左炔诺孕酮宫内节育系统对子宫内膜息肉宫腔镜术后患者性激素水平及子宫内膜厚度的影响

The effect of levonorgestrel intrauterine contraceptive system on sex hormone and endometrial thickness in patients with endometrial polyps after hysteroscopic operation

目的探讨左炔诺孕酮宫内节育系统(LNG-IUS)在子宫内膜息肉(EP)患者宫腔镜术后治疗中的效果。方法采用随机数字表法将2020年1月至2021年11月浙江省荣军医院和嘉兴市第一医院治疗的68例EP患者分为A组和B组,各34例。两组均给予宫腔镜手术,术后A组给予地屈孕酮片治疗,B组放置LNG-IUS。比较两组术前及术后6、12个月的子宫内膜厚度,术前、术后12个月的血管内皮生长因子(VEGF)、γ干扰素(IFN-γ)、总胆固醇(CHO)、载脂蛋白A1(LAA1)、性激素水平,治疗期间的不良反应。结果两组术后12个月的子宫内膜厚度均低于术前、术后6个月,术后6个月低于术前;且术后6、12个月,与A组比较,B组子宫内膜厚度更低(P<0.05)。两组治疗前后及两组间血清性激素水平比较,差异无统计学意义(P>0.05)。与治疗前比较,术后12个月两组血清IFN-γ、VEGF、CHO、LAA1水平均降低,且与A组比较,B组更低(P<0.05)。治疗期间,B组不良反应发生率低于A组(P<0.05)。结论将LNG-IUS应用于EP患者宫腔镜术后的治疗中可有效改善患者子宫内膜厚度,调整患者血清IFN-γ、VEGF及血脂指标水平,其对患者性激素的影响较小,且具有较高的安全性。

Objective To investigate the effect of levonorgestrel intrauterine contraceptive system(LNG-IUS)on postoperative treatment of endometrial polyps(EP)patients undergoing hysteroscopy.Methods A total of 68 patients with EP treated in Rongjun Hospital of Zhejiang Province and First Hospital of Jiaxing City from January 2020 to November 2021 were divided into the group A and the group B by random number table method,with 34 cases each group.Both groups underwent hysteroscopic surgery,with group A receiving treatment with dydrogesteronetablets and group B receiving LNG-IUS.The endometrial thickness before and 6,12 months after operation,vasclar endothelial growth factor(VEGF),interferon-γ(IFN-γ),total cholesterol(CHO),apolipoprotein A1(LAA1)and sex hormone levels before and 6 months after operation,adverse reactions during treatment between the two groups were compared.Results The thickness of endometrium in the two groups 12 months after operation was lower than that before operation and 6 months after operation,and that at 6 months after operation was lower than before operation.In addition,the endometrial thickness in group B was lower than that in group A at 6,12 months after operation(P<0.05).There was no significant difference in the levels of serum sex hormones between the two groups before and after treatment and between the two groups(P>0.05).Compared with that before treatment,the levels of serum IFN-γ,VEGF,CHO and LAA1 of the two groups decreased at 12 months after operation and compared with that in the group A,the group B were lower(P<0.05).During the treatment,the incidence of adverse reactions in the group B was lower than the group A(P<0.05).Conclusions The application of LNG-IUS in the treatment of EP patients after hysteroscopy can effectively improve the endometrial thickness of patients,and adjust their levels of serum IFN-γ,VEGF and lipid indexes,and which had little effect on sex hormones,and had a high safety.