused by GnRH-a，it is worthy of further clinical application.

【Key words】 Endometriosis； Gonadotropin releasing hormone； Reverse addition therapy； Clinical efficacy

First-authors address：Maoming Hospital of Traditional Chinese Medicine，Maoming 525000，Chinaendprint

doi：10.3969/j.issn.1674-4985.2017.19.013

子宫内膜出现在卵巢、宫骶韧带、阴道直肠膈及其他脏腹膜等子宫体以外的部位时，称为子宫内膜异位症（EMT），简称内异症，是育龄期妇女常见且难治愈的一种妇科疾病[1]。保守手术联合促性腺激素释放激素激动剂（GnRH-a）类药物使用是临床治疗EMT有效的治疗手段[2]。虽然GnRH-a类药物使用后，能缓解内异症带来的疼痛及症状，但是常出现绝经症状，如潮热、阴道干燥、骨质丢失、性欲减退等[3]。使用时GnRH-a类药物可以酌情给予反向添加治疗以提高雌激素水平，预防低雌激素水平引起的类绝经症状[4-5]。……