LNG-IUS与GnRHa方案治疗子宫腺肌病效果比较

Comparison of the efficacy of LNG-IUS and GnRHa in the treatment with adenomyosis

目的观察并比较左炔诺孕酮宫内释放系统(LNG-IUS,商品名曼月乐)和促性腺激素释放激素激动剂(GnRHa,商品名达菲林)方案治疗子宫腺肌病的效果。方法将40例子宫腺肌病患者随机分为曼月乐组与达菲林组,各20例。曼月乐组于月经周期第3～7天由专人宫内放置曼月乐,达菲林组在月经第1天注射达菲林,此后每隔28 d注射1次。观察两组治疗后痛经情况、月经量、子宫体积、子宫内膜厚度的变化,检测血清CA125水平。以后3个指标评价疗效。结果与治疗前相比,两组治疗后VAS改善、月经量明显减少(P均<0.05),血清CA125水平无明显变化(P均>0.05)。与治疗前比较,治疗后6个月曼月乐组子宫体积变化不明显(P>0.05),子宫内膜厚度明显变薄(P<0.05);达菲林组子宫体积变小(P<0.05),子宫内膜厚度改变不明显(P>0.05)。两组治疗后6个月子宫体积及血清CA125相比,P均<0.05。曼月乐组有效17例,无效3例,有效率为85%;达菲林组分别为18、2例和90%,两组有效率相比,P>0.05。两组同期(治疗6个月)治疗费用分别为1 330、11 184元,两组相比,P<0.01。结论 LNG-IUS方案与GnRHa方案治疗子宫腺肌病疗效相近,但曼月乐较达菲林更为经济。

Objective To compare efficacy of the levonorgestrel- releasing intrauterine system （ LNG-IUS, Mirena） with GnRH analogue （GnRHa, Triptorelin Acetate） on adenomyosis. Methods Forty women with adenomyosis were trea- ted with either LNG-IUS （n = 20, LNG-IUS group） or GnRHa （n = 20, GnRHa group）. These patients with adenomyosis were followed up in 1,3,6 months after placing LNG-IUS. Score of dysmenorrhea, menstrual flow and uterine volume, endo- metrium thicknes, CA125 were compared. Results After treatment of LNG-IUS or GnRHa, dysmenorrhea were complete- ly catabatic, themenstrual blood volume significantly reduced（ all P 〈 0.05 ）, but CA125 didnl change significantly（ all P 〉 0.05）. And the size of uteri didnt change significantly after LNG-IUS （all P 〉 0.05 ）. Patients with adenomyosis were followed up in 6 months after GnRHa, endometrium thicknes had no statistical significance. The size of uteri after GnRHa and endometrium thicknes after LNG-IUS were changed significantly（ all P 〈 0.05 ）. The response rate was 85% in LNG- IUS group and 90% in GnRHa group（P 〉0.05）. Six months of reatment costs in LNG-IUS group was less than GnRHa group（P 〈 0.01 ）. Conclusion The efficacy of LNG-IUS and GnRHa program in treatment of adenomyosis is similar, but the Mirena compared with Triptorelin Acetate is more economical.