作　　者： ; ; ; ; ;

机构地区： 佛山市第一人民医院

出　　处： 《中国妇产科临床杂志》 2020年第2期145-149,共5页

摘　　要： 目的探讨糖皮质激素联合促性腺激素释放激素激动剂(GnRH-α)在降低轻度子宫内膜异位症(EMT)患者复发性早期流产中的疗效。方法选择2016年5月至2017年3月本院收治的77例轻度EMT合并复发性流产患者纳入研究,根据患者意愿腹腔镜术后分别给予单纯GnRH-α治疗(GnRH-α组,n=37)和GnRH-α联合糖皮质激素治疗(联合组,n=40)。测定患者血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)和孕酮水平;进行视觉模拟评分法(VAS)疼痛评分,随访疼痛缓解、复发及受孕情况。结果联合组术后第1、3天各炎症因子水平低于GnRH-α组(P<0.05),E2、孕酮水平显著高于GnRH-α组(P<0.05);联合组患者术后第6、12个月疼痛VAS评分明显低于GnRH-α组(P<0.05);联合组患者术后疼痛和EM病灶复发率显著低于GnRH-α组(P<0.05),活产率(60.00%,24/40)显著高于GnRH-α组(35.14%,12/37)(P<0.05);两组患者的不良反应发生率比较,差异无统计学意义(P>0.05)。结论GnRH-α联合糖皮质激素对于缓解EMT合并复发性自然流产患者腹腔镜术后疼痛、降低术后复发、提高妊娠结局方面均有一定效果。 Objective To investigate the curative effect of glucocorticoid combined with gonadotropin-releasing hormon agonist(GnRH-α)on reducing recurrent early abortion rate in patients with mild endometriosis(EMT).Methods Patients with mild EMT and recurrent abortion who were admitted to the hospital from May 2016 to March 2017 were enrolled in the study.They were divided into GnRH-αgroup and combination group according to their wishes.After laparoscopic surgery,patients were treated with GnRH-αalone(GnRH-αgroup,n=37)and GnRH-αcombined with glucocorticoid(combined group,n=40).The levels of serum C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),follicle stimulating hormone(FSH),luteinizing hormone(LH)and estradiol(E2)were measured.Visual analogue scale(VAS)pain score was performed,and remission,recurrence and conception were recorded.Results On the 1st and 3rd day after surgery,levels of inflammatory factors in combination group were significantly lower than those in GnRH-αgroup(P<0.05).The level of E2 and progesterone in the combined group was significantly higher than that in the GnRH-αgroup(P<0.05).At 6 and 12 months after surgery,VAS scores in combination group were significantly lower than those in GnRH-αgroup(P<0.05).The recurrence rate of the combined group was significantly lower than that of the GnRH-αgroup(P<0.05),while the live birth rate in the combined group(60.00%;24/40)was significantly higher than that of the GnRH-αgroup(35.14%;12/37)(P<0.05).There was no significant adverse reaction between the two groups(P>0.05).Conclusion GnRH-αcombined with glucocorticoid has effect on relieving postoperative pain,reducing postoperative recurrence and improving pregnancy outcome in patients with EMT complicated with recurrent spontaneous abortion.

关 键 词： 子宫内膜异位症 复发性早期流产 糖皮质激素 促性腺激素释放激动剂

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