| Objective:Endometriosis is a one of the common gynecologic condition among fertile women. In recent years,the incidence of endometriosis has been increasing distinctly.These patients application of Gn RHa after surgery show menopausal syndrome obviously and cause a range of changes, which seriously affected women’s quality of life.Add-back therapy is a treatment,that is add appropriate quantity of hormones to relieve patients’ menopausal symptoms,and to improve the level of hormone to reduce problems mentioned above.This present study to investigste serum TNF-α,bone mineral density, pregnancy rate and recurrence rate after operation in endometriosis,which aims to investigate the clinical results about the Gn RHa in combination with add-back therapy(add progynova and dydrogesterone).Then study the necessity and safety of the endometriosis postoperative patients received Gn RHa combined with add-back therapy.Method: Sixty-four women with endometriosis after surgery were selected from our hospital during October 2011 to October 2013.There were thirty cases with fertility requirements remaining the uterus and bilateral ovaries,and among them twenty women not pregnant after one year of marriage.The others who have no fertility requirements decided whether to remove the uterus by themselves,but all the cases were all remaining bilateral ovaries(r AFS III-IV with pathological diagnosis).They were consented to participate in the present study. The age of the patients ranged from 19 to 42.They were randomly divided into two groups as Gn RHa group(Group A) and Add-back group(Group B). All the patients selected received the injection of the zoladex(3.6 mg i.h.) in every 28 days and a total of six times from 1th-2th day after operation. Group A(n=31) were treated with single Gn RHa and when the menopausal symptoms appear and the low level of E2,the women in Group B were given the progynova(1mg/d) and the dydrogesterone(5mg /d) to the end of the treatment, and adjust the dose of progynov timely on the basis of the estrogen level detection each month. Since the second injection of zoladex, all the patients received caltrate D3(600 mg/d) orally to the end of the treatment. The menopausal symptoms were observed with the Kupperman Menopausal Index, after the treatment between two groups. Both before and after the treatment, the degree of pain was graded according to the visual analog scale(VAS) to appraisal the concrete degree of pelvic pain, dysmenorrhea,and sexual pain. With ELISA method,detecting the content of serum TNF-α,within the same time.The bone mineral density of the patients’ L1-4 lumbar spine was measured with dual energy X-ray absorption metry before the treatment,three months and six months after the treatmen;and the bone metabolic biochemical markers(serum calcium and phosphours)were detected at the same time.One year after withdrawal of the drug,following the pregnancy and recurrence rate in two groups.Results:1 The difference of Kupperman score between two groups.Six months later, the Kupperman Score were 14.87±3.63 and 6.77±1.77 in the Group A and Group B. The difference has statistical significance(P<0.05).As to the incidence rate of specific menopausal symptoms in two groups,the incidence rate of the hot flush were 86.7% and 40.0%,mood swings were 56.7% and 20%,bone pain were 43.3%and 13.3%.The symptoms mentioned above in Group A were significantly common than those in Group B(P<0.05),and there were not significant relief on the others(P>0.05).2 The change of VAS score between two groups.The VAS score was decreased from the 7.81±1.46 to 0.99±0.52 in Group A,and from7.77±1.68 to 1.10±0.46 in Group B.There was statistical difference in individual groups before and after the treatment(P<0.05), but no statistical difference was between two groups before and after the treatment(P>0.05).3 The serum level of TNF-α between two groups.In the progress of the treatment,both level of TNF-α dropped obviously. The serum level of TNF-α from 40.01±10.57 pg/ml to 11.55±3.72 pg/ml in Group A,and from 39.87±12.15 pg/ml to 12.15±3.51 pg/ml in Group B.There were significant difference before and after the treatment in both groups(P<0.05),but no difference was found between two groups in the course of treatment(P>0.05).4 Detection the content of bone mineral density and the bone metabolic biochemical markers(serum calcium and phosphours) in two groups before and after treatment.After three months later,the content of bone mineral density T score is 0.04±0.53 and 0.05±0.64 in Group A and Group B,Comparing with the preoperative, the difference was not obvious(P>0.05).Six months later,the bone mineral density T score were-1.03±0.94 and-0.53±0.72 in the Group A and Group B.The T score was significantly decreased in both groups between the six months and the start of treatment(P<0.05),and there was obviously difference between two groups after six months treatment(P<0.05).Three months later,the level of serum calcium were2.24±0.08mmol/L and 2.22±0.07mmol/L in Group A and Group B respectively,and no obvious increase compared with preoperative in both groups(P>0.05). Six months later, the content of serum calcium were 2.34±0.09mmol/L and 2.31±0.06 mmol/L in the Group A and Group B respectively.The difference between serum calcium six months after treatment in both groups and that of before treatment was statisticaly significant(P<0.05).In the progress of treatment,the level of serum calcium the difference between two groups was not obvious(P>0.05).The content of serum phosphours were 1.24±0.07mmol/L and 1.23±0.06 mmol/L in Group A and Group B after three months treatment, and no significant decrease compared with preoperative in both groups(P>0.05).Six months later,the level of serum phosphours were 1.18±0.08mmol/L and 1.18±0.05 mmol/ L in the Group A and Group B. The groups before the treatment had higher level of serum phosphours than that who received six months treatment(P<0.05),and in the course of the treatment no difference was found between two groups(P>0.05).5 Comparing the difference of the pregnancy and recurrance rate in two groups after 1year.The following year after withdrawal of the drug,there are 11 patients with infertility after one year of marriage in Group A before the treatment, after the treatment,4 female in gestation,the pregnancy rate is 36.4%,and in Group B there are 9 patients with infertility before the treatment, after the treatment,3 women in gestation, and the pregnancy rate is 33.3%,there was no significant statistical difference between two groups(P>0.05).Over the same period of follow-up no recurrence in two groups.Conclusions:1 Gn RHa combined with add-back therapy is an effective therapy after surgery, it can relieve the side effects on menopausal syndrome, such as hot flush, mood swings and bone pain caused by low estrogen level. It is a good way to improve the patients’ quality of life.2 Application of Gn RHa for a long time would cause osteoporosis risk factors, add-back therapy can relieve bone losses, increase the content of bone mineral density.3 Endometriosis patients undergoing drug therapy of Gn RHa can elevate the pregnancy rate in infertility female.4 The level of serum TNF-α was closely related to the occurrence of endometriosis, thus it can be as a good clinical detection for the endometriosis early diagnosis and therapy. Application of Gn RHa in combination with add-back therapy is safe and effective to endometriosis, and in short term has not elevated the serum TNF-α content, indicating that it may not have played a significant role in the promoting post- operative recurrence and development of endometriosis. |
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