高强度聚合超声联合促性腺激素释放激素激动剂治疗子宫腺肌病的疗效及对血红蛋白水平的影响

Effect of high intensity focused ultrasound combined with GnRHa on adenomyosis and its effect on hemoglobin level

目的研究高强度聚合超声(high intensity focused ultrasound,HIFU)联合促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist,GnRHa)治疗子宫腺肌病(adenomyosis,AM)的临床疗效。方法选取湖北省妇幼保健院2014年2月至2015年5月收治的AM患者114例,采用随机数字表法将其分为联合组、HIFU组及GnRHa组3组,每组各38例,其中HIFU组采用HIFU治疗,GnRHa组采用GnRHa治疗,联合组则采用HIFU联合GnRHa治疗。分别于治疗前、治疗后3月、6月及12月对3组患者的病灶面积、痛经程度、子宫体积及血红蛋白(hemoglobin,Hb)水平进行测定和比较。结果治疗后3月、6月及12月,3组患者的病灶面积、子宫体积及痛经评分均小于治疗前,联合组小于HIFU组、GnRHa组;同时3组血Hb水平明显高于治疗前,联合组高于HIFU组和GnRHa组,差异均有统计学意义(P<0.05)。结论 HIFU联合GnRHa治疗AM的疗效显著优于单纯HIFU和GnRHa治疗,可明显减轻患者的痛经程度,缩小病灶面积,促进子宫恢复正常体积,同时还能显著提升血Hb水平,值得在临床推广。

Objective To study the effect of high intensity focused ultrasound （HIFU） combined with gonadotropin - releasing hormone agonist（GnRHa） on adenomyosis（AM）. Methods 114 AM patients in Hubei Maternal and Child Health Care Hospital from February 2014 to May 2015 were selected as the research object, and were randomly divided into three groups：HIFU group, GnRHa group and combined group, with 38 cases in each group. The HIFU group were treated with HIFU, the GnRI-Ia group were treated with GnRHa and combined group were treated with HIFU combined with GnRHa respectively. Lesion size, degree of dysmenorrhea, uterine volume and serum hemoglobin （Hb） levels of 3 months, 6 months and 12 months before and after treatment were measured and compared in the three groups. Results 3 months, 6 months and 12 months after treatment, lesion area, uterine volume and dysmenorrhea score of the combined group were significantly lower than the HIFU group and GnRHa group. While the blood Hb levels were significantly higher than before treatment in the three groups, and were higher in the combined group than in the HIFU group and GnRHa group. The differences were statistically significant（P 〈0. 05）. Conclusion HIFU combined with GnRHa treatment of AM was significantly better than HIFU and GnRHa treatment alone. It can significantly reduce patiems＇ dysmenorrhea, reduce the lesion size, to promote the uterus to restore its normal volume, and also significantly improve blood Hb levels. It is worthy of clinical promotion.