血清前列腺素E_2预测左炔诺孕酮缓释系统治疗子宫腺肌病痛经效果的价值探讨

Predicted Value of Serum Prostaglandin E2on the Dysmenorrheal Treatment Effect in Adenomyosis Patients with Levonorgestrel-releasing Intrauterine System

目的:探讨子宫腺肌病(adenomyosis,ADS)患者血清前列腺素E2(prostaglandin E2,PGE2)水平预测左炔诺孕酮缓释系统(levonorgestrel-releasing intrauterine system,LNG-IUS)治疗ADS痛经效果的可能性。方法:因ADS痛经放置LNG-IUS的患者41例,根据痛经缓解情况分为治疗有效组(n=32)和治疗无效组(n=9)。ELISA法测定放置LNG-IUS前及放置后6个月血清PGE2水平并进行组内、组间比较,分析LNG-IUS对ADS痛经患者血清PGE2水平的影响以及血清PGE2水平与LNG-IUS治疗痛经效果的相关性。结果:有效组血清PGE2水平治疗前为20.95±3.07 pg/ml,治疗6个月后为5.56±1.72 pg/ml,差异有统计学意义(P<0.05)。无效组血清PGE2水平治疗前为5.74±1.12 pg/ml,治疗6个月后为4.95±1.39 pg/ml,两者无统计学差异(P>0.05)。治疗前有效组血清PGE2浓度显著高于无效组(P<0.05)。患者放置LNG-IUS 6个月后视觉模拟评分(visual ana-logue scale,VAS)变化与放置前血清PGE2水平呈正相关,血清PGE2浓度越高,VAS下降越明显(P<0.05)。结论:PGE2可能与部分ADS患者痛经的发生有关,LNG-IUS通过降低PGE2浓度而缓解痛经,因此高水平PGE2患者可选择LNG-IUS治疗痛经,低水平PGE2患者则建议选择其他方式治疗痛经。

Objective： To explore the possibility of the serum prostaglandin E2 （PGE2） levgl predictive value on the dysmenorrheal treatment effect in the adenomyosis （ADS） patients with levonorgestrel-releasing intrauterine system （LNG-IUS）. Methods： Forty-one ADS patients treated with LNG-IUS because of dysmenorrhea were collected. These patients were divided into effective group （n=32） and noneffective group （n=9） according to the effect of relieving dysmenorrhea. The serum PGE2 level before and after 6 months of the LNG-IUS treatment were compared by ELISA, and the influence of serum PGE2 level caused by LNG- IUS and the correlation between the serum PGE2 level and the dysmenorrheal treatment effect with LNG-IUS were analyzed. Results： The serum PGE2 concentrations were 20.95±3.07 pg/ml and 5.56 ± 1.72 pg/ml in the effective group before and after 6 months with LNG-IUS treatment, there was a significant difference between them （P〈0.05）. The serum PGE2 concentrations were 5.74 ±1.12 pg/ml and 4.95± 1.39 pg/ml in the noneffective group before and after 6 months with LNG-IUS treatment, there was no significant difference between them. The serum PGE2 concentration in the effective group was significantly higher than that in the noneffective group （P〈0.05）. The change of visual analogue scale （VAS） score after 6 months of LNG-IUS treatment had a positive correlation with the serum PGE2 level before LNG-IUS treatment, the higher serum PGE2 concentration was, the more obviously the VAS score decreased （r=0.845, P〈0.05）. Conclusion： PGE2 might be involved in the occurrence of ADS dysmenorrhea and LNG-IUS relieved dysmenorrhea through decreasing the PGE2 level. It is suggested that the patients with high PGE2 level choose LNG-IUS to treat their dysmenorrhea and the patients with low PGE2 level use other ways to treat dysmenorrhea.