Abstract：Objective: To investigate the influence of high-intensity focused ultrasound (HIFU) combined with leuprorelin and Mirena (levonorgestrel intrauterine system) on the levels of sex hormones, cancer antigen (CA125) and anti-mullerian hormone (AMH) in patients with adenomyosis (AM). Methods: A total of 182 patients with AM were enrolled in this study from June 2021 to June 2022. They were divided into HIFU group (n=20, receiving HIFU treatment, refusing to inject leuprorelin and placing Mirena) and HIFU + leuprorelin group (n=61, receiving HIFU combined with leuprorelin treatment, and refusing to place Mirena), HIFU + leuprorelin + Mirena group (n=101, receiving HIFU combined with leuprorelin and Mirena treatment). Three groups of patients were treated with HIFU once and followed up for 2 years. The clinical efficacy, sex hormones levels [estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone (FSH)], CA125, AMH, C-reactive protein (CRP), uterine volume, menstrual volume, endometrial thickness and pain score (VAS) before and after treatment and incidence rates of adverse reactions during treatment were compared among the three groups. Results: The HIFU + leuprorelin + Mirena group had higher total clinical effective rate after treatment than the HIFU + leuprorelin group and HIFU group (P<0.05). Before treatment, the E2, LH and FSH levels among the three groups were not statistically different (P>0.05). The levels of E2, LH and FSH in the three groups were obviously declined after treatment than those before treatment (P<0.05). After treatment, the differences of E2, LH and FSH were greater in HIFU + leuprorelin + Mirena groupthan those in HIFU + leuprorelin group and HIFU group, and were greater in HIFU + leuprorelin group than those in HIFU group (P<0.05). The levels of CA125, CRP and AMH were not statistically different among the three groups before treatment (P>0.05). After treatment, the CA125 and CRP levels in the three groups were lowered significantly (P<0.05), but the AMH level was not obviously changed after treatment (P>0.05). The differences of CA125 and CRP in HIFU+ leuprorelin + Mirena group after treatment were greater than those in HIFU+ leuprorelin and HIFU groups, and the differences in HIFU+ leuprorelin group were greater than those in HIFU group (P<0.05). Before treatment, no statistical differences were shown in uterine volume, menstrual volume, endometrial thickness and VAS score among the three groups (P>0.05). After treatment, the uterine volume, menstrual volume, endometrial thickness and VAS score were significantly reduced in the three groups compared with those before treatment (P<0.05). The differences of uterine volume, menstrual volume, endometrial thickness and VAS score in HIFU+ leuprorelin + Mirena group after treatment were greater than those in HIFU+ leuprorelin group and HIFU group, and were greater in HIFU+ leuprorelin group than those in HIFU group (P<0.05). During treatment, there were no statistical differences in the incidence rates of adverse reactions among the three groups (P>0.05). After 2 years of follow-up, 3 patients in HIFU group had recurrence symptoms, mainly manifested as increased menstrual volume and aggravated dysmenorrhea. The efficacy in HIFU + leuprorelin + Mirena group was higher than that in HIFU + leuprorelin group and HIFU group (P<0.05). Conclusion: HIFU combined with leuprorelin and Mirena can enhance the therapeutic effect of AM patients, effectively regulate the levels of sex hormones and serum indicators, reduce the uterine volume and endometrial thickness, lower the menstrual volume, and relieve the pain, and it has no significant damage to ovarian reserve function, with good safety.
唐秋林, 唐辰典, 陈桂清. 高强度聚焦超声联合亮丙瑞林曼月乐节育环对子宫腺肌病患者性激素CA125及AMH水平的影响[J]. 河北医学, 2024, 30(10): 1659-1665.
TANG Qiulin, TANG Chendian, CHEN Guiqing. Influence of High-intensity Focused Ultrasound Combined with Leuprorelin and Mirena on Sex Hormones CA125 and AMH Levels in Patients with Adenomyosis. HeBei Med, 2024, 30(10): 1659-1665.
[1] Galati G,Ruggiero G,Grobberio A,et al.The role of different medical therapies in the management of adenomyosis: a systematic review and meta-analysis[J].Clin Med,2024,13(11):3302. [2] Xu P,Ling S,Hu E,et al.Efficacy of hysteroscopic levonorgestrelreleasing intrauterine device fixation in the treatment of adenomyosis: a cohort study[J].Biomed Rep,2024,21(1):109. [3] 关琼,杨爱玉,吴绪峰.子宫腺肌病患者在醋酸亮丙瑞林基础上联合左炔诺孕酮宫内节育系统或地诺孕素治疗的效果比较[J].中国医药,2023,18(1):86-90. [4] 郭爱玲,刘萍,马艳,等.GnRH-α联合曼月乐环对子宫腺肌病患者卵巢功能、性激素水平及性生活质量的影响[J].湖南师范大学学报(医学版),2021,18(4):75-78. [5] 中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国中医药科技出版社,2002.134-139. [6] 郭孙伟,刘惜时.子宫腺肌病发病机制和病理生理研究进展[J].山东大学学报(医学版),2022,60(7):6-19. [7] 苏萍,韩健,刘强,等.HIFU联合GnRH-a及LNG-IUS序贯治疗子宫腺肌病痛经的临床研究[J].中国生育健康杂志,2020,31(5):465-468. [8] Siedek F,Yeo SY,Heijman E,et al.Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU): technical background and overview of current clinical applications (Part 1) [J].Rofo,2019,191(6):522-530. [9] Chen S,Wang J,Sun W,et al.Efficacy of the levonorgestrel-releasing intrauterine device is associated with different subtypes of adenomyosis: a retrospective study[J].Ann Transl Med,2020,8(21):1356. [10] Tang Y,Ming-Tao Y,Xiang RM,et al.Preoperative CA125 as a risk factor for symptom recurrence of adenomyosis after ultrasound-guided high-intensity focused ultrasound ablation surgery[J].Int Hyperthermia,2022,39(1):1164-1169.
2024, Vol. 30 
冀公网安备13080202000677号