目的 探討屈螺酮炔雌醇聯(lián)合左炔諾孕酮宮內(nèi)緩釋系統(tǒng)（LNG-IUS）治療子宮腺肌病的療效，并檢測相關(guān)激素水平。方法 選取2009年6月-2013年6月浚縣人民醫(yī)院就診的子宮腺肌病患者150例，隨機分為治療組（75例）和對照組（75例），對照組患者在月經(jīng)期第3天由專門的醫(yī)務(wù)人員放置LNG-IUS。治療組患者在此基礎(chǔ)上口服屈螺酮炔雌醇片，放置LNG-IUS當(dāng)天開始服用，1片/d，每個周期21 d，服用一個周期后停用7 d。兩組患者均連續(xù)治療3個周期。比較兩組患者痛經(jīng)、經(jīng)量、子宮體積以及陰道點滴出血時間的發(fā)生情況。并測定兩組治療前后孕激素（PRL）、雌二醇（E₂）、卵泡刺激素（FSH）、黃體生成素（LH）的水平。結(jié)果 治療后，兩組患者痛經(jīng)、經(jīng)量評分均較治療前得到顯著改善，同組治療前后差異有統(tǒng)計學(xué)意義（P<0.05）；治療組隨訪1、3個月痛經(jīng)評分、月經(jīng)失血圖（PBAC）評分均顯著低于對照組，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組患者子宮體積均顯著減小，同組治療前后差異有統(tǒng)計學(xué)意義（P<0.05）；治療組隨訪1、3、6個月的子宮體積顯著小于對照組，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）；治療后治療組子宮點滴出血時間顯著低于對照組（P<0.05）。治療后，治療組E₂較治療前顯著升高，F(xiàn)SH、LH較治療前顯著降低，治療前后差異有統(tǒng)計學(xué)意義（P<0.05）；治療后，治療組這些指標(biāo)與對照組相比差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 屈螺酮炔雌醇聯(lián)合LNG-IUS治療子宮腺肌病有較好的臨床療效，能夠顯著改善患者痛經(jīng)癥狀、減少月經(jīng)量和陰道點滴出血時間，值得臨床推廣應(yīng)用。

Objective To explore the clinical efficacy of drospirenone ethinylestradiol combined with levonorgestrel intrauterine releasing system (LNG-IUS) in the treatment of adenomyosis, and the related hormone level was detected. Methods Patients (150 cases) with adenomyosis for the treatment in Junxian People's Hospital from June 2009 to June 2013 were randomly divided into treatment (75 cases) and control (75 cases) groups. The patients in the control group were placed LNG-IUS by specialized medical personnel in 3 d of menstrual period. The patients in the treatment group were po administered with Drospirenone Ethinylestradiol Tablets on the basis of the control group when LNG-IUS was placed, 1 tablet/d. Each cycle was 21 d, and patients took one cycle then stopped, without treatment for 7 d. The patients in two groups were treated for three cycles. Dysmenorrhea, menstrual volume, uterus volume, and bleeding time of vaginal intravenous drip in two groups were compared. And the levels of progesterone (PRL), estradiol (E₂), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were determined in two groups before and after the treatment. Results After treatment, the score of dysmenorrheal and menstrual volume were significantly improved, and the differences was statically significant in the same group before and after treatment (P < 0.05). Dysmenorrhea and PBAC scores in the treatment group were significantly lower than those in the control group followed up for 1 and 3 months, with significant difference between the two groups (P < 0.05). After treatment, the uterine volumes in two groups were significantly decreased, and the difference was statically significant in the same group before and after treatment (P < 0.05). The uterine volume in treatment group was significantly less than that in control group followed up for 1, 3, and 6 months, with significant difference between the two groups (P < 0.05). After treatment, bleeding time of vaginal intravenous drip in treatment group was lower than that in control group (P < 0.05). After treatment, E₂ in treatment group was significantly higher, while the levels of FSH and LH were significantly reduced, and the difference was statistically significant before and after treatment. After treatment, these indicators in treatment group were statistically significant compared with the control group (P < 0.05). Conclusion Drospirenone ethinylestradiol combined with LNG-IUS has a good clinical efficacy in the treatment of adenomyosis, can significantly improve the dysmenorrhea, and reduce menstrual volume and bleeding time of vaginal intravenous drip, which is worthy of clinical application.

國家自然科學(xué)基金資助項目（30973179）