孟侠,王静依,刘海凤,杨智玲
MENG Xia,WANG Jingyi,LIU Haifeng,YANG Zhiling

• 1:成都医学院第二附属医院&核工业四一六医院妇产科

摘要(Abstract)：

目的:探究醋酸亮丙瑞林对子宫内膜异位症患者血清血管内皮生长因子(VEGF)、癌胚抗原(CEA)及糖类抗原125(CA125)水平的影响。方法:140例子宫内膜异位症患者随机均分为对照组(炔雌醇环丙孕酮片治疗)及观察组(注射用醋酸亮丙瑞林微球治疗),连续治疗4个月;治疗前及治疗4个月时,采用酶联免疫吸附法(ELISA)检测2组患者血清VEGF、CEA、CA125、雌二醇(E_2)、黄体生成素(LH)及卵泡刺激素(FSH)水平,采用视觉模拟疼痛(VAS)评分评估患者腹部疼痛、采用月经失血图(PBAC)评分评估患者患者月经量、观察并记录患者治疗期间不良反应发生情况。结果:治疗4个月时,2组患者血清VEGF、CA125、E_2、LH及FSH均较治疗前降低(P<0.01),观察组低于对照组(P<0.05);血清CEA水平比较,仅对照组治疗4个月时高于治疗前(P<0.05);治疗4个月时2组患者VAS评分、PBAC评分均较治疗前降低,且观察组低于对照组(P<0.05或P<0.01);2组患者治疗期间不良反应检出率差异无统计学意义(χ~2=0.201,P=0.654)。结论:醋酸亮丙瑞林可有效缓解子宫内膜异位症患者腹部疼痛及减少月经量,其机制可能有降低血清VEGF和CA125水平,抑制雌激素分泌有关。
Objective: To investigate the effect and safety of lepirelin acetate on serum levels of vascular endothelial growth factor(VEGF), carcinoembryonic antigen(CEA) and carbohydrate antigen 125(CA125) in patients with endometriosis. Methods: 140 patients with endometriosis were randomly divided into the control group(treatment with ethinylestradiol and progesterone tablets) and the observation group(treatment with lebulin acetate microspheres for injection) for 4 months. By using enzyme-linked immunosorbent(ELISA) detection of two groups of patients before and after the April treatment VEGF, CEA, CA125, estradiol(E2), luteinizing hormone(LH) and follicle-stimulating hormone(FSH) levels, using visual analog pain score(VAS) assessment of patients with abdominal pain, menstrual blood loss figure(PBAC) score evaluation menstrual quantity, observe and record the patient treatment in patients with adverse reactions occurred during the study. Results: After treatment, serum VEGF and CEA levels in both groups were significantly lower than those before treatment. Serum VEGF and CA125 levels in the observation group were significantly lower than those in the control group(P<0.01), while serum CEA levels in the control group were higher than those before treatment(P< 0.05).After treatment, serum E2, LH and FSH in the two groups were lower than those before treatment, and were significantly lower in the observation group than in the control group(P<0.05 or P<0.01). VAS score and PBAC score in both groups after treatment were lower than those before treatment, and those in the observation group were lower than those in the control group(P<0.05 or P<0.01).There was no significant difference in the detection rate of adverse reactions between the two groups(χ~2=0.201,P=0.654). Conclusion: Lepirelin acetate can effectively relieve abdominal pain and reduce menstrual flow in patients with endometriosis, and the mechanism may be related to lowering serum VEGF and CA125 levels and inhibiting estrogen secretion.

关键词(KeyWords)： 子宫内膜异位症;血管内皮生长因子类;癌胚抗原;醋酸亮丙瑞林;炔雌醇环丙孕酮;糖类抗原125;安全性分析
endometriosis;vascular endothelial growth factors;carcinoembryonic antigen;leucopropyl acetate;ethinylestradiol cycloprogesterone;carbohydrate antigen 125;safety analysis

Abstract:

Keywords:

基金项目(Foundation): 白求恩公益基金会临床科研专项资助基金项目(ZHYX201904003)

