GnRH-a联合左炔诺孕酮宫内缓释系统对子宫腺肌症患者疼痛症状、血清MMPs及复发的影响

Influence of GnRH-α combined with levonorgestrel intrauterine device system for treating women with adenomyosis on their pain symptoms,serum MMPs level,and recurrence rate

目的:探讨促性腺激素释放激素激动剂(GnRH-α)联合左炔诺孕酮宫内缓释系统(LNG-IUS)对子宫腺肌症(AM)患者疼痛、血清基质金属蛋白酶(MMPs)及复发率影响。方法:将121例AM患者随机分为对照组(n=59)与观察组(n=62),对照组宫内放置LNG-IUS,观察组给予GnRH-α联合LNG-IUS治疗。比较两组治疗6个月后效果,包括子宫内膜厚度、子宫体积,痛经视觉模拟量表(VAS)、月经失血图评分(PBAC),检测血清癌抗原125(CA125)、神经生长因子(NGF)、MMP-2和MMP-9水平。结果:治疗6个月,观察组总有效率(91.9%)高于对照组(76.3%),子宫体积、子宫内膜厚度、痛经VAS评分及PBAC评分,以及血清CA125、NGF、MMP-2和MMP-9下降幅度均高于对照组(均P<0.05),阴道出血时间延长率(3.2%)、不规则出血率(4.8%)及LNG-IUS脱落率(3.2%)均低于对照组(18.6%、62.7%、22.0%)(P<0.05)。随访12个月,观察组复发率(4.8%)低于对照组(18.6%)(P<0.05)。结论:GnRH-α联合LNG-IUS治疗AM可显著改善痛经症状,降低脱落率及复发率,安全可行,其机制可能与调节MMPs表达有关。

Objective:To investigate the influence of gonadotropin releasing hormone agonist(GnRH-α)combined with levonorgestrel intrauterine device system(LNG-IUS)for treating women with adenomyosis(AM)on their pain symptoms,serum matrix metalloproteinases(MMPs)level,and recurrence rate.Methods:121 women with AM were randomly divided into control group(n=59)and observation group(n=62).The women in the control group were given LNG-IUS,and the women in the observation group were given GnRH-αcombined with LNG-IUS.After 6 months of treatment,the efficacy,the endometrial thickness,the uterine volume,the dysmenorrhea visual analog scale(VAS)score,the pictorial blood loss assessment chart(PBAC)scores of women were compared between the two groups.The serum levels of cancer antigen 125(CA125),the nerve growth factor(NGF),MMP-2,and MMP-9 of the women in the two groups were detected.Results:After 6 months of treatment,the total effective rate of the women in the observation group(91.9%)was significant higher than that(76.3%)of the women in the control group.The degree of the decline value of uterine volume,endometrial thickness,dysmenorrhea VAS score,and PBAC score,and the levels of serum CA125,NGF,MMP-2 and MMP-9 of the women in the observation group were significant more than those of the women in the control group(P<0.05).The rate of vaginal bleeding time prolonged,the irregular bleeding rate,and the decyclizing rate of the women in the observation group were 3.2%,4.8%,and 3.2%,respectively,which were significant lower than those(18.6%,62.7%,and 22.0%,respectively)of the women in the control group(P<0.05).After 12 months of followed up,the recurrence rate of the women in the observation group was 4.8%,which was significant lower than that(18.6%)of the women in the control group(P<0.05).Conclusion:GnRH-αcombined with LNG-IUS is safe and feasible for treating women with AM,it can significantly alleviate the symptoms of dysmenorrhea,reduce the rate of LNG-IUS expulsion rate and recurrence rate of AM with safety,which’s mechanism may be related to the regulation of the expression of MMPs.