GnRH-a联合LNG-IUS治疗弥漫型子宫腺肌病所致异常子宫出血疗效

Curative effct of gonadotropin-releasing hormone agonist combined with levonorgestrel releasing intrauterine systems for treating patients with abnormal uterine bleeding caused by diffuse adenomyosis

目的:研究促性腺激素释放激素激动剂(GnRH-a)联合左炔诺孕酮宫内释放系统(LNG-IUS)治疗弥漫型子宫腺肌病所致异常子宫出血(AUB)临床效果。方法:选取2019年6月-2021年7月于本院妇产科门诊治疗的AUB患者120例,随机分成两组各60例,分别采用GnRH-a联合LNG-IUS治疗(GnRH-a组)、复方口服避孕药(COC)联合LNG-IUS治疗(COC组),对比两组治疗疗效、治疗前后月经量[月经失血图(PBAC)]评分、子宫体积大小、CA125及血红蛋白(Hb)水平变化。结果:治疗后,GnRH-a组症状改善率(98.3%)、Hb水平(109.57±7.31g/L)均高于COC组(85.0%、105.03±8.39g/L);阴道不规则出血(5.0%)、LNG-IUS下移(0)、子宫体积(101.93±4.40cm^(3))、血清CA125水平(12.34±2.71U/ml)、月经量(PBAC)评分(25.95±3.64分)均低于COC组(35.0%、10.0%、178.16±6.97cm^(3)、19.11±3.83U/ml、45.63±5.97分)(均P<0.05)。结论:GnRH-a联合LNG-IUS治疗弥漫型子宫腺肌病所致异常子宫出血临床疗效提高,能显著改善月经量,对LNG-IUS下移影响更小。

Objective:To explore the curative effect of gonadotropin-releasing hormone agonist(GnRH-a)combined with levonorgestrel releasing-intrauterine systems(LNG-IUS)for treating patients with abnormal uterine bleeding caused by diffuse adenomyosis(AUB).Methods:A total of 120 patients with AUB who treated in obstetrics and gyne-cology clinic were selected and were randomly divided into two groups(60 cases in each group)between June 2019 and July 2021.The patients in the study group were treated with GnRH a combined with LNG IUS,and the patients in the control group were treated with oral contraceptives(COC)combined with LNG-IUS.The efficacy of the treatment,and the changes of menstrual blood volume score by pictorial blood loss assessment chart(PBAC),the uterine volume size,and levels of serum CA125 and hemoglobin(Hb)before and after treatment of the patients were compared be-tween the two groups.Results:The symptom improvement rate(98.3%)and the Hb level(109.57±7.31g/L)of the patients in the study group after treatment were significantly higher than those(85.0% and 105.03±8.39g/L)of the patients in the control group.The vaginal irregular bleeding rate(5.0%),the rate downward displacement of LNG-IUS(0),the uterine volume(101.93±4.40cm^(2)),the serum CA125 level(12.34±2.71U/ml),and the PBAC score(25.95±3.64 points)of the patients in the study group after treatment were all significantly lower than those in control group(35.0%,10.0%,178.16±6.97cm^(2),19.11±3.83U/ml,and 45.63±5.97 points)of the patients in the control group(all P<0.05).Conclusion:GnRH-a combined with LNG IUS for treating patients with abnormal uterine bleeding caused by diffuse AUB can increase the clinical efficacy,and which can significantly improve the menstrual volume,with less influence on the downward displacement of LNG IUS.