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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。
Objective: To investigate the possible effect of levonorgestrel-releasing intrauterine system (LNG-IUS) on the treatment of ADS dysmenorrhea by detecting the level of prostaglandin E2 (PGE2) in patients with adenomyosis (ADS) Sex. Methods: 41 patients with LNG-IUS due to dysmenorrhea were divided into treatment group (n = 32) and treatment ineffective group (n = 9) according to their relief. The levels of PGE2 in serum before and 6 months after LNG-IUS placement were determined by ELISA. The effects of LNG-IUS on serum PGE2 levels in ADS patients and the effect of LNG-IUS on dysmenorrhea Relevance. Results: The serum level of PGE2 in effective group was 20.95 ± 3.07 pg / ml before treatment and 5.56 ± 1.72 pg / ml after 6 months of treatment, the difference was statistically significant (P <0.05). The level of PGE2 in the invalid group was 5.74 ± 1.12 pg / ml before treatment and 4.95 ± 1.39 pg / ml after 6 months of treatment, with no significant difference between the two groups (P> 0.05). Pre-treatment effective group serum PGE2 concentration was significantly higher than the ineffective group (P <0.05). There was a positive correlation between the change of visual analogue scale (VAS) and serum PGE2 level 6 months after the LNG-IUS was placed in the patient. The higher the serum PGE2 concentration, the more the VAS decreased (P <0.05). CONCLUSIONS: PGE2 may be associated with dysmenorrhea in some ADS patients. LNG-IUS relieves dysmenorrhea by decreasing PGE2 concentration. Therefore, LNG-IUS can be used to treat dysmenorrhea in patients with high PGE2 level, and other methods to treat dysmenorrhea are suggested in patients with low PGE2 level.