目的 探討曲普瑞林聯(lián)合他莫昔芬治療子宮肌瘤的臨床療效及對血清轉(zhuǎn)化生長因子-β1（TGF-β1）、血管內(nèi)皮生長因子（VEGF）、缺氧誘導(dǎo)因子-1α（HIF-1α）水平的影響。方法 選取2018年5月—2020年5月聊城市第二人民醫(yī)院收治的140例子宮肌瘤患者作為研究對象，根據(jù)治療方法分為對照組（70例）和觀察組（70例）。對照組患者口服枸櫞酸他莫昔芬片，1片/次，1次/d。觀察組患者在對照組基礎(chǔ)上肌內(nèi)注射注射用醋酸曲普瑞林，月經(jīng)周期開始的第3～5天肌內(nèi)注射1次，之后每隔28 d注射1次，3.75 mg/次。兩組均治療3個月。觀察兩組臨床療效、不良反應(yīng)，并比較治療前后子宮體積、肌瘤體積及血清促卵泡激素（FSH）、雌二醇（E₂）、孕酮（P）、TGF-β1、VEGF、HIF-1α水平。結(jié)果 治療后，觀察組總有效率為91.43%，明顯高于對照組的75.71%（P<0.05）。治療后，兩組患者子宮體積、肌瘤體積均明顯小于治療前（P<0.05），且觀察組患者子宮體積、肌瘤體積均明顯小于對照組（P<0.05）。治療后，兩組患者血清FSH、E₂、P水平均明顯低于治療前（P<0.05），且觀察組患者血清FSH、E₂、P水平均明顯低于對照組（P<0.05）。治療后，兩組患者血清TGF-β1、VEGF、HIF-1α水平均明顯低于治療前（P<0.05），且觀察組患者血清TGF-β1、VEGF和HIF-1α水平均明顯低于對照組（P<0.05）。治療期間，兩組不良反應(yīng)發(fā)生率相比差異無統(tǒng)計(jì)學(xué)意義。結(jié)論 在他莫昔芬基礎(chǔ)上聯(lián)用曲普瑞林治療子宮肌瘤，可提高療效，縮小子宮、肌瘤體積，明顯降低血清雌激素、TGF-β1、VEGF、HIF-1α水平，且具有一定安全性。

Objective To investigate the clinical efficacy of triptorelin combined with tamoxifen in treatment of uterine fibroids and its influences on serum TGF-β1, VEGF, HIF-1α levels. Methods A total of 140 patients with uterine fibroids treated in The Second People's Hospital of Liaocheng from May 2018 to May 2020 were selected as the research subjects, and were divided into control group (70 cases) and observation group (70 cases) according to the treatment methods. Patients in the control group were po administered with Tamoxifen Citrate Tablets, 1 tablet/time, once daily. Patients in the observation group were given intramuscular injection of Triptorelin Acetate for Injection on the basis of control group, one intramuscular injection was given on the 3rd to 5th day of the menstrual cycle, and once every 28 days thereafter, 3.75 mg/time. Both groups were treated for 3 months. Clinical efficacy and adverse reactions of two groups were observed. Uterine volume, fibroid volume, and serum levels of FSH, E₂, P, TGF-β 1, VEGF, and HIF-1α were compared before and after treatment. Results After treatment, the total effective rate of observation group was 91.43%, which was significantly higher than 75.71% of control group (P < 0.05). After treatment, the uterine volume, and fibroid volume in two groups were significantly lower than before treatment (P < 0.05), and the uterine volume and fibroid volume in observation group were significantly lower than control group (P < 0.05). After treatment, the serum levels of FSH, E₂ and P in two groups were significantly lower than before treatment (P < 0.05), and the serum levels of FSH, E₂ and P in observation group were significantly lower than those in control group (P < 0.05). After treatment, the serum TGF-β1, VEGF, and HIF-1α levels in two groups were significantly lower than before treatment (P < 0.05), and the serum TGF-β1, VEGF, and HIF-1α levels in observation group were significantly lower than control group (P < 0.05). During treatment, there was no significant difference in the incidence of adverse reactions between the two groups. Conclusion Triprerelin combined with triprerelin in treatment of uterine fibroids can improve the efficacy, reduce the volume of uterine and fibroids, and significantly reduce the levels of serum estrogen, TGF-β1, VEGF and HIF-1α, with certain safety.

山東省重點(diǎn)研發(fā)計(jì)劃項(xiàng)目（2018GSF118126）