摘要
目的探讨依托孕烯植入剂与左炔诺孕酮宫内缓释系统(levonorgestrel-releasing intrauterine system,LNG-IUS)治疗子宫腺肌病患者的效果比较。方法本研究为病例对照研究。选取西北妇女儿童医院2021年9月至2023年9月收治的子宫腺肌病患者90例。应用随机数字表法将患者分为观察组与对照组,各45例。观察组患者给予依托孕烯植入剂治疗,对照组患者给予LNG-IUS治疗。比较两组患者治疗前和治疗12个月后子宫情况、疼痛视觉模拟量表(visual analogue scale,VAS)评分、月经模式、性激素[雌二醇、黄体生成素(luteinizing hormone,LH)和卵泡刺激素(follicle-stimulating hormone,FSH)]水平、实验室指标[血红蛋白、血清铁蛋白(serum ferritin,SF)和糖抗原125]水平和治疗期间不良反应发生率。呈正态分布的计量资料以x±s表示,两组多时间点间比较采用重复测量的方差分析,两两比较采用LSD-t检验;两组间比较采用两独立样本t检验,治疗前后比较采用配对t检验。计数资料以例(%)表示,组间比较采用χ^(2)检验。结果治疗12个月后,观察组与对照组患者子宫体积和子宫内膜厚度均较治疗前降低[观察组:(122.72±13.52)cm^(3)比(202.72±20.75)cm^(3),(6.83±1.35)mm比(9.84±1.76)mm,t值分别为21.67、9.10,均P<0.001;对照组:(134.82±17.64)cm^(3)比(203.46±20.03)cm^(3),(7.52±1.52)mm比(9.79±1.82)mm,t值分别为17.25、6.42,均P<0.001],且观察组均低于对照组(t值分别为3.65、2.28,P值分别为<0.001、0.025);雌二醇、LH、FSH水平均低于治疗前[观察组:(1.40±0.30)nmol/L比(2.42±0.41)nmol/L,(10.12±1.14)U/L比(12.84±2.63)U/L,(5.32±0.87)U/L比(9.34±1.35)U/L,t值分别为13.47、6.36、10.03,均P<0.001;对照组:(1.68±0.33)nmol/L比(2.40±0.48)nmol/L,(11.41±1.53)U/L比(12.96±2.25)U/L,(7.03±1.04)U/L比(9.53±1.31)U/L,t值分别为8.29、3.82、16.79,均P<0.001],且观察组均低于对照组(t值分别为4.21、4.54、8.46、均P<0.001);血红蛋白和SF水平均高于治疗前[观察组:(116.46±3.07)mg/L比(109.46±3.64)mg/L,(117.33±16.46)μg/L比(53.82±7.52)μg/L,t值分别为9.86、18.95,均P<0.001;对照组:(114.63±3.48)mg/L比(110.63±3.48)mg/L,(95.34±12.63)μg/L比(52.58±8.21)μg/L,t值分别为5.45、23.61,均P<0.001],且观察组均高于对照组(t值分别为2.64、7.11,P值分别为0.010、<0.001),糖抗原125水平均低于治疗前[观察组:(40.31±3.10)kU/L比(68.31±4.75)kU/L,t=33.12、P<0.001;对照组:(57.45±4.27)kU/L比(67.64±4.83)kU/L,t=10.60,P<0.001],且观察组低于对照组(t=21.79、P<0.001)。治疗3、6、12个月后,两组患者VAS评分均逐渐降低,且观察组均低于对照组[(4.35±0.88)分比(4.71±0.75)分,(3.21±0.73)分比(3.63±0.82)分,(2.64±0.51)分比(3.16±0.64)分,均P<0.05]。治疗前,两组患者的月经模式比较差异无统计学意义(均P>0.05);治疗12个月后,观察组月经模式正常频率比例高于对照组[68.9%(31/45)比46.7%(21/45),χ^(2)=4.56、P=0.033],出血频发比例低于对照组[6.7%(3/45)比22.2%(10/45),χ^(2)=4.41、P=0.036]。治疗期间两组患者不良反应发生率比较差异无统计学意义[8.9%(4/45)比11.1%(5/45),χ^(2)=0.00、P=1.000]。结论与LNG-IUS相比,依托孕烯植入剂可有效改善子宫腺肌病患者子宫情况,缓解痛经症状,改善性激素和实验室指标水平,安全性较高。
Objective To investigate the effect and safety of etonogestrel implant and levonorgestrel-releasing intrauterine system(LNG-IUS)in the treatment of adenomyosis.Methods Eighty patients with adenomyosis in Northwest Women's and Children's Hospital were selected from September 2021 to September 2023.According to the random number table method,they were divided into observation group and control group,with 45 cases in each group.The patients in observation group were treated with etonogestrel implant,while the patients in control group were given LNG-IUS.The uterine conditions,visual analogue scale(VAS)score,menstrual pattern,sex hormones[estradiol,luteinizing hormone(LH)and follicle stimulating hormone(FSH)]and laboratory indicators[hemoglobin,serum ferritin(SF)and carbohydrate antigen 125]before treatment and after 12 months of treatment and incidence of adverse reactions were compared between the two groups of patients.Measurement data were expressed as x±s.Repeated measures analysis of variance was used for comparison between the two groups at multiple time points.LSD-t test was used for pairwise comparison.Two independent sample t test was used for comparison between the two groups.Paired t test was used for comparison before and after treatment.Enumeration data were expressed as n(%),and χ^(2) test was used for comparison between groups.Results After 12 months of treatment,the uterine volume and endometrial thickness in observation group and control group were reduced compared to before treatment[observation group:(122.72±13.52)cm^(3) vs.