探讨曼月乐联合亮丙瑞林治疗子宫腺肌症的临床效果

Investigation on the clinical effect of Mirena combined with leuprorelin in the treatment of uterine adenomyosis

目的探讨子宫腺肌症采用左炔诺孕酮宫内节育系统(商品名:曼月乐)与亮丙瑞林联合治疗的效果。方法90例子宫腺肌症患者,依据治疗方法不同分为联合治疗组及单独治疗组,各45例。联合治疗组采用曼月乐与亮丙瑞林联合治疗,单独治疗组采用曼月乐单独治疗。比较两组子宫体积、子宫内膜厚度、子宫血流动力学指标[舒张期末期血流速度(EDV)、收缩期峰值流速(PSV)、阻力指数(RI)]、痛经程度[中文版COX痛经症状量表(CMSS)评分]、月经量[月经失血图(PBAC)评分],性激素指标[促卵泡激素(FSH)、促黄体生成素(LH)、雌二醇(E_(2))]、复发相关指标[基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)、糖类抗原125(CA125)、血管内皮生长因子(VEGF)、半胱氨酸-天冬氨酸特异性蛋白酶(Caspase-3)]、性生活质量[性生活质量调查表(SLQQ)评分],不规则出血、脱环、并发症发生情况,临床疗效,治疗满意度。结果治疗后,两组患者的子宫体积、子宫内膜厚度、EDV、PSV、CMSS疼痛程度评分、CMSS持续时间评分、PBAC评分均小于本组治疗前,RI均高于本组治疗前,且联合治疗组患者的子宫体积(168.37±12.31)cm^(3)、子宫内膜厚度(4.42±1.18)mm、EDV(7.03±1.16)cm/s、PSV(33.56±5.27)cm/s、CMSS疼痛程度评分(9.15±1.25)分、CMSS持续时间评分(9.62±1.45)分、PBAC评分(56.32±9.10)分均小于单独治疗组的(181.26±11.37)cm^(3)、(7.02±1.20)mm、(8.88±1.52)cm/s、(37.03±6.10)cm/s、(16.62±1.23)分、(16.25±1.22)分、(110.23±12.14)分,RI(0.86±0.11)高于单独治疗组的(0.73±0.18),差异具有统计学意义(P<0.05)。治疗后,两组患者的血清FSH、LH、E_(2)、MMP-2、MMP-9、CA125、VEGF水平均低于本组治疗前,血清Caspase-3水平,SLQQ性伴侣、生理因素、情感因素评分及总分均高于本组治疗前,且联合治疗组患者的血清FSH(9.14±1.02)U/L、LH(5.42±1.16)U/L、E_(2)(63.56±6.42)pmol/L、MMP-2(51.66±2.60)ng/L、MMP-9(61.34±1.80)ng/L、CA125(36.27±6.13)U/ml、VEGF(123.18±14.80)ng/L均低于单独治疗组的(10.56±1.56)U/L、(8.75±1.16)U/L、(81.23±9.46)pmol/L、(59.86±2.60)ng/L、(69.61±1.81)ng/L、(54.18±9.71)U/ml、(144.82±16.36)ng/L,血清Caspase-3(6.40±0.83)μg/ml,SLQQ性伴侣评分(20.42±3.15)分、生理因素评分(47.42±5.12)分、情感因素评分(38.54±4.26)分及总分(106.38±8.45)分均高于单独治疗组的(4.86±0.64)μg/ml、(15.23±2.40)分、(32.26±5.05)分、(21.56±3.54)分、(69.05±8.41)分,差异具有统计学意义(P<0.05)。联合治疗组患者的不规则出血率4.44%、脱环率2.22%均低于单独治疗组的28.89%、17.78%,差异具有统计学意义(P<0.05)。联合治疗组患者的并发症发生率4.44%低于单独治疗组的22.22%,差异具有统计学意义(P<0.05)。联合治疗组患者的总有效率95.56%高于单独治疗组的77.78%,差异具有统计学意义(P<0.05)。联合治疗组患者的治疗满意度91.11%高于单独治疗组的73.33%,差异具有统计学意义(P<0.05)。结论子宫腺肌症采用曼月乐与亮丙瑞林联合治疗的效果较曼月乐单独治疗好,更能缩小患者的子宫体积、子宫内膜厚度,改善子宫血流动力学,减轻痛经程度,减少月经量,改善性激素水平,降低复发率,提升性生活质量,减少不规则出血、脱环、并发症的发生,临床疗效更为显著,且更能提升患者的治疗满意度。

