文章摘要
肖莉莎,姚青青,段世军,周 妮,郭 琳,张蓓蕾.子宫内膜异位症的激素治疗对卵巢纤维化和卵巢储备的影响[J].,2022,(9):1681-1686
子宫内膜异位症的激素治疗对卵巢纤维化和卵巢储备的影响
The Effect of Hormone Therapy for Endometriosis on Ovarian Fibrosis and Ovarian Reserve
投稿时间:2021-09-06  修订日期:2021-09-30
DOI:10.13241/j.cnki.pmb.2022.09.016
中文关键词: 子宫内膜异位症  卵巢纤维化  卵巢储备  激素治疗
英文关键词: Endometriosis  Ovarian fibrosis  Ovarian reserve  Hormone therapy
基金项目:国家自然科学基金项目(81260387/H1621)
作者单位E-mail
肖莉莎 西安国际医学中心医院妇科 陕西 西安 710000 xiaolisha198703@163.com 
姚青青 西安国际医学中心医院妇科 陕西 西安 710000  
段世军 空军军医大学第二附属医院影像科 陕西 西安 710038  
周 妮 西安交通大学第二附属医院妇科 陕西 西安 710004  
郭 琳 空军军医大学第二附属医院妇科 陕西 西安 710038  
张蓓蕾 空军军医大学第二附属医院妇科 陕西 西安 710038  
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中文摘要:
      摘要 目的:探讨子宫内膜异位症的激素治疗对卵巢纤维化和卵巢储备的影响。方法:选取2019年9月-2021年8月西安国际医学中心医院收治的86例子宫内膜异位症患者,将其随机分为四组(A、B1、B2、C),A组未接受任何激素治疗,B1组和B2组接受炔诺酮孕激素治疗,C组接受促性腺激素释放激素(GnRH)治疗。比较四组24个月复发率、复发期间肿瘤直径大小、抗苗勒激素(AMH)和促卵泡激素(FSH)水平以及血清转化生长因子-β1(TGF-β1)和平滑肌肌动蛋白(α-SMA)的表达。结果:与治疗前相比,A组斑点样出血以及痛经情况未发生变化(P>0.05),B1、B2和C组斑点样出血升高,痛经情况降低(P<0.05);治疗后,B1、B2和C组较A组斑点样出血升高、痛经情况降低,C组较B1、B2组升高(P<0.05)。与治疗期间对比,四组子宫内膜异位症复发率均发生变化(P<0.05)。在治疗期间,与A组相比,B1组、B2组和C组子宫内膜异位症复发率降低,且B1组、B2组较C组降低;在随访期间,B1组、B2组复发率低于C组(P<0.05)。与治疗期间相比,A组随访期间子宫内膜瘤直径比较无差异(P>0.05),B1、B2和C组增大(P<0.05)。B1、B2和C组较A组子宫内膜瘤直径减小(P<0.05),而C组较B1、B2组增大(P<0.05)。与治疗前相比,四组治疗后血清FSH水平升高,血清AMH水平降低(P<0.05);治疗后,B1、B2和C组较A组血清FSH水平降低,AMH水平升高(P<0.05)。各组治疗后较治疗前TGF-β1和α-SMA的蛋白表达降低(P<0.05);治疗后B1、B2和C组较A组TGF-β1和α-SMA蛋白表达水平降低(P<0.05)。结论:与GnRH相比,孕激素可能是子宫内膜异位症术后卵巢储备和纤维治疗的更好选择。
英文摘要:
      ABSTRACT Objective: To investigate the effect of hormone therapy for endometriosis on ovarian fibrosis and ovarian reserve. Methods: A total of 86 patients with endometriosis admitted to the Xi'an International Medical Center Hospital from September 2019 - August 2021 were selected and randomly divided into four groups(A, B1, B2 and C). Group A did not receive any hormone therapy, group B1 and B2 received norethinyl progesterone therapy, and group C received GnRH therapy. The recurrence rate at 24 months, tumor diameter during recurrence, FSH and AMH levels, and serum TGF-β1 and α-SMA protein expressions were compared among the four groups. Results: Compared with before treatment, there was no change in spotty bleeding and dyspenorrhea in group A (P>0.05), spot bleeding increased and dyspenorrhea decreased in groups B1, B2 and C(P<0.05); After treatment, spotty bleeding and dyspenorrhea were increased and decreased in groups B1, B2 and C compared with group A, and increased in group C compared with group B1 and B2 (P<0.05). The relapse was recorded after 12 months of treatment and 12 months of follow-up. Endometriosis recurrence rates changed in all four groups compared with the treatment period (P<0.05). During treatment, the recurrence rate of endometriosis in groups B1, B2 and C was lower than that in group A, and B1 and B2 groups were lower than that in group C. During follow-up, the recurrence rate of group B1 and B2 was lower than that of group C (P<0.05). Compared with treatment, there was no difference in endometrial tumor diameter during follow-up in group A (P>0.05), increased in groups B1, B2 and C (P<0.05). The diameter of endometrioma in groups B1, B2 and C was smaller than that in group A(P<0.05), and increased in group C compared with groups B1 and B2(P<0.05). Compared with before treatment, serum FSH levels were increased and serum AMH levels were decreased in four groups after treatment(P<0.05); After treatment, serum FSH levels in groups B1, B2 and C were lower than those in group A, and serum AMH levels were higher (P<0.05). The protein expressions of TGF-β1 and α-SMA decreased after treatment compared with before treatment(P<0.05); After treatment, TGF-β1 and α-SMA protein expressions in groups B1, B2 and C were lower than those in group A(P<0.05). Conclusion: Compared with GnRH, progesterone may be the uterus A better choice for ovarian reserve and fiber therapy after endometriosis.
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