补肾调肝汤联合GnRH-a治疗子宫内膜异位症的安全性及对围绝经期症状的影响

王俊

【摘要】 目的：评价补肾调肝汤联合促性腺激素释放激素激动剂（gonado-tropin-releasing hormone agonist，GnRH-a）治疗子宫内膜异位症（endometriosis，EMT）的安全性及对围绝经期症状的影响。方法：回顾性分析包头市蒙医中医医院妇产科于2019年1月—2022年1月收治的306例EMT患者的临床资料，根据治疗方法不同分为对照组（采用醋酸曲普瑞林治疗）和联合组（补肾调肝汤+醋酸曲普瑞林治疗），各153例。统计比较两组治疗效果、疼痛程度、安全性及复发率。结果：联合组治疗总有效率为91.50%，显著高于对照组的81.70%（P<0.05）。两组治疗后慢性盆腔疼痛、痛经和性交痛的视觉模拟评分法（VAS）评分均较治疗前明显降低，联合组治疗后慢性盆腔疼痛、痛经和性交痛VAS评分均显著低于对照组（P<0.05）。联合组各项围绝经期症状发生率均显著低于对照组（P<0.05）；两组其他不良反应发生率比较，差异均无统计学意义（P>0.05）。联合组复发率显著低于对照组（P<0.05）。结论：补肾调肝汤联合GnRH-a治疗EMT的效果肯定，可缓解患者的疼痛，以及减少围绝经期症状、不良反应发生率及复发率。

【关键词】 子宫内膜异位症 补肾调肝汤 促性腺激素释放激素激动剂 安全性 围绝经期症状

Safety of Bushen Tiaogan Decoction Combined with GnRH-a in the Treatment of Endometriosis and Its Influence on Perimenopausal Syndromes/WANG Jun. //Medical Innovation of China， 2024， 21（15）： 067-071

[Abstract] Objective： To evaluate the safety of Bushen Tiaogan Decoction combined with gonado-tropin-releasing hormone agonist （GnRH-a） in the treatment of endometriosis （EMT） and its influence on perimenopausal syndromes. Method： Clinical data of 306 patients with EMT admitted to Department of Obstetrics and Gynecology， Baotou Mongolian Medicine Hospital of Traditional Chinese Medicine from January 2019 to January 2022 were retrospectively analyzed. They were divided into control group （treated with Triptorelin Acetate） and combination group （Bushen Tiaogan Decoction + Triptorelin Acetate） according to different treatment methods， with 153 cases in each group. The therapeutic effect， pain degree， safety and recurrence rate of the two groups were statistically compared. Result： The total effective rate of combination group was 91.50%， which was significantly higher than that of control group （81.70%） （P<0.05）. The visual analogue scale （VAS） scores of chronic pelvic pain， dysmenorrhea and dyspareunia in the two groups after treatment were significantly lower than those before treatment， and the VAS scores of chronic pelvic pain， dysmenorrhea and dyspareunia in the combination group were significantly lower than those in the control group （P<0.05）. The incidences of perimenopausal syndromes in the combination group were significantly lower than those in the control group （P<0.05）. There were no significant differences in the incidences of other adverse reactions between the two groups （P>0.05）. The recurrence rate in combination group was significantly lower than that in control group （P<0.05）. Conclusion： Bushen Tiaogan Decoction combined with GnRH-a is effective in the treatment of EMT， which can relieve the pain of patients， reduce the perimenopausal syndromes， the incidence of adverse reactions and the recurrence rate.

[Key words] Endometriosis Bushen Tiaogan Decoction GnRH-a Safety Perimenopausal syndromes

First-author's address： Department of Obstetrics and Gynecology， Baotou Mongolian Medicine Hospital of Traditional Chinese Medicine， Baotou 014040， China

doi：10.3969/j.issn.1674-4985.2024.15.016

子宫内膜异位症（endometriosis，EMT）系具有生长功能的子宫内膜组织（腺体和间质）出现在子宫腔被覆内膜及子宫肌层以外的部位，是一种雌激素依赖性、慢性炎症性妇科常见疾病，其病发率、复发率均较高，多数患者伴有痛经、盆腔痛、性交痛等盆腹腔疼痛症状及月经改变，并可能导致不孕[1-2]，严重影响患者生理和心理健康。近年来，EMT的发病率呈逐年攀升趋势，但迄今尚未完全清楚该病发生机制，临床诊断和治疗都较为困难，是妇科疾病当中的“难治之症”。促性腺激素释放激素激动剂（gonado-tropin-releasing hormone agonist，GnRH-a）是目前EMT的基础治疗药物，能够抑制卵巢功能，降低雌激素表达水平进而促进病灶萎缩，实现治疗和降低复发的作用[3-4]。但既往研究表明，单一GnRH-a类药物长期应用易引发潮热、失眠、盗汗等多种类似围绝经期症状，进一步降低患者生活质量[5]。……