Advances in evidence-based medical research of GnRHa for fertility protection after chemotherapy / 中国临床药理学与治疗学

With an improvement in the long-term survival rates of cancer patients, the requirements for fertility protection of young cancer patients after chemotherapy are increasingly prominent. Early studies have shown that gonadotropin-releasing hormone agonist (GnRHa) has a protective effect on fertility. But in recenct year, relevant studies have shown that its protective effect is controversial. This article reviews the clinical researches of GnRHa for fertility protection in patients with common tumors, and explores its evidence-based medicine, in the hope of providing references for reasonable clinical application.

Non-surgical management of uterine myoma / 中国实用妇科与产科杂志

Uterine fibroids are benign diseases with high incidence and unknown pathogenesis.Currently,fibroid excavation or hysterectomy is the most commonly used treatment,but for women who require conservative treatment or with fertility requirements,there is still no optimal treatment option.At present,GnRH agonists/antagonists,selective progesterone receptor antagonists,levonorgestrel sustained release,uterine artery embolization,high-intensity focused ultrasound and other non-traditional surgical treatments provide new treatment options for conservative treatment of uterine fibroids from different angles.

Etiology and treatment of central precocious puberty

The timing of pubertal onset is occurring at younger ages. This phenomenon is associated with many environmental factors such as sufficient nutrition, stress, many kinds of endocrine-disrupting chemicals, and genetic background. The loss of transcriptional repression induces kisspeptin release, resulting in pulsatile gonadotropin-releasing hormone secretion, which trigger pubertal onset. According to many reports, gonadotropin-releasing hormone agonists therapy for patients with rapidly progressive central precocious puberty is effective for improving final adult height. However, those results were obtained from the treatment of relatively young patients at earlier stages of puberty. A large cohort study investigating the environmental causes of precocious puberty as well as genetic factors is needed.

Clinical effect of laparoscopic surgery combined with gonadotropin-releasing hormone agonist in the treatment of endometriosis / 中国基层医药

Objective To investigate the clinical efficacy of laparoscopic surgery combined with gonadotropin-releasing hormone agonist (GnRH-a) in the treatment of endometriosis (EMs).Methods 86 patients with EMs were selected as study subjects.The patients were divided into two groups by random number table.43 patients in the control group underwent laparoscopic surgery,while 43 patients in the observation grouop received GnRH-a treatment based on laparoscopic surgery,and the clinical effect was analyzed.Results The total effective rate was 93.02％ in the observation group,which was significantly higher than 72.09％ in the control group.The recurrence rate in the observation group was 11.63％,which was significantly lower than 32.56％ in the control group,the difference was statistically significant (x2 =7.55,8.41,all P ＜ 0.05).After treatment,the levels of FSH,LH,and E2 of the observation group were (1.71 ± 0.64) U/L,(2.66 ± 0.75) U/L,(96.72 ± 14.51) pmol/L,respectively,which were significantly lower than before treatment (t =8.80,7.80,7.55,all P ＜ 0.05),and the differences were statistically significant compared with the control group (t =8.55,7.48,7.19,all P ＜ 0.05).The total pregnancy rate of the observation group was 70.59％,which was significantly higher than 38.71％ of the control group,the difference was statistically significant (x2 =7.77,P ＜ 0.05).The pain relief rate,dysmenorrhea rate,remission rate of chronic pelvic pain in the observation group were 90.70％,86.05％,93.02％,which were significantly higher than those in the control group (x2 =6.55,7.01,7.88,all P ＜ 0.05).The incidence rate of adverse reactions in the observation group was 11.63％,which was significantly lower than 27.91％ in the control group,the difference was statistically significant (x2 =7.06,P ＜ 0.05).The main adverse reactions were hot flashes sweating,vaginal dryness,insomnia,fatigue and other low estrogen symptoms,which could tolerate,after treatment to relieve or disappear,liver and kidney function tests had no abnormalities.Conclusion Laparoscopic surgery combined with GnRH-a in the treatment of endometriosis can improve the treatment effect,improve the symptoms and reproductive hormone levels,improve the postoperative pregnancy rate,reduce the recurrence rate,and with high safety,it is worthy of clinical promotion and application.

Gonadotropin-releasing hormone antagonists in prostate cancer hormone therapy: Clinical application and prospective / 第二军医大学学报

Hormone therapy (androgen deprivation therapy, ADT) is the first line treatment for advanced prostate cancer. Gonadotropin-releasing hormone (GnRH) agonist is commonly used for ADT, with the risk of flare-up effect at the first dose and testosterone fluctuation, which needs combination of anti-androgen drugs to alleviate the deterioration of the clinical condition. GnRH antagonists directly bind to GnRH receptor, blocking its activity, and they can be used in prostate cancer treatment, without testosterone flare-up effect. This review focused on functional mechanisms of GnRH agonists and antagonists, and history and clinical application of GnRH antagonists, so as to evaluate the clinical safety and effectiveness of GnRH antagonists and to discuss their clinical value and future prospects.