促性腺激素释放激素激动剂治疗左炔诺孕酮缓释系统所致阴道不规则出血的效果

Efficacy of GnRH-a in reducing intermenstrual vaginal bleeding in users of the Levonorgestrel intrauterine system

目的对促性腺激素释放激素激动剂（GnRH-a）治疗左炔诺孕酮缓释系统（LNG-IUS）所引起的阴道不规则出血的效果进行评价。方法选择2012年1～7月于新疆医科大学第一附属医院妇科门诊就诊的40例子宫内膜异位症患者为研究对象,根据其经济情况及自愿原则分成两组,每组20例。实验组注射GnRH-a 3次后放置LNG-IUS,对照组直接放置LNG-IUS。观察两组治疗前,放环后6、12个月的痛经评分、月经前半周期静脉血的雌二醇（E2）水平、月经间期阴道淋漓出血时间、月经间期阴道淋漓出血量评分等指标。结果与治疗前比较,实验组和对照组在放环后各时间点痛经评分均明显下降,月经间期阴道淋漓出血时间及出血量均明显增加,差异均有统计学意义（P〈0.05）,月经前半周期静脉血的E2水平均无显著变化,差异无统计学意义（P〉0.05）。放环6、12个月后,实验组的月经间期阴道淋漓出血时间[1.00（0.00,1.00）、0.00（0.00,0.75）d]、月经间期阴道淋漓出血量评分[1.00（0.00,2.00）、0.00（0.00,0.75）分]均低于对照组[3.00（0.00,4.00）、1.00（0.00,2.00）d;8.50（0.00,14.75）、1.00（0.00,3.75）分],差异均有统计学意义（P〈0.05）;实验组痛经评分及静脉血E2水平与对照组比较,差异均无统计学意义（P〉0.05）。结论 GnRH-a可有效改善LNG-IUS所致的月经间期阴道淋漓出血。

Objective To explore the efficacy of GnRH-a in reducing intermenstrual vaginal bleeding in users of the Levonorgestrel intrauterine system（LNG-IUS）. Methods 40 cases of endometriosis from January to July 2012 in the First Affiliated Hospital of Xinjiang Medical University were selected as study objects, and they were divided into two groups according to patients＇ will, treatment group and control group, with 20 cases in each group. The treatment group were inserted LNG-IUS following 3 courses of treatment by GnRH-a and the control group were directly inserted LNG-IUS. The score of dysmenorrhea, the level of estradiol（E2）, the amount and time of intermenstrual spotting of patients in two groups before and after treatment for 6 and 12 months were compared. Results After treatment, the scores of dysmenorrhea in two groups dropped very significantly, the amount and time of intermenstrual spotting increased significantly, the differences were statistically significant（P〈0.05）, the levels of E2had no marked change（P〉0.05）. After treatment for 6 and 12 months, the time of intermenstrual spotting [1.00（0.00, 1.00）, 0.00（0.00, 0.75） d] and the scores of amount of intermenstrual spotting [1.00（0.00, 2.00）, 0.00（0.00, 0.75） scores] of treatment group were lower than those of the control group [3.00（0.00, 4.00）, 1.00（0.00, 2.00） d; 8.50（0.00, 14.75）, 1.00（0.00, 3.75） scores], the differences were statistically significant（P〈0.05）. The scores of dysmenorrhea and the level of E2of the treatment group was not significantly different from the control group（P〉0.05）. Conclusion GnRH-a combined with LNG-IUS has significant effects on reducing intermenstrual vaginal bleeding in using of the Levonorgestrel intrauterine system.