作者(Author): 孟侠,王静依,刘海凤,杨智玲
MENG Xia,WANG Jingyi,LIU Haifeng,YANG Zhiling

DOI: 10.19367/j.cnki.1000-2707.2020.01.019

参考文献(References)：

• [1] 孙敏,张媛,虞蔚,等.曼月乐巩固治疗子宫内膜异位症术后患者的疗效观察[J].贵州医药,2017,41(6):628-629.
• [2] 刘辉艳,孙伟伟,王娜娜,等.赵瑞华教授治疗子宫内膜异位症的临证思路[J].环球中医药,2017,10(4):500-502.
• [3] 程艳艳.护理干预对腹腔镜下子宫内膜异位症手术患者情绪的影响[J].护士进修杂志,2017,30(9):822-824.
• [4] 谢桃利.炔雌醇环丙孕酮片联合散结镇痛胶囊对子宫内膜异位症患者疼痛程度、安全性及妊娠情况的影响[J].实用心脑肺血管病杂志,2018,26(1):112-113.
• [5] 蒋春彦,蒋秋丽.醋酸亮丙瑞林微球联合炔雌醇环丙孕酮片对子宫内膜异位症患者疗效及复发率的影响[J].药物评价研究,2018,41(10):97-100.
• [6] 张余芳,林尧,卢秀英,等.醋酸亮丙瑞林治疗子宫内膜异位症的临床观察[J].中国药房,2017,27(26):3675-3677.
• [7] 沈栗帆,何艳,季菲,等.醋酸亮丙瑞林对子宫内膜异位症内分泌水平及骨密度的影响[J].新疆医科大学学报,2017,40(2):170-173.
• [8] 中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊治指南[J].中华妇产科杂志,2015,50(3):161-169.
• [9] LIN S Y ,LEE R K ,WU Y M,et al.Reproducibility of the revised American fertility society classification of endometriosis using laparoscopy or laparotomy[J].International Journal of Gynecology & Obstetrics,1998,60(3):265-269.
• [10]ALTENBURG J,WORTEL K,GRAAFF C S,et al.Validation of a visual analogue score (LRTI-VAS) in non-CF bronchiectasis[J].Clinical Respiratory Journal,2016,10(2):168-175.
• [11]冯力民,夏恩兰,黄晓武,等.应用月经失血图评估月经血量[J].中华妇产科杂志,2001,36(1):51.
• [12]温丽,郭珍,常春红,等.子宫内膜异位症患者血清和腹腔液中VEGF、IL-6、TNF-α及CA125表达及临床意义[J].现代中西医结合杂志,2017,26(5):467-470.
• [13]刘洪雪,李健,罗平.宫-腹腔镜联合治疗子宫内膜异位症合并不孕患者术后妊娠的影响因素分析[J].实用妇产科杂志,2017,33(2):144-147.
• [14]吕昕瞳.自拟补肾活血方剂联合炔雌醇环丙孕酮片及二甲双胍治疗多囊卵巢综合征疗效及对内分泌代谢和排卵的影响[J].现代中西医结合杂志,2017,26(5):508-510.
• [15]程丽英,刘阔,许德国.子宫内膜异位症和卵巢癌共同分子标志物的初步研究[J].肿瘤研究与临床,2017,29(2):116-119.
• [16]LJW T,HEYSE R,CRAEN M,et al.Consecutive cyproterone acetate and estradiol treatment in late-pubertal transgender female adolescents.[J].Journal of Sexual Medicine,2017,14(5):747.
• [17]郄雪莲,王丽娟,任丽坤,等.活血消异方联合炔雌醇环丙孕酮片治疗子宫内膜异位症的疗效观察[J].中医药导报,2018,24(22):84-87.
• [18]张佟,叶红.丹莪妇康煎膏联合醋酸亮丙瑞林微球治疗复发性子宫内膜异位症的临床研究[J].现代药物与临床,2018,33(6):1424-1427.
• [19]王磊,孙海茹,孙丽妍,等.醋酸亮丙瑞林对子宫内膜异位症患者血清雌二醇、孕酮及黄体生成素水平的影响[J].现代生物医学进展,2018,18(23):166-169.
• [20]龙平,洛若愚.腹腔镜联合醋酸亮丙瑞林治疗子宫内膜异位症合并不孕的临床效果[J].中国医药导报,2017,14(26):76-78.
• [21]章琼,滕慧,胡玉利,等.注射用醋酸亮丙瑞林微球联合腹腔镜对子宫内膜异位症患者血清TIMP-1、 MMP-9水平及受孕率的影响[J].河北医学,2019,25(5):726-732.
• [22]徐建锋,陈翠平,马艳娜.醋酸亮丙瑞林治疗子宫内膜异位症的疗效及对卵巢储备功能的影响[J].中国妇幼保健,2018,33(20):4603-4605.
• [23]汪涛,张岩.子宫内膜异位症保守手术后GnRHa联合戊酸雌二醇反向添加疗法的疗效及对血清VEGF、CA125、IL-6、TNF-α水平的影响[J].中国妇幼保健,2019,34(2):283-285.
• [24]李燕,朱君,张煜.PI3K/AKT信号转导通路和VEGF在子宫内膜异位症中的表达[J].中国性科学,2017,26(4):45-47.
• [25]韩倩,时光,赵瑞华.血清CA125在子宫内膜异位症的临床应用价值[J].中国妇产科临床杂志,2019,20(1):100-102.

文章评论(Comment)：