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目的观察和比较左炔诺孕酮宫内缓释系统(LNG-IUS)和去氧孕烯炔雌醇治疗无排卵性功能失调性子宫出血(功血)的疗效。方法75例无排卵性功血患者随机分为LNG-IUS组(n=38)和去氧孕烯炔雌醇组(n=37)进行治疗,对治疗前及治疗6mo的月经情况、血红蛋白、生殖激素水平、肝功能、血脂、体重指数及不良反应等进行统计。结果LNG-IUS组和去氧孕烯炔雌醇组患者月经量评分(据月经失血图法)的变化值分别为(498±s102)vs.(312±95)分,血红蛋白增加值为(33±14)vs.(16±7)g·L-1。治疗后月经量明显减少,血红蛋白显著增加(P<0.01);LNG-IUS组比去氧孕烯炔雌醇组月经量和血红蛋白改善作用更显著(P<0.05,P<0.01)。2组痛经均无明显改善。与治疗前相比,LNG-IUS组生殖激素水平无明显变化(P>0.05),去氧孕烯炔雌醇组雌二醇和孕酮水平下降(P<0.01);2组血脂各指标均在正常范围,LNG-IUS组高密度脂蛋白和载脂蛋白A显著上升(P<0.01),三酰甘油、总胆固醇、低密度脂蛋白和载脂蛋白B显著下降(P<0.01);2组肝功能和体重指数无明显变化(P>0.05)。不良反应均轻微、可耐受。结论LNG-IUS和去氧孕烯炔雌醇治疗无排卵性功血效果明显,LNG-IUS较去氧孕烯炔雌醇疗效更为显著,使用更具优势。
Objective To observe and compare the efficacy of levonorgestrel-releasing intrauterine system (LNG-IUS) and desogestrel ethinyl estradiol in the treatment of anovulatory dysfunctional uterine bleeding (dysfunctional uterine bleeding). Methods A total of 75 patients with anovulatory dysfunctional uterine bleeding were randomly divided into LNG-IUS group (n = 38) and desogestrel ethinyl estradiol group (n = 37). The menstrual status, hemoglobin, Reproductive hormone levels, liver function, blood lipids, body mass index and adverse reactions statistics. Results The values of menstrual flow (498 ± s102 vs. 312 ± 95) and LN (33) in LNG-IUS group and desogestrel ethinyl estradiol group were respectively ± 14) vs. (16 ± 7) g · L-1. After treatment, the amount of menstruation was significantly reduced and hemoglobin was significantly increased (P <0.01). The effect of LNG-IUS group on menstrual flow and hemoglobin was better than that of ethinyl estradiol group (P <0.05, P <0.01). 2 groups of dysmenorrhea no significant improvement. Compared with those before treatment, the level of reproductive hormone in LNG-IUS group had no significant change (P> 0.05), while the level of estradiol and progesterone in desoxygestrel ethinyl estradiol group decreased (P <0.01) Normal range, high density lipoprotein and apolipoprotein A in LNG-IUS group increased significantly (P <0.01), and triglyceride, total cholesterol, low density lipoprotein and apolipoprotein B in LNG-IUS group decreased significantly Liver function and body mass index had no significant change (P> 0.05). Adverse reactions are mild, tolerable. Conclusion LNG-IUS and ethinyl-desogestrel are effective in treating anovulatory dysfunctional uterine bleeding. LNG-IUS is more effective than ethinyl-desogestrel and has more advantages in use.