子宫内膜异位症腹腔镜手术后应用低剂量戈舍瑞林联合地诺孕素对患者雌激素水平、VEGF、MT1-MMP及复发率的影响OA
Influence of low-dose goserelin combined with dienogest on estrogen,VEGF,MT1-MMP and recurrence rate in patients with endometriosis after hysteroscopy with laparoscopy
目的:分析子宫内膜异位症(EMs)患者行腹腔镜手术后,联合应用低剂量戈舍瑞林与地诺孕素对血清雌激素(E2)水平、血管内皮生长因子(VEGF)、膜型基质金属蛋白酶1(MT1-MMP)及疾病复发率的影响,为临床术后治疗方案优化提供依据.方法:前瞻性纳入120例EMs患者,均行腹腔镜手术后,根据治疗方案不同分为联合组(n=60)与单药组(n=60).单药组予低剂量戈舍瑞林(1.8 mg/次,皮下注射,每28 d注射1次);联合组在单药组基础上加用地诺孕素(2 mg/次,口服,1次/d)治疗,均治疗6个月.比较两组患者血清激素及细胞因子水平、子宫内膜异位症健康量表(EHP-5)评分、复发率、卵巢储备功能及不良反应发生情况.结果:治疗后,两组 E2、P、VEGF、MT1-MMP均降低(P<0.05),但联合组 E2 更高(P<0.05),VEGF、MT1-MMP均更低(P<0.05),两组患者P水平比较,差异无统计学意义(P>0.05);两组患者抗苗勒管激素、双侧卵巢窦卵泡数均降低(P<0.05),但联合组高于单药组(P<0.05);两组患者EHP-5评分均降低(P<0.05),且联合组疼痛、情绪条目评分均低于单药组(P<0.05).术后12个月,联合组的复发率低于单药组(P<0.05).两组患者总不良反应总发生率比较,差异无统计学意义(P>0.05).结论:低剂量戈舍瑞林联合地诺孕素能下调 EMs术后患者的 E2、VEGF、MT1-MMP水平,降低复发率,安全性可控.
Objective:To analyze the influence of low-dose goserelin combined with dienogest on serum estrogen(E2),vascular endothelial growth factor(VEGF),membrane type 1 matrix metalloproteinase(MT1-MMP)and disease recurrence rate in patients with endometriosis(EMs)after hysteroscopy with laparoscopy,and to provide a basis for the optimization of clinical postoperative treatment regimen.Methods:A total of 120 patients with EMs were prospectively included.After hysteroscopy with laparoscopy,they were divided into combined group(n=60)and single drug group(n=60)based on different treatment regimens.The single drug group was treated with low-dose goserelin(1.8 mg/time,subcutaneous injection,once every 28 days),while the combined group was added with dienogest(2 mg/time,oral administration,once a day)on the basis of the single drug group,and both groups were treated for 6 months.The levels of serum hormones and cytokines,endometriosis health profile(EHP-5)scores,recurrence rate,ovarian reserve function and occurrence of adverse reactions were compared between the two groups.Results:After treatment,the levels of E2,P,VEGF and MT1-MMP were decreased in both groups(P<0.05).However,combined group exhibited a higher E2 level(P<0.05)and lower VEGF and MT1-MMP levels(P<0.05).There was no statistically significant difference in P level between the two groups after treatment(P>0.05).Both groups showed decreased anti-Müllerian hormone level and bilateral ovarian antral follicle count(P<0.05),but combined group had higher values than single drug group(P<0.05).Both groups exhibited reduced EHP-5 scores(P<0.05),with combined group had lower scores of pain and emotion items than single drug group(P<0.05).The recurrence rate at 12 months after surgery was lower in combined group than that in single drug group(P<0.05).The overall incidence rate of adverse reactions showed no statistically significant difference between the two groups(P>0.05).Conclusion:Low-dose goserelin combined with dienogest can down-regulate the levels of E2,VEGF and MT1-MMP in patients after EMs surgery,and reduce the recurrence rate,with controllable safety.
王春梅;魏顺英;杨发珍;张莎;陈金融;杨爱萍
青海红十字医院妇一科,青海 西宁 810001青海红十字医院妇一科,青海 西宁 810001青海红十字医院妇一科,青海 西宁 810001青海红十字医院妇一科,青海 西宁 810001青海红十字医院妇一科,青海 西宁 810001青海红十字医院妇一科,青海 西宁 810001
医药卫生
子宫内膜异位症腹腔镜手术戈舍瑞林地诺孕素术后复发
EndometriosisHysteroscopy with laparoscopyGoserelinDienogestPostoperative recurrence
《川北医学院学报》 2026 (6)
673-677,5
青海省卫生健康委员会指导性课题(2023-wjzkdx-369)青海大学医学部中青年科技项目(2023-kyy-7)
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