血清前列腺素E_2预测左炔诺孕酮缓释系统治疗子宫腺肌病痛经效果的价值探讨

目的:探讨子宫腺肌病(adenomyosis,ADS)患者血清前列腺素E2(prostaglandin E2,PGE2)水平预测左炔诺孕酮缓释系统(levonorgestrel-releasing intrauterine system,LNG-IUS)治疗ADS痛经效果的可能性。方法:因ADS痛经放置LNG-IUS的患者41例,根据痛经缓解情况分为治疗有效组(n=32)和治疗无效组(n=9)。ELISA法测定放置LNG-IUS前及放置后6个月血清PGE2水平并进行组内、组间比较,分析LNG-IUS对ADS痛经患者血清PGE2水平的影响以及血清PGE2水平与LNG-IUS治疗痛经效果的相关性。结果:有效组血清PGE2水平治疗前为20.95±3.07 pg/ml,治疗6个月后为5.56±1.72 pg/ml,差异有统计学意义(P<0.05)。无效组血清PGE2水平治疗前为5.74±1.12 pg/ml,治疗6个月后为4.95±1.39 pg/ml,两者无统计学差异(P>0.05)。治疗前有效组血清PGE2浓度显著高于无效组(P<0.05)。患者放置LNG-IUS 6个月后视觉模拟评分(visual ana-logue scale,VAS)变化与放置前血清PGE2水平呈正相关,血清PGE2浓度越高,VAS下降越明显(P<0.05)。结论:PGE2可能与部分ADS患者痛经的发生有关,LNG-IUS通过降低PGE2浓度而缓解痛经,因此高水平PGE2患者可选择LNG-IUS治疗痛经,低水平PGE2患者则建议选择其他方式治疗痛经。

Predicted Value of Serum Prostaglandin E2on the Dysmenorrheal Treatment Effect in Adenomyosis Patients with Levonorgestrel-releasing Intrauterine System

Objective: To explore the possibility of the serum prostaglandin E2(PGE2) level predictive value on the dysmenorrheal treatment effect in the adenomyosis(ADS) patients with levonorgestrel-releasing intrauterine system(LNG-IUS).Methods: Forty-one ADS patients treated with LNG-IUS because of dysmenorrhea were collected.These patients were divided into effective group(n=32) and noneffective group(n=9) according to the effect of relieving dysmenorrhea.The serum PGE2level before and after 6 months of the LNG-IUS treatment were compared by ELISA,and the influence of serum PGE2level caused by LNGIUS and the correlation between the serum PGE2 level and the dysmenorrheal treatment effect with LNG-IUS were analyzed.Results: The serum PGE2concentrations were 20.95 ± 3.07 pg/ml and 5.56 ± 1.72 pg/ml in the effective group before and after 6 months with LNG-IUS treatment,there was a significant difference between them(P<0.05).The serum PGE2concentrations were 5.74 ± 1.12 pg/ml and 4.95 ± 1.39 pg/ml in the noneffective group before and after 6 months with LNG-IUS treatment,there was no significant difference between them.The serum PGE2 concentration in the effective group was significantly higher than that in the noneffective group(P<0.05).The change of visual analogue scale(VAS) score after 6 months of LNG-IUS treatment had a positive correlation with the serum PGE2 level before LNG-IUS treatment,the higher serum PGE2concentration was,the more obviously the VAS score decreased(r=0.845,P<0.05).Conclusion: PGE2 might be involved in the occurrence of ADS dysmenorrhea and LNG-IUS relieved dysmenorrhea through decreasing the PGE2 level.It is suggested that the patients with high PGE2 level choose LNG-IUS to treat their dysmenorrhea and the patients with low PGE2 level use other ways to treat dysmenorrhea.