Objective To discuss the effect of levonorgestrel intrauterine system(trade name:Mirena)combined with leuprorelin in the treatment of uterine adenomyosis.Methods A total of 90 patients with uterine adenomyosis were divided into combined treatment group and single treatment group according to different treatment methods,with 45 cases in each group.The combined treatment group was treated with Mirena and leuprorelin,and the single treatment group was treated with Mirena alone.Both groups were compared in terms of uterine volume,endometrial thickness,uterine hemodynamic indices[end-diastolic velocity(EDV),peak systolic velocity(PSV),resistance index(RI)],dysmenorrhea degree[Cox Menstrual Symptom Scale(CMSS)score],menstrual volume[pictorial blood loss assessment chart(PBAC)score],sex hormone indicators[follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E_(2))],relapse-related indicators[matrix metalloproteinase-2(MMP-2),matrix metalloproteinase-9(MMP-9),carbohydrate antigen 125(CA125),vascular endothelial growth factor(VEGF),cysteinyl aspartate specific proteasea-3(Caspase-3)],sexual life quality[Sexual Life Quality Questionnaire(SLQQ)score],irregular bleeding,ring removal,complications,clinical efficacy,and treatment satisfaction.Results After treatment,the uterine volume,endometrial thickness,EDV,PSV,CMSS severity score,CMSS duration score and PBAC score in both groups were all lower than those before treatment in this group,and RI was higher than that before treatment in this group;in the combined treatment group,the uterine volume was(168.37±12.31)cm^(3),the endometrial thickness was(4.42±1.18)mm,EDV was(7.03±1.16)cm/s,PSV was(33.56±5.27)cm/s,CMSS severity score was(9.15±1.25)points,CMSS duration score was(9.62±1.45)points and PBAC score was(56.32±9.10)points,which were lower than those of(181.26±11.37)cm^(3),(7.02±1.20)mm,(8.88±1.52)cm/s,(37.03±6.10)cm/s,(16.62±1.23)points,(16.25±1.22)points and(110.23±12.14)points in single treatment group;RI of(0.86±0.11)in the combined treatment group was higher than that of(0.73±0.18)in the single treatment group;the differences were statistically significant(P<0.05).After treatment,the serum FSH,LH,E_(2),MMP-2,MMP-9,CA125 and VEGF levels in both groups were lower than those before treatment in this group,and serum Caspase-3 level,SLQQ sexual partner score,physiological factor score,emotional factor score and total score were higher than those before treatment in this group;the combined treatment group had serum FSH of(9.14±1.02)U/L,LH of(5.42±1.16)U/L,E_(2) of(63.56±6.42)pmol/L,MMP-2 of(51.66±2.60)ng/L,MMP-9 of(61.34±1.80)ng/L,CA125 of(36.27±6.13)U/ml and VEGF of(123.18±14.80)ng/L,which were lower than those of(10.56±1.56)U/L,(8.75±1.16)U/L,(81.23±9.46)pmol/L,(59.86±2.60)ng/L,(69.61±1.81)ng/L,(54.18±9.71)U/ml and(144.82±16.36)ng/L in single treatment group;in the combined treatment group,the serum Caspase-3 was(6.40±0.83)μg/ml,SLQQ sexual partner score was(20.42±3.15)points,the physiological factor score was(47.42±5.12)points,the emotional factor score was(38.54±4.26)points and the total score was(106.38±8.45)points,which were higher than those of(4.86±0.64)μg/ml,(15.23±2.40)points,(106.38±8.45)points,(32.26±5.05)points,(21.56±3.54)points and(69.05±8.41)points in the single treatment group;the differences were statistically significant(P<0.05).The irregular bleeding rate of 4.44%and the ring removal rate of 2.22%in the combined treatment group were lower than those of 28.89%and 17.78%in the single treatment group,and the differences were statistically significant(P<0.05).The complication rate of 4.44%in the combined treatment group was lower than that of 22.22%in the single treatment group,and the difference was statistically significant(P<0.05).The total effective rate of 95.56%in the combined treatment group was higher than that of 77.78%in the single treatment group,and the difference was statistically significant(P<0.05).The treatment satisfaction of 91.11%in the combined treatment group was higher than that of 73.33%in the single treatment group,and the difference was statistically significant(P<0.05).Conclusion The combined treatment effect of Mirena and leuprorelin for uterine adenomyosis is better than that of Mirena alone,which can reduce the uterine volume and endometrial thickness of patients,improve uterine hemodynamics,alleviate dysmenorrhea,reduce menstrual volume,improve sex hormone levels,reduce recurrence rate,improve sexual life quality,reduce irregular bleeding,ring removal and complications.The clinical effect is more significant,and it can also improve patient's satisfaction with treatment.