左炔诺孕酮宫内缓释系统联合GnRH⁃a治疗子宫腺肌病临床疗效观察

Clinical effects of levonorgestrel intrauterine sustainedrelease system combined with GnRH⁃a in treatment of adenomyosis

目的观察子宫腺肌病患者放置左炔诺孕酮宫内缓释系统(levonorgestrel intrauterine sustained release system,LNG⁃IUS,商品名:曼月乐)前皮下注射促性腺激素释放激素激动剂(gonadotropin⁃releasing hormone agonist,GnRH⁃a)的临床疗效。方法选取2020年8月至2021年6月秦皇岛市第一医院收治的60例子宫腺肌病患者作为研究对象,随机将其分为观察组和对照组,每组各30例。对照组患者于子宫腔内放置LNG⁃IUS,观察组在放置LNG⁃IUS前皮下注射3针GnRH⁃a,2组均治疗12个月。比较2组患者临床疗效:痛经改善程度、月经量、子宫体积及血清血管内皮生长因子(vascular endothelial growth factor,VEGF)、前列腺素E2(prostaglandin E2,PGE2)和CA125水平;记录2组患者不良反应发生率。结果与治疗前比较,治疗3、6、12个月后2组患者均出现痛经缓解、经量减少、子宫体积缩小及血清VEGF、PGE2和CA125水平下降情况,且治疗后各时间点观察组患者痛经缓解、经量减少、子宫体积缩小及血清VEGF、PGE2和CA125水平下降的幅度均大于对照组;观察组患者不良反应发生率低于对照组;差异均有统计学意义(P<0.05)。结论LNG⁃IUS联合GnRH⁃a治疗子宫腺肌病疗效显著,且能降低不良反应发生率。

Objective To observe the clinical effects of levonorgestrel intrauterine sustained release system(LNG⁃IUS)combined with gonadotropin⁃releasing hormone agonist(GnRH⁃a)in treatment of adenomyosis.Methods 60 patients with adenomyosis admitted to Qinhuangdao First Hospital from August 2020 to June 2021 were selected as study subjects and were randomly divided into the observation group and the control group,each consisting of 30 patients.The patients of in the control group were placed LNG⁃IUS in the uterine cavity,while the patients of the observation group were given with LNG⁃IUS in the uterine cavity after 3 injects of GnRH⁃a.Both groups received treatment for 12 months.The clinical effects were compared between the groups,such as improvement of dysmenorrhea,the amount of menstruation,uterine volume,serum vascular endothelial growth factor(VEGF),prostaglandin E2(PGE2)and CA125 level.The rates of adverse reactions were also recorded closely.Results 3,6 and 12 months after treatment,the symptoms of dysmenorrhea improved,the amount of menstruation dropped,the volume of uterine reduced,the levels of serum VEGF,PGE2 and CA125 of the 2 groups all dropped,as compared with those before treatment(P<0.05).Moreover,the alleviation of dysmenorrhea,the reduction of menstruation and uterine volume,as well as the reduction of serum VEGF,PGE2 and CA125 levels at different time points were all significantly better than those of the control group(P<0.05),and the rate of adverse reactions of the observation group was obviously lower than that of the control group(P<0.05).Conclusion LNG⁃IUS combined with gonadotropin⁃releasing hormone agonist(GnRH⁃a)in treatment of adenomyosis could achieve efficient therapeutic effects and reduce rates pf adverse reactions.