GnRH-a联合左炔诺孕酮宫内节育系统治疗子宫腺肌症疗效及对患者卵巢功能、CA125、CA153和CEA表达的影响  

Clinical efficacy of GnRH-a combined with a levonorgestrel-releasing intrauterine system(Mirena)in patients with adenomyosis and its effects on ovarian function,CA125,CA153 and CEA expression

作　　者：庞华琴 陈君霞[1] 阮雅文[1] Huaqin Pang;Junxia Chen;Yawen Ruan(Department of Gynecology,Shaoxing People's Hospital,Shaoxing 312099,Zhejiang Province,China)

机构地区：[1]绍兴市人民医院妇科,绍兴312099

出　　处：《中国基层医药》2022年第6期825-829,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省医药卫生科技计划项目(2018KY822)。

摘　　要：目的探讨促性腺激素释放激素激动剂(GnRH-a)联合左炔诺孕酮宫内节育系统(曼月乐)治疗子宫腺肌症疗效及对患者卵巢功能、糖类抗原125(CA125)、糖类抗原153(CA153)和癌胚抗原(CEA)表达的影响。方法选取绍兴市人民医院2017年9月至2020年9月收治的子宫腺肌症患者78例为观察对象,采用随机数字表法分为治疗组与对照组,每组39例。对照组患者给予左炔诺孕酮宫内节育系统治疗,治疗组在左炔诺孕酮宫内节育系统基础上前3个月给予GnRH-a治疗3个疗程。两组均于治疗6个月后评价。比较两组治疗前后痛经缓解程度、月经量、子宫体积和子宫内膜厚度、卵巢功能、CA125、CA153和CEA表达水平的变化。结果治疗组患者治疗后视觉模拟评分法(VAS)评分[(1.36±0.28)分]和月经失血图(PBAC)评分[(38.98±5.42)分]均低于对照组[(1.78±0.31)分、(63.42±6.75)分](t=6.27、17.63,均P<0.05)。治疗组患者治疗后子宫体积[(209.74±15.65)cm^(3)]和子宫内膜厚度[(7.37±0.57)mm]均低于对照组[(278.39±20.90)cm^(3)、(8.63±0.86)mm](t=16.45、7.62,均P<0.05)。两组患者治疗后血清促黄体生成素(LH)、卵泡刺激素(FSH)和雌二醇(E2)水平差异均无统计学意义(均P>0.05)。治疗组患者治疗后血清CA125[(26.87±7.21)U/L]、CA153[(23.12±7.38)U/mL]和CEA[(5.45±0.96)μg/L]均低于对照组[(49.93±8.97)U/L、(38.94±6.21)U/mL、(8.23±1.35)μg/L](t=12.51、10.24、10.48,均P<0.05)。结论GnRH-a联合左炔诺孕酮宫内节育系统治疗子宫腺肌症可显著缓解患者痛经、减少经量、缩小子宫体积及减少子宫内膜厚度,对卵巢功能无明显影响,可显著降低CA125、CA153和CEA水平,是子宫腺肌症一种安全有效的非手术治疗方法。Objective To investigate the efficacy of gonadotropin releasing hormone agonist(GnRH-a)combined with a levonorgestrel-releasing intrauterine system(Mirena)in patients with adenomyosis and its effects on ovarian function,carbohydrate antigen(CA)125,CA153 and carcino-embryonic antigen(CEA)expression.Methods Seventy-eight patients with adenomyosis who received treatment from September 2017 to September 2020 in Shaoxing People's Hospital were included in this study.They were randomly divided into treatment and control groups(n=39/group).Patients in the control group were treated with a levonorgestrel-releasing intrauterine system.Patients in the treatment group were treated with GnRH-a,once per month in the first 3 months based on treatment with a levonorgestrel-releasing intrauterine system.After 6 months of treatment,changes in dysmenorrheal relief,menstrual volume,uterine volume,endometrial thickness,ovarian function,CA125,CA153 and CEA levels relative to before treatment were compared.Results Visual analog scale score and pictorial blood assessment chart score in the treatment group were(1.36±0.28)points and(38.98±5.42)points,which were significantly lower than those in the control group[(1.78±0.31)points,(63.42±6.75)points,t=6.27,17.63,both P<0.05].Uterine volume and endometrial thickness in the treatment group were(209.74±15.65)cm^(3) and(7.37±0.57)mm,respectively,which were significantly lower than those in the control group[(278.39±20.90)cm^(3),(8.63±0.86)mm,t=16.45,7.62,P<0.05].There were no significant differences in serum levels of luteinizing hormone,follicle stimulating hormone and estradiol between the two groups(all P>0.05).Serum CA125,CA153 and CEA levels in the treatment group were(26.87±7.21)U/L,(23.12±7.38)U/mL and(5.45±0.96)μg/L,respectively,which were significantly lower than those in the control group[(49.93±8.97)U/L,(38.94±6.21)U/mL,(8.23±1.35)μg/L,t=12.51,10.24,10.48,P<0.05].Conclusion GnRH-a combined with a levonorgestrel-releasing intrauterine system(Mirena)can markedly relie

关 键 词：促性腺素释放激素 子宫腺肌病 卵巢功能试验 左炔诺孕酮 宫内避孕器 含药 抗原 肿瘤相关 碳水化合物 癌胚抗原 

分 类 号：R711.71[医药卫生—妇产科学]