(202.72±20.75)cm^(3),(6.83±1.35)mm vs.(9.84±1.76)mm,t=21.67,9.10,respectively,both P<0.001;control group:(134.82±17.64)cm^(3) vs.(203.46±20.03)cm^(3),(7.52±1.52)mm vs.(9.79±1.82)mm,t=17.25,6.42,respectively,both P<0.001],and the indicators in observation group were lower than those in control group(t=3.65,2.28,P<0.001,P=0.025,respectively).The levels of estradiol,LH and FSH were lower than those before treatment[observation group:(1.40±0.30)nmol/L vs.(2.42±0.41)nmol/L,(10.12±1.14)U/L vs.(12.84±2.63)U/L,(5.32±0.87)U/L vs.(9.34±1.35)U/L,t=13.47,6.36,10.03,respectively,all P<0.001;control group:(1.68±0.33)nmol/L vs.(2.40±0.48)nmol/L,(11.41±1.53)U/L vs.(12.96±2.25)U/L,(7.03±1.04)U/L vs.(9.53±1.31)U/L,t=8.29,3.82,16.79,respectively,all P<0.001],and the observation group had lower levels than the control group(t=4.21,4.54,8.46,respectively,all P<0.001).Hemoglobin and SF levels were higher than those before treatment,and the levels in observation group were higher than those in control group[observation group:(116.46±3.07)mg/L vs.(109.46±3.64)mg/L,(117.33±16.46)μg/L vs.(53.82±7.52)μg/L,t=9.86,18.95,respectively,both P<0.001;control group:(114.63±3.48)mg/L vs.(110.63±3.48)mg/L,(95.34±12.63)μg/L vs.(52.58±8.21)μg/L,t=5.45,23.61,respectively,both P<0.001],and the levels in observation group were higher than those in control group(t=2.64,7.11,P=0.010,P<0.001,respectively).The level of carbohydrate antigen 125 was lower than that before treatment,[observation group:(40.31±3.10)kU/L vs.(68.31±4.75)kU/L,t=33.12,P<0.001;control group:(57.45±4.27)kU/L vs.(67.64±4.83)kU/L,t=10.60,P<0.001],and the level in observation group was lower than that in control group(t=21.79,P<0.001).At 3,6 and 12 months after treatment,the VAS score in both group decreased gradually,and the scores in observation group were lower than those in control group[(4.35±0.88)points vs.(4.71±0.75)points,(3.21±0.73)points vs.(3.63±0.82)points,(2.64±0.51)points vs.(3.16±0.64)points,all P<0.05].Before treatment,there was no statistically significant difference in menstrual patterns between the two groups of patients(P>0.05).After 12 months of treatment,the proportion of normal menstrual patterns in the implant group was higher than that in the sustained-release group[68.9%(31/45)vs.46.7%(21/45),χ^(2)=4.56,P=0.033],while the proportion of frequent bleeding was lower than that in the sustained-release group[6.7%(3/45)vs.22.2%(10/45),χ^(2)=4.41,P=0.036].There was no statistical significant difference in the incidence of adverse reactions between the two groups during treatment[8.9%(4/45)vs.11.1%(5/45),χ^(2)=0.00,P=1.000].Conclusion Compared with LNG-IUS,etonogestrel can more effectively improve the uterine conditions,relieve the dysmenorrhea symptoms,and improve the blood related indicators,and with high safety.
作者
吴成丽
胡春艳
王伟强
贾亮
Wu Chengli;Hu Chunyan;Wang Weiqiang;Jia Liang(Department of Gynecology Ⅱ,Northwest Women's and Children's Hospital,Xi'an 710061,China)
出处
《中国综合临床》
2025年第4期241-247,共7页
Clinical Medicine of China
基金
陕西省卫生健康科研基金项目(2018D039)。
