左炔诺孕酮宫内缓释系统治疗功能失调性子宫出血的临床观察

The role of levonorgestrol-releasing intrauterine system in the treatment of dyfunctional uterine bleeding.

目的:观察左炔诺孕酮宫内缓释系统(LNG-IUS)治疗功能失调性子宫出血的临床效果。方法:48例确诊为功能失调性子宫出血的患者,放置LNG-IUS。置宫内节育器前后均行宫腔镜检查、月经量评分、测量子宫内膜厚度;检测卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)和孕酮(P)浓度及子宫内膜雌、孕激素受体(ER/PR)。结果:置宫内节育器3个月后,月经量明显减少,PBAC法月经量评分由置宫内节育器前(128.9±41.5)降至(52.2±13.8),具有统计学意义(P<0.01);子宫内膜由(12.9±4.2)mm降至(8.4±2.0)mm,差异具有统计学意义(P<0.05)。置宫内节育器6个月后,宫腔镜下观察,子宫内膜菲薄,病理显示内膜呈轻度分泌现象及间质蜕膜样变;ER、PR的表达均显著下调(P<0.01)。结论:LNG-IUS能有效地减少月经量,对增生的子宫内膜具有逆转作用,治疗功能失调性子宫出血效果好。

Objective：To evaluate the effect of levonorgestrol-releasing intrauterine system （ LNG-IUS ） on the endometrium. Methods ：48 patients with dysfunctional uterine bleeding were treated with LNG-IUS. The menstrual blood loss and the thickness of endometrium by color ultrasonography were observed and hysteroscopic examination was undertaken in pre- and post-insertion of LNG-IUS respectively. ER and PR expression in the endometrium with immunohistochemical method, serum-levels of FSH, LH, E2 and P were tested at 6 months after insertion. Results：Menstrual blood loss in the third month after insertion was decreased significantly and PBAC-score was changed from 128.9 ± 41.5 to 52.2 ± 13.8 （P 〈 0.01 ）. At 6 months after application of LNG-IUS, hysteroscopic observation showed that the endometrium became thinner,and the thickness of endometrium by ultrasonographic examination was reduced from 12.9 ± 4.2mm to 8.4 ± 2.0mm （ P 〈 0.01 ）. Pathological examination demonstrated that endometrial hyperplasia regressed and exhibited visible secretion and pseudeciducal reaction in all cases Expressions of ER fective therapy in and PR were down-regulated after treatment. Condusion：LNG-IUS is an ef- the treatment of endometfium hyperplasia. It strum blood loss and reverse the endometrium hyperplasia with can effectively reduce the menlittle effect on ovarian function.