2023 年第 1 期 第 18 卷

子宫腺肌病患者在醋酸亮丙瑞林基础上联合左炔诺孕酮宫内节育系统或地诺孕素治疗的效果比较

Comparison between levonorgestrel intrauterine system and dienogest based on leuprolide acetate in the treatment of adenomyosis

作者：关琼1杨爱玉1吴绪峰2

英文作者：Guan Qiong1 Yang Aiyu1 Wu Xufeng2

单位：1湖北省潜江市妇幼保健院妇科，潜江433199；2湖北省妇幼保健院妇科，武汉430000

英文单位：1Department of Gynecology Qianjiang Maternal and Child Health-Care Hospital of Hubei Province Qianjiang 433199 China; 2Department of Gynecology Maternal and Child Health Hospital of Hubei Province Wuhan 430000 China

关键词：子宫腺肌病；醋酸亮丙瑞林；左炔诺孕酮宫内节育系统；地诺孕素；性生活；生活质量

英文关键词：Adenomyosis;Leuprolideacetate;Levonorgestrelintrauterinesystem;Dienogest;Sexuallife;Qualityoflife

• 摘要：

• 目的  比较子宫腺肌病患者在醋酸亮丙瑞林基础上联合左炔诺孕酮宫内节育系统（曼月乐）或地诺孕素治疗的效果。方法  选取2018年1月至2020年4月于湖北省潜江市妇幼保健院接受治疗的101例确诊为子宫腺肌病患者为研究对象，按随机数字表法分为曼月乐组（51例）与地诺孕素组（50例）。2组均给予醋酸亮丙瑞林缓释微球皮下注射，曼月乐组加以曼月乐治疗，地诺孕素组加以地诺孕素治疗。比较2组患者治疗前和治疗3个月后的相关临床指标［子宫内膜厚度、子宫体积、月经失血图（PBAC）评分、中文版COX痛经症状量表(CMSS)评分、血清糖类抗原12-5 (CA12-5)、血管内皮生长因子(VEGF)］、性激素［血清促卵泡激素(FSH)、雌二醇、促黄体生成素（LH）］检查结果、性生活质量调查表(SLQQ)评分（得分越高表示性生活满意度越高）和子宫肌瘤/腺肌病症状及健康相关生活质量（UFS-QOL）量表评分以及治疗过程中的不良反应发生情况。结果治疗3个月后，2组子宫内膜厚度、子宫体积、PBAC评分、CMSS评分、CA12-5、VEGF水平均低于治疗前，且曼月乐组CA12-5、VEGF水平均低于地诺孕素组［（17±5）kU/L比（34±6）kU/L、（134±28）μg/L比（189±35）μg/L］（均P＜0.05）。治疗3个月后，2组患者FSH、雌二醇、LH水平均低于治疗前（均P＜0.05），且2组治疗后比较差异均无统计学意义（均P＞0.05）。治疗6个月后，2组患者SLQQ各维度评分及总分均高于治疗前，且曼月乐组均高于地诺孕素组（均P＜0.05）；2组患者UFS-QOL量表中症状严重程度评分均低于治疗前，而健康相关生命质量评分均高于治疗前，且曼月乐组健康相关生命质量评分高于地诺孕素组（均P＜0.05）。曼月乐组总不良反应发生率高于地诺孕素组［33.3%(17/51)比16.0%(8/50)］（P＜0.05）。结论  在醋酸亮丙瑞林基础上联合曼月乐或地诺孕素治疗子宫腺肌病患者均可有效缓解患者症状体征，在一定程度上降低患者卵巢功能，而前者在改善CA12-5、VEGF水平，提高性生活满意度及生活质量方面更优，但不良反应更多，临床可根据实际情况进行选择。

• Objective  To compare the effects between levonorgestrel intrauterine system (Mirena) and dienogest based on leuprorelin acetate in the treatment of patients with adenomyosis. Methods  Totally 101 patients with adenomyosis diagnosed in Qianjiang Maternal and Child Health-Care Hospital of Hubei Province from January 2018 to April 2020 were selected as subjects. They were divided into Mirena group (51 cases) and dienogest group (50 cases) according to the random number table method. Both groups were given subcutaneous injection of leuprolide acetate sustained-release microspheres, and Mirena group was additionally given Mirena while dienogest group was additionally given dienogest. The clinical indicators ［endometrial thickness, uterine volume, Pictorial Blood Loss Assessment Chart (PBAC) score, Chinese version of COX Menstrual Symptom Scale (CMSS) score, serum carbohydrate antigen 12-5(CA12-5), serum vascular endothelial growth factor (VEGF)］ and sex hormones ［serum follicle stimulating hormone (FSH), estradiol, luteinizing hormone (LH)］ were compared between the two groups before treatment and 3 months after treatment. The Sexual Life Quality Questionnaire (SLQQ) score (the higher the score, the higher the satisfaction of sexual life) and Uterine Fibroid Symptom and Quality of Life (UFS-QOL) score before treatment and 6 months after treatment and occurrence of adverse reactions during treatment were compared. Results  After 3 months of treatment, the endometrial thickness, uterine volume, PBAC score, CMSS score and levels of CA12-5 and VEGF in the two groups were lower than those before treatment, and the levels of CA12-5 and VEGF in Mirena group were lower than those in dienogest group［（17±5）kU/L vs （34±6）kU/L, （134±28）μg/L vs （189±35）μg/L］ (all P＜0.05). After 3 months of treatment, the levels of FSH, estradiol and LH of the two groups decreased (all P＜0.05), and there were no statistically significant differences between the two groups (all P＞0.05). After 6 months of treatment, each dimension score and total score of SLQQ in the two groups were higher than those before treatment, and the scores were higher in Mirena group (all P＜0.05); the score of symptom severity of UFS-QOL scale in the two groups was lower than that before treatment while the score of health-related quality of life was higher, and the score of health-related quality of life was higher in Mirena group than that in dienogest group (all P＜0.05). The total incidence rate of adverse reactions in Mirena group was higher than that in dienogest group［33.3%(17/51) vs 16.0%(8/50)］（P＜0.05）. Conclusions  Leuprolide acetate combined with Mirena or dienogest for patients with adenomyosis, both can effectively alleviate the symptoms and signs, and reduce the ovarian function to a certain extent. The former one is better in improving levels of CA12-5 and VEGF and increasing sexual life satisfaction and quality of life, but its adverse reactions are more Physicians should select the regimen based on actual conditions in clinical practice.