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目的探讨左炔诺孕酮宫内缓释系统(LNG-IUS)治疗子宫内膜增生的临床疗效及机制。方法选取2013年2月-2015年4月于济钢集团有限公司总医院就诊的无排卵性功能失调性子宫出血患者,其中经病理检查确诊为单纯性子宫内膜增生和复杂性子宫内膜增生的患者纳入研究,共180例。按照随机数字表将所有患者随机分为治疗组和对照组。治疗组放置LNG-IUS,对照组口服醋酸甲羟孕酮,共服用3个月经周期。观察两组患者治疗前后血红蛋白水平,月经周期中期子宫内膜厚度,子宫内膜腺体中的雌、孕激素受体评分,血清卵泡刺激素(FSH)、黄体生成素(LH)、孕酮(P)和雌二醇(E_2)水平,月经量PBAC评分,治疗组治疗前后子宫内膜组织学变化。结果治疗前,两组血红蛋白水平和子宫内膜厚度比较,差异均无统计学意义(P>0.05);治疗后,两组血红蛋白水平和子宫内膜厚度比较,差异均有统计学意义(P<0.05)。治疗前,两组雌、孕激素受体及月经量PBAC评分比较,差异均无统计学意义(P>0.05)。治疗后,两组雌激素受体评分比较,差异无统计学意义(P>0.05);孕激素受体及月经量PBAC评分比较,差异均有统计学意义(P<0.05)。治疗组治疗前后FSH和LH水平比较差异无统计学意义(P>0.05),P和E_2水平比较差异有统计学意义(P<0.05)。对照组治疗前后FSH、LH、P、E_2水平比较差异无统计学意义(P>0.05)。结论 LNG-IUS可能通过调节雌、孕激素受体数量调控性激素水平,进而有效治疗子宫内膜增生。
Objective To investigate the clinical efficacy and mechanism of levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of endometrial hyperplasia. Methods From February 2013 to April 2015, patients with anovulatory dysfunctional uterine bleeding who visited the General Hospital of Jinan Iron and Steel Group Co., Ltd. were diagnosed as simple endometrial hyperplasia and complicated endometrial hyperplasia by pathological examination Of patients included in the study, a total of 180 cases. According to random number table, all patients were randomly divided into treatment group and control group. LNG-IUS was placed in the treatment group, and medroxyprogesterone acetate was given to the control group, taking a total of 3 menstrual cycles. The levels of hemoglobin, the endometrial thickness in the mid-menstrual cycle, estrogen and progesterone receptor scores in endometrial glands, serum follicle stimulating hormone (FSH), luteinizing hormone (LH) and progesterone P) and estradiol (E2) levels, menstrual flow PBAC score, the treatment group before and after treatment of endometrial histological changes. Results Before treatment, there was no significant difference in hemoglobin level and endometrial thickness between the two groups (P> 0.05). After treatment, hemoglobin levels and endometrial thickness were significantly different between the two groups (P < 0.05). Before treatment, there was no significant difference in the two groups of estrogen and progesterone receptor and menstrual volume PBAC score (P> 0.05). After treatment, there was no significant difference in estrogen receptor score between the two groups (P> 0.05). There was significant difference between progesterone receptor and menstrual volume PBAC score (P <0.05). There was no significant difference in the levels of FSH and LH between the two groups before and after treatment (P> 0.05). There was significant difference between the two groups (P <0.05). The levels of FSH, LH, P and E_2 in the control group had no significant difference before and after treatment (P> 0.05). CONCLUSION: LNG-IUS may regulate hormones by regulating the number of estrogen and progesterone receptors, and then effectively treat endometrial hyperplasia.