目的 探讨止痛化癥胶囊联合左炔诺孕酮宫内节育系统治疗子宫腺肌病的临床疗效。方法 选取2020年3月—2021年12月郑州市金水区总医院收治的92例子宫腺肌病患者，根据随机数字表法将所有患者分为对照组和治疗组，每组各46例。对照组患者于月经第5～7天将左炔诺孕酮宫内节育系统放置于宫腔内，一次放置，随访观察6个月。治疗组在对照组基础上于饭后口服止痛化癥胶囊，4粒/次，3次/d，持续治疗6个月。观察两组的临床疗效，比较两组的血流动力学、子宫体积、疼痛程度和血清指标水平。结果 治疗后，治疗组的总有效率为95.65%，明显高于对照组的总有效率80.43%，差异有统计学意义（P<0.05）。治疗后，两组的平均血流速度（V_m）、脐动脉收缩期与舒张期的血流速度比值（S/D）、搏动指数（PI）明显低于治疗前（P<0.05）；治疗组的V_m、S/D、PI低于对照组，差异有统计学意义（P<0.05）。治疗后，两组的子宫体积、视觉模拟评分法（VAS）评分显著降低（P<0.05），且治疗组子宫体积、VAS评分较对照组降低更明显（P<0.05）。治疗后，两组的血清趋化因子配体-12（CXCL-12）、胰岛素样生长因子-1（IGF-1）、转化生长因子-β₁（TGF-β₁）水平低于治疗前（P<0.05），且治疗组血清CXCL-12、IGF-1、TGF-β₁水平较对照组更低（P<0.05）。结论 止痛化癥胶囊联合左炔诺孕酮宫内节育系统治疗子宫腺肌病的疗效确切，能够降低疼痛程度，改善血流动力学指标，有助于抑制病灶生长。

Objective To investigate the clinical effect of Zhitong Huazheng Capsules combined with Levonorgestrel Intrauterine System in treatment of adenomyosis. Methods Patients (92 cases) with adenomyosis in the General Hospital of Jinshui District Zhengzhou City from March 2020 to December 2021 were divided into control and treatment groups according to the random number table method, and each group had 46 cases. Patients in the control group were placed the levonorgestrel intrauterine contraceptive system in the uterine cavity on the 5th to 7th day of menstruation, and were followed up for 6 months. Patients in the treatment group were po administered with Zhitong Huazheng Capsules after meals on the basis of the control group, 4 grains/time, three times daily, and continued the treatment for 6 months. After treatment, the clinical efficacies were evaluated, and hemodynamics, uterine volume, degree of pain, serum factors in two groups were compared. Results After treatment, total effective rate of the treatment group was 95.65%, which was significantly higher than 80.43% of the control group (P < 0.05). After treatment, the V_m, S/D, and PI of two groups were significantly lower than those before treatment (P < 0.05). The V_m, S/D, and PI of the treatment group were lower than those of the control group (P < 0.05). After treatment, the uterine volume and VAS score of two groups were significantly decreased (P < 0.05), and the uterine volume and VAS score of the treatment group were significantly lower than that of the control group (P < 0.05). After treatment, the serum levels of CXCL-12, IGF-1, and TGF-β₁ in the two groups were lower than those before treatment (P < 0.05), and the serum levels of CXCL -12, IGF-1, and TGF-β₁ in the treatment group were lower than those in the control group (P < 0.05). Conclusion Zhitong Huazheng Capsules combined with Levonorgestrel Intrauterine System has clinical curative effect in treatment of adenomyosis, which can reduce the degree of pain, improve the level of hemodynamics, help to inhibit the growth of lesions.

R984