左炔诺孕酮宫内节育系统放置前给予戈舍瑞林治疗子宫腺肌病合并重度痛经的临床观察
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篇名: 左炔诺孕酮宫内节育系统放置前给予戈舍瑞林治疗子宫腺肌病合并重度痛经的临床观察
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摘要: 目的:探讨在左炔诺孕酮宫内节育系统放置前给予戈舍瑞林治疗子宫腺肌病合并重度痛经的临床效果及安全性。方法:选取三亚市计划生育技术服务中心2014年1月-2016年1月收治的子宫腺肌病合并重度痛经患者140例,按抽签法随机分为对照组和观察组,各70例。两组患者均在月经开始的7 d内放置左炔诺孕酮宫内节育系统,其中观察组患者在放置前1周给予醋酸戈舍瑞林缓释植入剂10.8 mg腹前壁皮下注射。6个月后进行疗效评定。比较两组患者的痛经改善情况,治疗前后的子宫体积、COX痛经症状评分量表(CMSS)评分、月经量、血红蛋白(Hb)和糖类抗原125(CA125)含量,以及不良反应发生情况。结果:观察组患者的痛经改善率为95.71%,显著高于对照组的81.43%,差异有统计学意义(P<0.05)。治疗前,两组患者的上述指标比较,差异均无统计学意义(P>0.05);治疗后,两组患者的CMSS评分和月经量均较治疗前显著降低或减少,Hb含量均较治疗前显著升高,CA125含量均较治疗前显著降低,且观察组均显著优于对照组,差异均有统计学意义(P<0.05);两组患者治疗前后子宫体积比较,差异无统计学意义(P>0.05)。两组患者的不良反应发生率(10.00% vs. 14.29%)比较,差异无统计学意义(P>0.05)。结论:左炔诺孕酮宫内节育系统放置前给予戈舍瑞林治疗子宫腺肌病合并重度痛经,可有效缓解患者痛经症状,减少月经量,改善Hb和CA125水平,且未增加不良反应发生风险。
ABSTRACT: OBJECTIVE: To investigate clinical efficacy and safety of goserelin in the treatment of adenomyosis complicated with severe dysmenorrheal before placing levonorgestrel intrauterine system (LIS). METHODS: A total of 140 adenomyosis patients with severe dysmenorrheal were selected from Sanya Family Planning Technology Service Center during Jan. 2014-Jan. 2016, and then divided into control group and observation group according to lottery method, with 70 cases in each group. Both groups received LIS within first 7 d of menstruation, and observation group was given Goserelin acetate sustained-release implant 10.8 mg subcutaneously via anterior abdominal wall one week before placing. Therapeutic efficacy was evaluated 6 months later. The improvement of dysmenorrhea was compared between 2 groups. The uterine volume, COX dysmenorrhea score (CMSS), menstrual volume, hemoglobin (Hb) and CA125 content were compared between 2 groups before and after treatment. The occurrence of ADR was also compared. RESULTS: The rate of dysmenorrheal improvement in observation group was 95.71%, which was significantly higher than 81.43% of control group, with statistical significance (P<0.05). Before treatment, there was no statistical significance in above indexes between 2 groups (P>0.05). Compare to before treatment, CMSS score, menstrual volume and CA125 content of 2 groups were decreased significantly after treatment, while Hb content was increased significantly; the observation group was significantly better than the control group, with statistical significance (P<0.05). There was no statistical significance in uterine volume between 2 groups before and after treatment (P>0.05). There was no statistical significance in the incidence of ADR (10.00% vs. 14.29%) between 2 groups(P>0.05). CONCLUSIONS: Goserelin in the treatment of adenomyosis complicated with severe dysmenorrheal before placing LIS can effectively relieve dysmenorrheal, reduce menstrual volume and improve Hb and CA125 levels, but do not increase the risk of ADR.
期刊: 2017年第28卷第26期
作者: 罗英媚,李庆,麦燕,黎先萍,张敏
AUTHORS: LUO Yingmei,LI Qing,MAI Yan,LI Xianping,ZHANG Min
关键字: 左炔诺孕酮宫内节育系统;促性腺激素释放激素激动剂;戈舍瑞林;子宫腺肌病;重度痛经;月经量;血红蛋白;糖类抗原125
KEYWORDS: Levonorgestrel intrauterine system; GuRH-A; Goserelin; Adenomyosis; Severe dysmenorrheal; Menstrual volume; Hb; CA125
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