目的 探讨曲普瑞林联合他莫昔芬治疗子宫肌瘤的临床疗效及对血清转化生长因子-β1（TGF-β1）、血管内皮生长因子（VEGF）、缺氧诱导因子-1α（HIF-1α）水平的影响。方法 选取2018年5月—2020年5月聊城市第二人民医院收治的140例子宫肌瘤患者作为研究对象，根据治疗方法分为对照组（70例）和观察组（70例）。对照组患者口服枸橼酸他莫昔芬片，1片/次，1次/d。观察组患者在对照组基础上肌内注射注射用醋酸曲普瑞林，月经周期开始的第3～5天肌内注射1次，之后每隔28 d注射1次，3.75 mg/次。两组均治疗3个月。观察两组临床疗效、不良反应，并比较治疗前后子宫体积、肌瘤体积及血清促卵泡激素（FSH）、雌二醇（E₂）、孕酮（P）、TGF-β1、VEGF、HIF-1α水平。结果 治疗后，观察组总有效率为91.43%，明显高于对照组的75.71%（P<0.05）。治疗后，两组患者子宫体积、肌瘤体积均明显小于治疗前（P<0.05），且观察组患者子宫体积、肌瘤体积均明显小于对照组（P<0.05）。治疗后，两组患者血清FSH、E₂、P水平均明显低于治疗前（P<0.05），且观察组患者血清FSH、E₂、P水平均明显低于对照组（P<0.05）。治疗后，两组患者血清TGF-β1、VEGF、HIF-1α水平均明显低于治疗前（P<0.05），且观察组患者血清TGF-β1、VEGF和HIF-1α水平均明显低于对照组（P<0.05）。治疗期间，两组不良反应发生率相比差异无统计学意义。结论 在他莫昔芬基础上联用曲普瑞林治疗子宫肌瘤，可提高疗效，缩小子宫、肌瘤体积，明显降低血清雌激素、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.

山东省重点研发计划项目（2018GSF118126）