高强度聚焦超声联合亮丙瑞林曼月乐节育环对子宫腺肌病患者性激素CA125及AMH水平的影响  

Influence of High-intensity Focused Ultrasound Combined with Leuprorelin and Mirena on Sex Hormones CA125 and AMH Levels in Patients with Adenomyosis

作　　者：唐秋林 唐辰典 陈桂清 TANG Qiulin;TANG Chendian;CHEN Guiqing(Suining Central Hospital,Sichuan Suining 629000,China)

机构地区：[1]四川省遂宁市中心医院妇科,四川遂宁629000

出　　处：《河北医学》2024年第10期1659-1666,共8页Hebei Medicine

基　　金：2020年度超声医学工程国家重点实验室开放课题,(编号:2020KFKT009)。

摘　　要：目的:探讨高强度聚焦超声(HIFU)联合亮丙瑞林、曼月乐节育环对子宫腺肌病(AM)患者性激素、癌抗原(CA125)及抗缪勒管激素(AMH)水平的影响。方法:本研究共纳入182例AM患者,收治时间2021年6月至2022年6月,根据治疗方式分为HIFU组(n=20,接受HIFU治疗,拒绝注射亮丙瑞林和安置曼月乐节育环)、HIFU+亮丙瑞林组(n=61,接受HIFU联合亮丙瑞林治疗,拒绝安置曼月乐节育环)、HIFU+亮丙瑞林+曼月乐组(n=101,接受HIFU联合亮丙瑞林、曼月乐节育环治疗)。三组患者均治疗1次HIFU,并随访2年。比较三组治疗前后临床疗效、性激素水平[雌二醇(E2)、黄体生成素(LH)、促卵泡激素(FSH)]、CA125、AMH、C-反应蛋白(CRP)水平,子宫体积、月经量、子宫内膜厚度、疼痛评分(VAS)及治疗期间不良反应发生率。结果:治疗后,HIFU+亮丙瑞林+曼月乐组临床总有效率为91.09%,高于HIFU+亮丙瑞林组和HIFU组(P<0.05)。治疗前,三组E2、LH、FSH水平差异无统计学意义(P>0.05)。治疗后,三组E2、LH、FSH水平较治疗前明显降低(P<0.05)。治疗后,HIFU+亮丙瑞林+曼月乐组E2、LH、FSH的差值大于HIFU+亮丙瑞林组和HIFU组,HIFU+亮丙瑞林组E2、LH、FSH的差值大于HIFU组(P<0.05)治疗前,三组CA125、CRP、AMH水平差异无统计学意义(P>0.05)。治疗后,三组CA125、CRP水平较治疗前均明显降低(P<0.05),而三组AMH水平在治疗后无明显变化(P>0.05)。治疗后,HIFU+亮丙瑞林+曼月乐组的CA125、CRP差值大于HIFU+亮丙瑞林组和HIFU组,HIFU+亮丙瑞林组CA125、CRP的差值大于HIFU组(P<0.05)。治疗前,三组的子宫体积、月经量、子宫内膜厚度及VAS评分差异无统计学意义(P>0.05)。治疗后,三组的子宫体积、月经量、子宫内膜厚度及VAS评分均较治疗前显著减少(P<0.05)。治疗后,HIFU+亮丙瑞林+曼月乐组子宫体积、月经量、子宫内膜厚度及VAS评分差值大于HIFU+亮丙瑞林组和HIFU组,HIFU+亮丙瑞林组的子宫体积Objective:To investigate the influence of high-intensity focused ultrasound(HIFU)combined with leuprorelin and Mirena(levonorgestrel intrauterine system)on the levels of sex hormones,cancer antigen(CA125)and anti-mullerian hormone(AMH)in patients with adenomyosis(AM).Methods:A total of 182 patients with AM were enrolled in this study from June 2021 to June 2022.They were divided into HIFU group(n=20,receiving HIFU treatment,refusing to inject leuprorelin and placing Mirena)and HIFU+leuprorelin group(n=61,receiving HIFU combined with leuprorelin treatment,and refusing to place Mirena),HIFU+leuprorelin+Mirena group(n=101,receiving HIFU combined with leuprorelin and Mirena treatment).Three groups of patients were treated with HIFU once and followed up for 2 years.The clinical efficacy,sex hormones levels[estradiol(E2),luteinizing hormone(LH),follicle stimulating hormone(FSH)],CA125,AMH,C-reactive protein(CRP),uterine volume,menstrual volume,endometrial thickness and pain score(VAS)before and after treatment and incidence rates of adverse reactions during treatment were compared among the three groups.Results:The HIFU+leuprorelin+Mirena group had higher total clinical effective rate after treatment than the HIFU+leuprorelin group and HIFU group(P<0.05).Before treatment,the E2,LH and FSH levels among the three groups were not statistically different(P>0.05).The levels of E2,LH and FSH in the three groups were obviously declined after treatment than those before treatment(P<0.05).After treatment,the differences of E2,LH and FSH were greater in HIFU+leuprorelin+Mirena groupthan those in HIFU+leuprorelin group and HIFU group,and were greater in HIFU+leuprorelin group than those in HIFU group(P<0.05).The levels of CA125,CRP and AMH were not statistically different among the three groups before treatment(P>0.05).After treatment,the CA125 and CRP levels in the three groups were lowered significantly(P<0.05),but the AMH level was not obviously changed after treatment(P>0.05).The differences of CA125 and CRP in HIFU+leuprorel

关 键 词：高强度聚焦超声 亮丙瑞林 曼月乐节育环 子宫腺肌病 性激素 癌抗原125 抗缪勒管激素 

分 类 号：R711.71[医药卫生—妇产科学]