屈螺酮炔雌醇片与左炔诺孕酮宫内缓释系统联合治疗子宫内膜增生不伴非典型增生的疗效及对卵巢储备功能的影响

Clinical observation of Drospirenone and Ethinylestradiol Tablets Ⅱ combined with LNG-IUS in treatment of endometrial hyperplasia without atypical hyperplasia and ovarian reserve function

目的观察屈螺酮炔雌醇片(Ⅱ)与左炔诺孕酮宫内缓释系统(levonorgestrel intrauterine sustained release system, LNG-IUS)联合应用在治疗子宫内膜增生不伴非典型增生患者中的临床效果及对卵巢储备功能的影响。方法回顾性分析2017年10月至2018年10月于本院诊断为子宫内膜增生不伴非典型增生57例患者的临床资料,其中放置LNG-IUS者29例(LNG-IUS组),放置LNG-IUS同时口服屈螺酮炔雌醇片(Ⅱ)者28例(LNGIUS+药物组),比较两组阴道不规则流血、宫内节育器移位等及治疗后卵巢储备功能的变化。结果 LNG-IUS+药物组治疗后子宫内膜厚度与LNG-IUS组比较,明显变薄[(5.21±2.11)mm,(7.59±1.45 mm)]、月经期明显缩短[(4.21±1.03)d,(7.02±2.09)d],差异均有统计学意义(P <0.05)。两组治疗前后卵巢窦卵泡数(AFC)、血抗苗勒管激素(anti-mullerian hormone, AMH)、血清抑制素B (inhibition B,INHB)及性激素水平比较,差异均无统计学意义(P>0.05)。治疗后阴道不规则流血(21.05%,12/57),宫内节育器移位(15.79%,9/57)、痤疮(10.53%,6/57)、体质量增加(12.28%,7/57)发生率比较,差异均有统计学意义(P <0.05)。结论 LNG-IUS与屈螺酮炔雌醇片(Ⅱ)联合应用可有效治疗子宫内膜增生不伴非典型增生,对卵巢储备功能无明显影响,但应预防放置后不良反应。

Objective To investigate the clinical efficacy of Drospirenone and ethinylestradiol tablets Ⅱ combined with levonorgestrel intrauterine system(LNG-IUS) in the treatment of endometrial hyperplasia without atypical hyperplasia. Methods 57 cases of endometrial hyperplasia without atypical hyperplasia who received the treatment from October 2017 to October 2018 were selected as this study subjects. One group received LNG-IUS(29 cases), while the other group received Drospirenone and ethinylestradiol tablets Ⅱ combined with LNG-IUS(28 cases). The effects of irregular vaginal bleeding, LNG-IUS displacement and ovarian reserve function after treatment between the two groups were compared. Results Endometrial thickness in the LNG-IUS +drug group was significantly thinner than that in the LNG-IUS group(5.21±2.11 vs. 7.59±1.45 mm). The menstrual period was significantly shortened(4.21±1.03 vs. 7.02±2.09 d), and the difference was statistically significant(P < 0.05). In the two groups, the total number of follicle number(AFC), anti-mullerian hormone(AMH), serum inhibin B(INHB), and gonadal hormone had no statistically significant difference before and after treatment(P > 0.05). After treatment, there were statistically significant differences in the incidences of irregular vaginal bleeding 21.05%(12/57), IUD displacement 15.79%(9/57), acne 10.53%(6/57), and body mass increase 12.28%(7/57)(P < 0.05). Conclusion Combined application of Drospirenone and ethinylestradiol tablets Ⅱ and LNG-IUS can effectively treat endometrial hyperplasia without atypical hyperplasia, and have no significant effect on ovarian reserve function. Adverse reactions after placement should be prevented.