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

目的观察左炔诺孕酮宫内节育系统(曼月乐,LNG-IUS)治疗无排卵型功能失调性子宫出血(AUB-O)的疗效及其对子宫内膜血管内皮细胞生长因子、雌激素受体和孕激素受体的影响。方法将2015年6月~2016年9月我院收治的78例AUB-O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(妈富隆)口服,观察组予曼月乐治疗。比较两组治疗前与治疗12个月后血红蛋白水平(HGB)、血清雌二醇(E_2)、孕酮(P)、垂体分泌卵泡刺激素(FSH)、黄体生成素(LH)激素水平及子宫内膜厚度,采用SP免疫组织化学检测两组治疗前及12个月后子宫内膜腺体和间质中的血管内皮生长因子(VEGF)、雌激素受体(ER)、孕激素受体(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(P0.01)。治疗后,两组的血红蛋白水平均较治疗前显著升高(P0.01),子宫内膜厚度显著减少(P0.01),E_2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(P0.01)。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(P0.01)。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(P0.01)。观察组的的总有效率为94.9%,显著高于对照组的79.5%(P0.05)。两组的不良反应发生情况无统计学差异(P0.05)。结论曼月乐治疗AUB-O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,且较口服妈富隆更加简便、有效、安全。

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

Objective:To observe the therapeutic effect of levonorgestrel intrauterine system (LNG-IUS) on anovulatory dysfunctional uterine bleeding (AUB-O) and its effect on the expression of vascular endothelial growth factor (VEGF),estrogen receptor (ER) and progesterone receptor (PR) in endometrium.Methods:Seventy eight patients with AUB-O were collected from June 2015 to September 2016.The patients were divided into control group and observation group,39 patients in each group.On the basis of conventional therapy,the patients were given dexyprogesterone ethinyl estradiol tablets orally in control group,and the patients were given LNG-IUS treatment in observation group.The hemoglobin (HGB),serum E 2,progesterone (P),FSH,LH levels and endometrial thickness were measured before and after treatment in both groups.The expression of VEGF,ER,and PR in endometrium glands and stroma were determined before and 12 months after the treatment by SP immunohistochemistry.The clinical efficacy and side effects were compared between the two groups.Results:The controlled bleeding and complete hemostasis were significantly shorter in the observation group than those in the control group (P<0.01).The hemoglobin levels after treatment in both groups were significantly higher than those before treatment (P<0.01),and the endometrial thickness was significantly decreased (P<0.01).E 2 levels were significantly lower and P was significantly increased than those before treatment,and the improvement of the observation group was more significant than the control group (P<0.01).The positive rate of VEGF in the endometrial glands and stroma was significantly higher and the positive rate of ER and PR was significantly lower after treatment than before treatment in the observation group (P<0.01).The positive rate of VEGF was significantly higher and the positive rate of ER and PR was significantly lower in the observation group than those in the control group(P<0.01).The total effective rate of the observation group (94.9%) was significantly higher than that of the control group (79.5%) (P<0.05).There was no significant difference in adverse reaction between the two groups (P>0.05).Conclusions:LNG-IUS can regulate the endometrial ER,PR,VEGF expression in endometrium to achieve clinical treatment better.It is more convenient,effective and safe than oral administration of dexamethasone.