GnRH-a预处理结合高强度聚焦超声治疗子宫腺肌病的效果研究

Study on the Effect of GnRH-a Pretreatment Combined with High Intensity Focused Ultrasound in the Treatment of Adenomyosis

目的:探讨促性腺激素释放激素激动剂(GnRH-a)预处理结合高强度聚焦超声治疗子宫腺肌病的效果。方法:以随机数字表法将2019年1月~2021年5月我院收治的298例子宫腺肌病患者随机分为对照组和试验组,各149例。对照组给予高强度聚焦超声治疗,试验组给予GnRH-a预处理,连续治疗2个月经周期后结合高强度聚焦超声治疗,两组治疗后均随访2年。比较两组治疗前、治疗后3个月的病灶体积、子宫体积、月经量、疼痛程度、激素、血清细胞因子水平、治疗期间的不良反应及随访期间的复发情况和妊娠结局。结果:与治疗前比较,治疗后3个月,两组病灶体积、子宫体积缩小,试验组小于对照组(P<0.05);两组月经量、疼痛数字评分法(NRS)评分、血清雌二醇(E_(2))、黄体生成素(LH)、卵泡刺激素(FSH)、转化生长因子β2(TGF-β2)、血管内皮生长因子(VEGF)水平降低,试验组低于对照组(P<0.05);两组血清脂联素(ADP)水平升高,试验组高于对照组(P<0.05)。试验组治疗期间的骶尾胀痛、放射痛、下腹疼痛、阴道不规则流血发生率与对照组比较无差异(P>0.05);试验组随访期间的复发率、流产率分别为6.04%、10.58%,低于对照组的17.45%、35.21%(P<0.05);试验组随访期间的临床妊娠率为69.80%,高于对照组的47.65%(P<0.05)。结论:GnRH-a预处理结合高强度聚焦超声可调节子宫腺肌病患者激素及血清细胞因子水平,缩小患者病灶体积、子宫体积,减少其月经量,减轻其疼痛程度,进而利于患者妊娠结局的改善,且具有良好的安全性。

Objective:To investigate the effect of gonadotropin releasing hormone agonist(GnRH-a)pretreatment combined with high intensity focused ultrasound in the treatment of adenomyosis.Methods:298 patients with adenomyosis admitted to our hospital from January 2019 to May 2021 were randomly divided into the control group and the experimental group using a random number table method,with 149 patients in each group.The control group received high intensity focused ultrasound treatment,while the experimental group received GnRH-a pretreatment,after 2 consecutive menstrual cycles,high intensity focused ultrasound treatment was combined.Both groups were followed up for 2 years after treatment.The lesion volume,uterine volume,menstrual volume,pain level,levels of hormones,serum cytokine before and 3 months after treatment,adverse reactions during treatment,recurrence and pregnancy outcomes during followed up between the two groups were compared.Results:Compared with before treatment,after 3 months of treatment,the lesion volume and uterine volume of the two groups decreased,experimental group was smaller(P<0.05);the menstrual volume,score of numeric rating scale(NRS),serum levels of estradiol(E_(2)),luteinizing hormone(LH),follicle stimulating hormone(FSH),and transforming growth factorβ2(TGF-β2),vascular endothelial growth factor(VEGF)of the two groups decreased,the experimental group compared to the control group was lower(P<0.05);the level of serum adiponectin(ADP)increased in both groups,experimental group was higher(P<0.05).There was no significant difference in the incidence of sacrococcygeal pain,radiating pain,lower abdominal pain,and irregular vaginal bleeding between the experimental group and the control group during the treatment period(P>0.05);the recurrence rate and abortion rate during the followed up period in the experimental group were 6.04%and 10.58%,respectively,lower than the control group's 17.45%and 35.21%(P<0.05);the clinical pregnancy rate during the followed up period in the experimental group was 69.80%,which was higher than 47.65%in the control group(P<0.05).Conclusion:GnRH-a pretreatment combined with high intensity focused ultrasound could regulate levels of hormone and serum cytokine in patients with adenomyosis,reduce lesion volume and uterine volume,reduce menstrual flow,alleviate pain,and improve pregnancy outcomes,with good safety.