Gnrh-a And Reverse To Add The Treatment Of Uterine Endometriosis Pain, And Il-18, Tnf-alpha

【Background】Pain is the major symptom of Endometriosis(EMS),and has impacted patients'QOL(quality of life).Interleukine 18(IL-18)and tumor necrosis factorα(TNF-α) play important roles of the mechanism of endometriosis-associated pain,and have vital effects on the other parts of EMS as well.Gonatrophin releasing hormone analogue(GnRH-a) has been used serepately or with surgery to relieve symptoms like pain and provide prevention from relapse.Add-back therapy use additional sexual hormones based on GnRH-a in order to minimize the influence of artificial menopause.Up to now few studies has been made on the change of the levels of IL-18,TNF-αin those patients who accepts these two therapies,as well as the relationship between these two cytokines and pain and levels of hormones.【Objective】We intend to evaluate the influence of GnRH-a and Add-back therapy on IL-18,TNF-αas well as the relationship between these two cytokines and endometriosis-associated pain.【Method】1.We collected 28 patients with endometriosis who aged at the range of 24-45 years old and had been diagnosed by surgery(laparoscopically or traditionally, limited in two months,rASⅢ-Ⅳ) and 10 normal women as control.They all completed VAS(visual analogue scale) to measure their pain level.We also collected their peripheral venial blood ant-therapy and post-therapy and their peritoneal fluid during operations to measure their levels of IL-18 and TNF-α.2.28 patients with endometriosis were divided into two groups(14 patients each) as GnRH-a group(group-G) and Add-back group(group-A).Group-G accept injections of Zoladex(3.6mg,i.h.) once 28 days post-therapy for three times, group-A had a half estriol patch(1.5mg/patch,containing 50μg estriol per 24hrs) before the first zoladex,and orally took 6mg Medroxyprogesterone Acetate at night till over.Then they completed VAS and had vaginal cytological examination, Follicle stimulating hormone(FSH),estradiol(E₂),IL-18 and TNF-αas well.【Result】1.All the patients with endometiosis had symptoms of pain;the level of IL-18 in blood and peritoneal fluid of patients with endometriosis was significantly higher than the level of controls(P＜0.01);the level of TNF-αin blood and peritoneal fluid of patients with endometriosis was significantly higher than the level of controls(P＜0.01).2.The ant-therapy levels of IL-18 in blood of group-G and group-A were higher than the post-therapy levels(P＜0.01);the ant-therapy levels of TNF-αin blood of group-G and group-A were significantly higher than the post-therapy levels(P＜0.01);the results of VAS in both groups were decreased significantly after therapy,and held to the recovery of menstruation,and their effects of pain-relief were equal;the ant-therapy and post-therapy levels of IL-18 in blood of patients with endometriosis were correlated with the score of Pain assessment (P＜0.01),while the correlation between the ant-therapy level of TNF-αin blood of patients was doubtfully and the scores of pain assessment was doubtful.【Conclusion】The levels of IL-18 and TNF-αsignificantly increase,and the level of IL-18 are likely to be correlated with level of endometriosis-associated pain; GnRH-a therapy and add-back therapy may relieve pain symptom by decreasing the levels of these two cytokines,and add-back therapy wouldn't reduce the relief of pain symptom.