左炔诺孕酮宫内缓释系统联合戈舍瑞林治疗子宫内膜不典型增生的临床效果观察

Clinical effect observation of different doses of levonorgestrel intrauterine releasing system combined with goserelin in the treatment of atypical endometrial hyperplasia

目的探讨左炔诺孕酮宫内缓释系统(LNG-IUS)联合戈舍瑞林治疗子宫内膜不典型增生(AEH)的临床效果。方法选择2015年1月至2019年12月我院收治的AEH患者140例,依照随机数字表法分为试验组与对照组各70例。对照组给予戈舍瑞林治疗,试验组给予LNG-IUS联合戈舍瑞林治疗,观察两组患者治疗前后月经量、子宫内膜厚度。血清促黄体生成素(LH)、促卵泡生成素(FSH)及雌二醇(E2)等雌激素水平,肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、C反应蛋白(CRP)等炎性因子水平,血清人附睾蛋白4(HE4)、血管内皮生长因子(VEGF)等肿瘤相关因子水平。妊娠结局及不良反应。结果治疗后,试验组PBAC得分、子宫内膜厚度均小于对照组(P<0.05),血清LH、FSH、E2、TNF-α、IL-6、CRP、HE4、VEGF水平均低于对照组(P<0.05)。试验组不良妊娠发生率低于对照组(P<0.05)。治疗期间两组均无严重不良反应发生。结论LNG-IUS、戈舍瑞林联合治疗AEH可有效调节雌激素过度分泌,降低血清炎性因子及肿瘤相关因子水平,改善妊娠结局,且不增加不良反应发生率,安全可靠。

Objective To investigate the clinical effect of levonorgestrel intrauterine releasing system(LNG-IUS)with goserelin in the treatment of atypical endometrial hyperplasia(AEH).Methods One hundred and forty AEH patients who were admitted to our hospital from January 2015 to December 2019 were involved in this study and divided into experimental or control group using the random number table method,70 in each group.The control group was given goserelin treatment while the experimental group was given LNG-IUS with goserelin treatment.Menstrual volume,endometrial thickness,levels of luteinizing hormone(LH),follicle-stimulating hormone(FSH)and estradiol(E2),levels of inflammatory factors such as serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP),and levels of tumor-related factors such as serum human epididymal protein 4(HE4)and vascular endothelial growth factor(VEGF)were observed before and after treatment.Pregnancy outcome and adverse reactions were also observed.Results After treatment,PBAC score and the endometrial thickness in the experimental group were lower than those in the control group(P<0.05).The levels of serum LH,FSH,E2,TNF-α,IL-6,CRP,HE4 and VEGF in the experimental group were lower than those in the control group(P<0.05).The incidence of adverse pregnancy in the experimental group were lower than those in the control group(P<0.05).No serious adverse reactions occurred in both groups during treatment.Conclusion Combined LNG-IUS with goserelin in the treatment of AEH can effectively regulate the over secretion of estrogen,reduce the serum levels of inflammatory factors and tumor-related factors,and improve the pregnancy outcome without increasing the incidence of adverse reactions.It is safe and reliable.