GnRH-a 联合LNG-IUS 对子宫内膜异位症术后 患者血清ENA-78 及MCP-1 水平的影响

Effect of GnRH-a combined with LNG-IUS on serum ENA-78 and MCP-1 levels in postoperative patients with endometriosis

摘要:

目的 探讨促性腺激素释放激素激动剂（GnRH-a）联合左炔诺孕酮宫内缓释系统（LNG-IUS）， 对子宫内膜异位症（EMT）术后患者血清上皮细胞来源的中性粒细胞活化肽78（ENA-78）及单核细胞趋 化因子1（MCP-1）水平的影响。方法 选取2013 年7 月—2016 年2 月在南通大学第二附属医院实施腹腔 镜手术的96 例EMT 患者作为研究对象，并分为对照组（单用GnRH-a）和观察组（GnRH-a 联合LNGIUS）， 每组48 例。采用门诊复查或电话随访的方式在治疗前（T0）及治疗第3（T1）、6（T2）、12（T3）及24（T4） 个月记录患者疼痛视觉模拟评分（VAS）、血清ENA-78、MCP-1 及糖类抗原125（CA125）水平，比较两 组复发率和药物不良反应率的差异。结果 两组不同时间点VAS 评分、ENA-78、MCP-1 及CA125 有差异 （P <0.05）；两组间VAS 评分、ENA-78、MCP-1 及CA125 有差异（P <0.05）；两组VAS 评分、ENA-78、 MCP-1 及CA125 变化趋势有差异（P <0.05）。观察组复发率低于对照组（P <0.05）；两组治疗期间无严重药 物不良反应。结论 GnRH-a 联合LNG-IUS 不仅可降低EMT 患者术后血清ENA-78、MCP-1 及CA125 水平， 缓解疼痛，降低术后复发率，同时还具有较高的安全性，值得临床推广应用。

Abstract:

Objective To investigate the role of gonadotropin-releasing hormone agonist (GnRH-a) combined with levonorgestrel-releasing intrauterine system (LNG-IUS) in the neutralization of serum epithelial cells in patients with endometriosis (EMT) after surgery of granulocyte activation peptide-78 (ENA-78) and monocyte chemokine-1 (MCP-1) levels. Methods Ninety-six patients with EMT undergoing laparoscopic surgery in our hospital from July 2013 to February 2016 were included in the study and included either a control group (GnRH-a alone) or an observation group (GnRH-a combined with LNG-IUS), 48 cases in each group. Patients’ pain visual analogue scale (VAS), serum ENA were recorded before treatment (T0) and treatment 3rd (T1), 6th (T2), 12th (T3), 24th (T4) months by outpatient review or telephone follow-up. Serum ENA-78, MCP1, and carbohydrate antigen 125 (CA125) levels, and the differences in relapse rate and adverse drug response rates between the two groups. Results The VAS scores and the expression differences of ENA-78, MCP-1 and CA125 at different time points were statistically significant (P < 0.05); the difference in VAS score, ENA-78, MCP-1, and CA125 between the observation group and the control group was also statistically significant (P < 0.05). At the same time, the observation group and the control group were statistically significant in the trends of VAS score and the expression levels of ENA-78, MCP-1 and CA125. (P < 0.05). The recurrence rate of observation group was lower than that of control group (P < 0.05). In addition, both groups were treated during no serious adverse drug reactions were observed. Conclusions GnRH-a combined with LNG-IUS can not only reduce the serum ENA-78, MCP-1, and CA125 levels in patients with EMs, relieve pain and reduce postoperative recurrence rate, but also has high safety, which is worthy of clinical application.