Effect Of Chemotherapy On Ovarian Function And Its Protection In Young Patients With Gestational Trophoblastic Neoplasia

Objective To evaluate the effects of chemotherapy and different chemotherapy regimens on ovarian function in young patients with gestational trophoblastic neoplasia.To investigate the protective effect of gonadotropin releasing hormone agonist on ovarian function in young patients with gestational trophoblastic neoplasia.Methods From January 2017 to December 2018,to collect the patients with trophoblastic tumors in Obstetrics and Gynecology of Ning Xia University General Hospital,Cardiovascular and Cerebrovascular Hospital,Ning Xia University Cancer Hospital,Yin chuan Maternal and Child Health Hospital,and Autonomous Region Hospital,they were confirmed by histological diagnosis or clinical evaluation.A total of 38 patients.According to different clinical stages,14 cases were treated with 5-FU chemotherapy?group A,namely the single 5-FU group?,12 cases with 5-FU+Act-D chemotherapy?group B,namely the combined 5-FU group?,and 5 cases with EMA/CO chemotherapy?group C,namely the EMA/CO group?,7 patients received leuprolide acetate to protect ovarian function during the same period of chemotherapy?the GnRH-a protection group?.Observe A,B,C three groups before and after chemotherapy in patients with menstrual changes,according to clinical symptom Kupperman score,B ultrasonic examination before and after chemotherapy ovarian average diameter,and by ELLSA method to detect three groups of patients'serum AMH expression before chemotherapy,different time points in the process of chemotherapy and after chemotherapy one month and three month,to assess the effect of chemotherapy on ovarian function and how three different chemotherapy regimens influence on ovarian function.By comparing GnRH-a protection group and unprotected group,menstrual changes and low estrogen symptoms before and after chemotherapy?improved Kupperman score?8points?and ELISA were used to detect pre-chemotherapy,chemotherapy,and January and March after chemotherapy.Changes in serum AMH,etc.,to explore whether GnRH-a has protective effects on ovarian function damage caused by chemotherapy.Results 1.The amenorrhea rate?100%?in the EMO/CO group after chemotherapy was significantly higher than that in the single 5-FU group?21.43%?and 5-FU combined group?25%???²=9.901,P=0.006?;70.97%The patient's menstruation recovered within 3 months after stopping chemotherapy.The menstrual recovery time in the 5-FU group?4.75±2.67weeks?was significantly shorter than the 5-FU combination group?8.18±2.64?and the EMA/CO group?10.00±1.41??F=6.719,P=0.005?.2.Three groups of patients had clinically relevant symptoms such as insomnia,fatigue,irritability and irritability,and the difference was not statistically significant??²=1.650,P=0.530?.3.The serum AMH levels of the three groups gradually decreased with the prolongation of chemotherapy time(F _time=92.107,P=0.000).There was no significant difference in serum AMH levels between the three groups before chemotherapy and after the first chemotherapy(F _{before chemotherapy}=0.150,P=0.862;F _{after 1 chemotherapy}=1.161,P=0.328),after the third chemotherapy,the 5-FU combined group and the EMA/CO group decreased significantly compared with the single 5-FU group?F=7.620,P=0.002?;By the end of chemotherapy,the average serum AMH decreased by 56.32%,of which 5-FU combined group decreased by 58.41%,while the average decline rate of EMA/CO group was as high as 80.88%?F=11.543,P=0.000?.4.The serum AMH of the patients in the three groups increased with the prolongation of the time from the end of chemotherapy.The serum AMH level of patients in EMA/CO group at 1 month and 3 months after chemotherapy was significantly lower than that in the single 5-fu group and the combined 5-fu group(F_{1 month}=4.238,P=0.025;F_{3 month}=4.216,P=0.025);Three months after chemotherapy,the serum AMH level of patients in the 5-fu group was no different from that before chemotherapy?F=3.894,P=0.070?,but the serum AMH level in the 5-fu group?F=21.558,P=0.001?and EMA/CO group?F=20.537,P=0.020?was still lower than that before chemotherapy.5.The average diameter of the left/right ovary after chemotherapy in both groups was smaller than that before chemotherapy,and the difference was statistically significant(F _left=20.994/F _right=25.734,P=0.000).6.GnRH-a protection group compared with unprotected group:There was no significant difference in low estrogen symptoms between the two groups?t=0.131,P=1.000?;GnRH-a protection group had 100%amenorrhea,and unprotected The difference of amenorrhea rate between the 32.26%patients was statistically significant??²=13.272,P=0.002?.However,the serum AMH of the protection group was higher than that of the unprotected group during chemotherapy and after chemotherapy.The difference was statistically significant?P<0.05?.Conclusion 1.Chemotherapy drugs have transient damage to ovarian function in patients with pregnancy trophoblastic tumor,of which 5-fu has little effect on ovarian reserve function,while EMA/CO scheme has the greatest impact.2.For high-risk patients with GTN,fluorouracil based multi-drug combination scheme has the least impact on ovarian function.3.GnRH-a combined with chemotherapy has a good protective effect on ovarian function.