摘要
目的探究曼月乐环、地诺孕素分别联合促性腺激素释放激素激动剂(GnRHa)对子宫内膜异位症术后患者有效性和安全性的影响。方法选择2022年2月至2023年3月收治于商水县人民医院的80例子宫内膜异位症手术患者作为此次研究对象,通过随机数字表法将上述研究对象分为曼月乐环组和地诺孕素组,每组40例。两组患者术后均给予GnRHa治疗,曼月乐环组在此基础上联合曼月乐环进行治疗,地诺孕素组在此基础上联合地诺孕素进行治疗,两组患者均治疗6个月。观察两组治疗6个月后月经异常、继发性痛经缓解时间;治疗前后血清抗苗勒管激素(AMH)、前列腺素F2α(PGF2α)水平,以及子宫动脉血流阻力指数(RI)、子宫内膜厚度和子宫体积的变化;并记录治疗后复发和不良反应发生情况。结果治疗结束后,地诺孕素组月经异常和继发性痛经症状缓解所需时间均短于曼月乐环组,差异有统计学意义(P<0.05),地诺孕素组和曼月乐环组血清AMH水平、RI值均上升(P<0.05),血清PGF2α水平下降(P<0.05),子宫内膜厚度、子宫体积均较治疗前减小(P<0.05);且地诺孕素组血清AMH水平上升程度、血清PGF2α水平下降程度、RI值上升程度,以及子宫内膜厚度和子宫体积减小程度均大于曼月乐环组(P<0.05),不良反应总发生率和复发率均低于曼月乐环组,但差异无统计学意义(P>0.05)。结论地诺孕素较曼月乐环联合GnRHa能更快缓解子宫内膜异位症患者临床症状,升高血清AMH水平,降低血清PGF2α水平,对子宫血流动力学及内膜形态指标产生积极影响,并有助于减少子宫内膜异位症手术患者术后复发风险,且具有良好的安全性。
Objective To investigate the effectiveness and safety of the Mirena intrauterine system and dienogest,each combined with a gonadotropin-releasing hormone agonist(GnRHa),in patients after surgery for endometriosis.Methods A total of 80 patients who underwent surgery for endometriosis and were admitted to our hospital from February 2022 to March 2023 were enrolled.According to a random number table,they were divided into a Mirena group(n=40)and a dienogest group(n=40).After surgery,all patients received GnRHa therapy.On this basis,patients in the Mirena group were additionally treated with the Mirena intrauterine system,whereas patients in the dienogest group were additionally treated with oral dienogest.The treatment duration in both groups was 6 months.The time to resolution of abnormal menstruation and secondary dysmenorrhea after 6 months of treatment was recorded.Anti-mullerian hormone(AMH),prostaglandin F2α(PGF2α),uterine artery resistance index(RI),endometrial thickness,and uterine volume were measured before and after treatment.Recurrence and adverse reactions after treatment were also observed.Results After completion of treatment,the time required for relief of abnormal menstruation and secondary dysmenorrhea was shorter in the dienogest group than in the Mirena group(P<0.05).Serum AMH level and RI value increased in both the dienogest group and the Mirena group(P<0.05),whereas serum PGF2αlevel decreased(P<0.05),and endometrial thickness and uterine volume were reduced compared with those before treatment(P<0.05).Moreover,the increase in serum AMH level,the decrease in serum PGF2αlevel,the increase in RI value,and the reductions in endometrial thickness and uterine volume were all greater in the dienogest group than in the Mirena group(P<0.05).The overall incidence of adverse reactions and the recurrence rate were both lower in the dienogest group than in the Mirena group(P<0.05).Conclusion Compared with the Mirena intrauterine system,dienogest in combination with GnRHa provides more rapid relief of clinical symptoms in patients with endometriosis,increases serum AMH level and reduces serum PGF2αlevel,and it has a positive effect on uterine hemodynamics and endometrial morphology indicators,and helps prevent postoperative recurrence of endometriosis,with a favorable safety profile.
作者
吕涌娅
LYU Yongya(Department of Obstetrics and Gynecology,Shangshui County People’s Hospital,Zhoukou,Henan 466100,China)
出处
《临床研究》
2025年第12期52-55,共4页
Clinical Research
