不同孕激素对子宫内膜不典型增生的治疗效果

Clinical effect of different progesterone on atypical endometrial hyperplasia

目的探讨不同孕激素对子宫内膜不典型增生(AEH)的治疗效果。方法选择2017年1月至2018年12月于我院行宫腔镜检查+诊刮术且术后病理证实为AEH患者116例,采用随机数字表法均分为2组。甲地孕酮组58例均口服甲地孕酮160 mg,1次/d,共3个月。左炔诺孕酮组58例行左炔诺孕酮宫内缓释系统治疗3个月。比较观察2组临床疗效、炎性因子水平、不良反应发生情况。结果甲地孕酮组有效率93.1%,高于左炔诺孕酮组的74.1%,差异有统计学意义(P<0.05)。甲地孕酮组治疗后白介素-6、超敏C反应蛋白及肿瘤坏死因子-α水平均低于左炔诺孕酮组,差异均有统计学意义(P均<0.05)。甲地孕酮组恶心呕吐、失眠、下腹痛、淋漓出血等不良反应发生率均低于左炔诺孕酮组,但差异均无统计学意义(P均>0.05);甲地孕酮组血栓发生率高于左炔诺孕酮组,差异有统计学意义(P<0.05)。结论在AEH的孕激素治疗中,口服甲地孕酮的作用高于放置左炔诺孕酮宫内缓释系统,且安全性良好,值得临床推广应用。

Objective To analyze the clinical effect of different progesterone on atypical endometrial hyperplasia(AEH).Methods The 116 patients with AEH were selected.AEH was confirmed by hysteroscopy,curettage and postoperative pathology.All the patients were randomly divided into two groups.Fifty-eight patients in the megestrol group was treated with megestrol 160 mg once a day for 3 months.Fifty-eight patients in the levonorgestrel group was treated with levonorgestrel-releasing intrauterine system for 3 months.The clinical efficacy,inflammatory factor levels and adverse reactions were observed and compared.Results The response rate of the megestrol group(93.1%)was higher than that of the levonorgestrel group(74.1%,P<0.05).The levels of interleukin-6,hypersensitive C reactive protein and tumor necrosis factor-αin the megestrol group were lower than those in the levonorgestrel group(P<0.05).The incidences of nausea and vomiting,insomnia,lower abdominal pain and bleeding from dripping in the megestrol group were lower than those in the levonorgestrel group,but the difference was not statistically significant(P>0.05).The incidence of thrombus in the megestrol group was higher than that in the levonorgestrel group(P<0.05).Conclusion In the progesterone treatment of AEH,the effect of oral megestrol is higher than levonorgestrel-releasing intrauterine system,and the adverse reactions is tolerated.