地诺孕素治疗对醋酸炔诺酮治疗效果不佳的子宫内膜异位症患者的疗效分析

Analysis of dienogest in patients with endometriosis- related pain after poor treatment of norethisterone acetate

目的:对于经常性疼痛和经醋酸炔诺酮治疗6个月后效果不佳的子宫内膜异位症患者,再经地诺孕素治疗6个月后患者的治疗效果满意度评价。方法:纳入65名患者进行两年的前瞻性研究;患者在经地诺孕素治疗期间与醋酸炔诺酮治疗期间效果的比较,主要观测指标采用李克特量表(Likert scale)进行测定,次要观测指标评价疼痛度、生活质量、性功能变化和囊肿体积的变化。结果:地诺孕素治疗3个月和6个月与醋酸炔诺酮治疗时基线值相比患者的满意度明显改善(P<0.001);EHP-30和FSFI对生活质量和性生活质量的评价表明,患者在治疗6个月后明显改善;在治疗期间子宫内膜异位的结节体积未发生明显变化。结论:本研究结果表明地诺孕素可以用于子宫内膜异位症患者有效的治疗手段,尤其是对于经醋酸炔诺酮治疗效果不佳的患者。对于地诺孕素和醋酸炔诺酮作为一线和二线治疗药物尚需进一步的临床对比性实验研究。

Objectives： To evaluate patients＇ satisfaction at 6- months dienogest（ DNG） treatment in women with symptomatic rectovaginal endometriosis that had pain persistence and were unsatisfied after 6- month norethisterone acetate（ NETA） therapy. Methods： The prospective study enrolled 65 women. The main outcome was measured by using a Likert scale. Secondary outcomes were to evaluate the differences in endometriosis- related pain,quality of life,sexual function changes and volumetric nodules changes during DNG compared to NETA treatment. Results： Patient satisfaction improved at 3- and 6- month（ P〈0. 001,respectively） treatment with DNG compared with baseline treatment with NETA months. Changes in self- assessment of quality of life and quality of sexual life wre evaluated with the EHP- 30 and FSFI,and improvement was found after 6 months＇ treatment. There was no significant change in the volume of the endometriotic nodules during treatment. Conclusion： DNG is effective in treating symptomatic women with endometriosis even in a particular endometriotic subpopulation after poor NETA treatment. Further randomized clinical trials comparing these two progestins both in first and second line are warranted.