左炔诺孕酮宫内缓释系统与地诺孕素治疗子宫腺肌病的临床疗效

Clinical efficacy of levonorgestrel-releasing intrauterine system and dienogest in the treatment of adenomyosis

目的评价左炔诺孕酮宫内缓释系统(LNG-IUS)与地诺孕素(DNG)治疗子宫腺肌病的疗效。方法回顾性分析54例子宫腺肌病患者的临床资料。其中,经LNG-IUS治疗的患者(LNG-IUS组)31例,经DNG治疗的患者(DNG组)23例。采用月经失血图(PBAC)评分评估月经量,VAS疼痛评分评估痛经情况,阴道B超检查测量子宫体积。比较两组治疗前与治疗6个月后痛经、月经量和子宫体积的改善情况;记录治疗期间不良反应发生情况。结果与治疗前比较,两组患者治疗6个月后VAS疼痛评分降低,子宫体积缩小(P<0.05),但两组间比较无统计学差异(P>0.05)。两组治疗6个月后PBAC评分较治疗前降低(P<0.05),其中LNG-IUS组比DNG组效果更明显(P<0.05)。LNG-IUS组治疗期间主要的不良反应为阴道点滴出血、乳房胀痛和体重增加;DNG组患者最常见的不良反应是阴道点滴出血和乳房胀痛。LNG-IUS组阴道点滴出血发生率高于DNG组(P<0.05)。结论LNG-IUS及DNG均能有效缓解子宫腺肌病患者痛经及月经过多症状,同时可一定程度上缩小子宫体积,且不良反应可耐受。

Objective To evaluate the efficacy of levonorgestrel-releasing intrauterine system(LNG-IUS)and dienogest(DNG)in the treatment of adenomyosis.Methods The clinical data of 54 patients with adenomyosis were retrospectively analyzed,of whom 31 patients were treated with LNG-IUS(group LNG-IUS)and 23 patients were treated with DNG(group DNG).Menstrual blood volume was assessed by pictorial blood loss assessment chart(PBAC),dysmenorrhea was assessed by VAS pain score,and uterine volume was measured by vaginal B-ultrasound.The improvement of dysmenorrhea,menstrual blood volume and uterine volume before and 6 months after treatment were compared between the two groups.The incidence of adverse reactions during treatment was recorded.Results After 6 months of treatment,VAS pain scores were significantly decreased and the uterine volume was smaller than those before in the two groups(P<0.05),which were not significantly different between the two groups(P>0.05).Compared to before,PBAC scores of the two groups were significantly reduced after treatment(P<0.05),which were more obvious in group LNG-IUS than those in group DNG(P<0.05).The main adverse reactions during treatment in group LNG-IUS were vaginal drip bleeding,breast tenderness and weight gain,which were vaginal bleeding and breast tenderness in group DNG.The incidence of vaginal drip bleeding was higher in group LNG-IUS than that in group DNG(P<0.05).Conclusion In patients with adenomyosis,both LNG-IUS and DNG can effectively attenuate the symptoms of dysmenorrhea and menorrhagia,and reduce the uterine volume to a certain extent.The treatment-related adverse reactions during treatment are well tolerated.