左炔诺孕酮宫内节育系统治疗无排卵型功能失调性子宫出血的疗效

中国临床药理学与治疗学 ›› 2017, Vol. 22 ›› Issue (6): 699-704.

左炔诺孕酮宫内节育系统治疗无排卵型功能失调性子宫出血的疗效

夏丽娟¹，何云芹²，邵明君²

¹兰溪市妇幼保健院妇产科，兰溪 321100，浙江；²金华市中心医院妇产科，金华 321000，浙江

收稿日期:2017-01-16 修回日期:2017-02-21 出版日期:2017-06-26 发布日期:2017-06-26
作者简介:夏丽娟，女，本科，副主任医师，研究方向：妇产科学。 Tel：15257810901 E-mail:q668860@163.com

Efficacy of levonorgestrel intrauterine system in the treatment of dysfunctional uterine bleeding

XIA Lijuan¹, HE Yunqin ², SHAO Mingjun ²

¹Department of Obstetrics and Gynecology, Lanxi Maternal and Child Health Care Hospital, Lanxi 321100, Zhejiang, China; ²Department of Obstetrics and Gynecology, Jinhua Central Hospital, Jinhua 321000, Zhejiang, China

Received:2017-01-16 Revised:2017-02-21 Online:2017-06-26 Published:2017-06-26

摘要/Abstract

摘要：

目的:观察左炔诺孕酮宫内节育系统（LNG-IUS）治疗无排卵型功能失调性子宫出血（DUB）的疗效及其对子宫内膜血管内皮细胞生长因子（VEGF）、雌激素受体（ER）和孕激素受体（PR）的影响。方法: 将2015年6月至2016年9月本院收治的78例DUB患者，随机分为对照组和观察组，每组39例。在常规治疗基础上，对照组予去氧孕烯炔雌醇片口服，观察组予LNG-IUS治疗。比较两组治疗前与治疗12月后血红蛋白水平（HGB）、血清雌二醇（E2）、孕酮（P）、垂体分泌卵泡刺激素（FSH）、促黄体生成素（LH）激素水平及子宫内膜厚度，采用SP免疫组化检测两组治疗前及12个月后子宫内膜腺体和间质中的VEGF、ER、PR的阳性表达。比较两组的临床疗效、不良反应。结果: 观察组的控制出血及完全止血时间均显著短于对照组，差异均有统计学意义（P<0.01）。治疗后，两组的血红蛋白水平均较治疗前显著升高（P<0.01），子宫内膜厚度显著减少（P<0.01），E2均较治疗前显著降低，P显著升高，且观察组改善程度较对照组更加明显，差异亦有统计学意义（P<0.01）。观察组患者治疗后的子宫内膜腺体及间质中的VEGF阳性率显著高于治疗前，ER、PR阳性率显著低于治疗前（P<0.01）。且治疗后观察组的VEGF阳性率高于对照组，ER、PR阳性率低于对照组（P<0.01）。观察组的总有效率为94.9%，显著高于对照组的79.5%（P<0.05）。两组的不良反应发生情况无统计学差异（P>0.05）。结论:LNG-IUS治疗DUB能更好的通过调节子宫内膜ER、PR、VEGF的表达，达到临床治疗效果，且较口服去氧孕烯炔雌醇片更加简便、有效、安全。

关键词: 左炔诺孕酮, 无排卵型功能失调性子宫出血, 血管内皮细胞生长因子, 雌激素受体, 孕激素受体

Abstract:

AIM: To observe the therapeutic effect of levonorgestrel intrauterine system on anovulatory dysfunctional uterine bleeding (DUB) and its impact on endometrial vascular endothelial growth factor（VEGF）, estrogen receptor（ER） and progesterone receptor(ER). METHODS: 78 patients with DUB from June 2015 to September 2016 were divided into control group and observation group, 39 cases in each group. On the basis of conventional treatment, the control group was given dexyprogesterone ethinyl estradiol tablets orally, the observation group levonorgestrel intrauterine system of treatment. The levels of gemoglobin (HGB), serum estradiol (E2), progesterone (P), secretion of follicle stimulating hormone (FSH), luteinizing hormone (LH) hormone in the two groups were measured before and after treatment. The expression of VEGF, ER and PR in the endometrial glands and stroma were measured by SP immunohistochemical method before and 12 months after treatment. The clinical efficacy and side effects were compared between the two groups. RESULTS: Control bleeding and complete hemostasis were significantly shorter in the observation group than in the control group (P<0.01). After treatment, the levels of hemoglobin in both groups were significantly higher than those before treatment (P<0.01), the endometrial thickness was significantly decreased (P<0.01), E2 was significantly lower than before treatment, P was significantly increased, and the observation group improved more than the control group, and the difference was statistically significant (P<0.01). The positive rate of VEGF in endometrial glands and stroma of observation group was significantly higher than that of before treatment (P<0.01), and the positive rates of ER and PR in gland and stroma were significantly lower than those before treatment (P<0.01). The positive rates of VEGF and VEGF in the observation group were higher than those in the control group. The positive rates of ER and PR were lower than those in the control group (P<0.01). The total effective rate of the observation group was 94.9%, which was significantly higher than that of the control group (79.5%, P<0.05). There were no statistically significant differences in adverse events between the two groups. CONCLUSION: Levonorgestrel intrauterine sustained release system can improve the expression of endometrial ER, PR and VEGF by DUB, and it is more, safe and effective than oral administration of dexyprogesterone ethinyl estradiol tablets.

Key words: levonorgestrel, anovulatory dysfunctional uterine bleeding, vascular endothelial growth factor, estrogen receptor, progesterone receptor

中图分类号:

R711.52

夏丽娟，何云芹，邵明君. 左炔诺孕酮宫内节育系统治疗无排卵型功能失调性子宫出血的疗效[J]. 中国临床药理学与治疗学, 2017, 22(6): 699-704.

XIA Lijuan, HE Yunqin, SHAO Mingjun. Efficacy of levonorgestrel intrauterine system in the treatment of dysfunctional uterine bleeding[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2017, 22(6): 699-704.

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