释放左炔诺孕酮宫内节育器对多囊卵巢综合征患者子宫内膜保护性研究

Protective Effect of Levonorgestrel-Releasing Intrauterine System on the Endometrium of Polycystic Ovary Syndrome Patients

目的:探讨释放左炔诺孕酮宫内节育器(IUD)对多囊卵巢综合征(PCOS)患者子宫内膜的保护作用。方法:采用前瞻性研究方法,141例PCOS患者分为两组,观察组74例放置左炔诺孕酮IUD,对照组67例口服复方醋酸环丙孕酮(CPA),观察干预前、干预6个月后患者子宫内膜各项指标变化,并对干预1年患者的依从性和不良反应进行随访。结果:放置左炔诺孕酮IUD后子宫内膜明显变薄,形态学观察处于明显的抑制状态,腺体数目(GN)、腺细胞核分裂数(GM)、间质细胞核分裂数(SM)、腺腔横切直径(GD)及腺上皮细胞高度(GH)均较干预前有显著下降,GN、GD及GH下降值与对照组比较,差异有统计学意义(P<0.05),随访发现两组不良反应发生率分别为32.4%和64.2%,差异有统计学意义。结论:释放左炔诺孕酮IUD用于PCOS患者,对子宫内膜有明确保护疗效,且副反应轻微,依从性好。

Objective： To investigate the protective effect of the levonorgestrel - releasing intrauterine system （ LNG - IUS） on the endometrium of polycystic ovary syndrome （PCOS） patients. Methods： A total of 141 women suffered with PCOS were enrolled and randomly allocated into two groups ： 74 in the LNG - IUS group and 67 in the cyprotemne acetate （CPA） group. The endometrial morphological and pathological features of the patients in the two groups were evaluated 6 months before and after treatment. The side effects and compliance of the patients in the two groups were followed up for 1 year. Results： The endometrial thickness of the patients in the LNG - IUS group reduced and the endometrial activities were inhibited significantly. The endometrial number of glands （ GN）, the number of glandular mitoses （ GM）, the number of stroma mitoses （ SM）, the diameter of the glandular lumen （GD） and the height of glandular cells （GH） were all decreased significantly after the insertion of LNG - IUS. Significant differences were also found in the decline of GN, GD and GH between the LNG - IUS group and the CPA group （ P 〈 0.05 ）. The incidence of the side effects in the patients of the LNG - IUS group and the CPA group were 32.4% and 64.2% respectively, showing the significant difference （ P 〈 0.05 ）. Conclusion ： LNG - IUS with less side effects and better compliance can effectively protect the endometrium of the PCOS patients.