促性腺激素释放激素激动剂联合左炔诺孕酮宫内缓释系统治疗子宫腺肌症患者的价值

Value of gonadotropin-releasing hormone agonist combined with levonorgestrel intrauterine sustained-release system in the treatment of patients with uterine adenomyosis

目的探讨促性腺激素释放激素激动剂(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、血清基质金属蛋白酶(MMPs)及复发的影响。方法选取2019年3月至2020年3月滕州市中医医院妇产科收治的71例子宫腺肌症患者作为研究对象,根据编号奇偶数分为观察组(n=36)与对照组(n=35)。对照组采用GnRH-a治疗,观察组在对照组基础上联合左炔诺孕酮宫内缓释系统治疗,比较两组治疗前后血清基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)、血管内皮生长因子(VEGF)水平及视觉模拟评分法(VAS)评分、不良反应发生情况及复发情况。结果治疗后,观察组MMP-9、MMP-2、VEGF水平均低于对照组,差异有统计学意义(P<0.05);治疗后,观察组VAS评分低于对照组,差异有统计学意义(P<0.05)。观察组阴道不规则出血、出血时间延长发生率及复发率均低于对照组,差异有统计学意义(P<0.05)。结论GnRH-a联合左炔诺孕酮宫内缓释系统可调节MMPs及VEGF水平,减轻患者疼痛程度,降低复发率与不良反应发生率,值得临床推广应用。

Objective To investigate the effects of gonadotropin-releasing hormone agonist(GnRH-a)combined with levonorgestrel intrauter-ine sustained-release system on pain symptoms,serum matrix metalloproteinases(MMPs)and recurrence in patients with uterine adenomyosis.Methods 71 patients with uterine adenomyosis admitted to the department of Obstetrics and Gynecology of Tengzhou Hospital of Traditional Chi-nese Medicine from March 2019 to March 2020 were selected as the study subjects,and they were divided into the observation group(n=36)and the control group(n=35)according to the odd and even numbers method.The control group was treated with GnRH-a,and the observation group was treated with levonorgestrel intrauterine sustained-release system on the basis of the control group,the serum matrix metalloproteinase-2(MMP-2),matrix metalloproteinase-9(MMP-9)and vascular endothelial growth factor(VEGF),visual analogue score(VAS)before and after treatment,and the occurrence of adverse reactions and recurrence were compared between the two groups.Results After treatment,the serum levels of MMP-9,MMP 2,VEGF in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05);after treat-ment,the score of VAS in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05);the incidence of irregular vaginal bleeding,prolonged bleeding time,and recurrence rate in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion GnRH-a combined with levonorgestrel intrauterine sustained-release system can regulate the levels of MMPs and VEGF,reduce the pain degree of patients,and reduce the recurrence rate and the incidence of adverse re-actions,which is worthy of clinical promotion and application.