目的 探讨屈螺酮炔雌醇联合左炔诺孕酮宫内缓释系统（LNG-IUS）治疗子宫腺肌病的疗效，并检测相关激素水平。方法 选取2009年6月-2013年6月浚县人民医院就诊的子宫腺肌病患者150例，随机分为治疗组（75例）和对照组（75例），对照组患者在月经期第3天由专门的医务人员放置LNG-IUS。治疗组患者在此基础上口服屈螺酮炔雌醇片，放置LNG-IUS当天开始服用，1片/d，每个周期21 d，服用一个周期后停用7 d。两组患者均连续治疗3个周期。比较两组患者痛经、经量、子宫体积以及阴道点滴出血时间的发生情况。并测定两组治疗前后孕激素（PRL）、雌二醇（E₂）、卵泡刺激素（FSH）、黄体生成素（LH）的水平。结果 治疗后，两组患者痛经、经量评分均较治疗前得到显著改善，同组治疗前后差异有统计学意义（P<0.05）；治疗组随访1、3个月痛经评分、月经失血图（PBAC）评分均显著低于对照组，两组比较差异有统计学意义（P<0.05）。治疗后，两组患者子宫体积均显著减小，同组治疗前后差异有统计学意义（P<0.05）；治疗组随访1、3、6个月的子宫体积显著小于对照组，两组比较差异有统计学意义（P<0.05）；治疗后治疗组子宫点滴出血时间显著低于对照组（P<0.05）。治疗后，治疗组E₂较治疗前显著升高，FSH、LH较治疗前显著降低，治疗前后差异有统计学意义（P<0.05）；治疗后，治疗组这些指标与对照组相比差异有统计学意义（P<0.05）。结论 屈螺酮炔雌醇联合LNG-IUS治疗子宫腺肌病有较好的临床疗效，能够显著改善患者痛经症状、减少月经量和阴道点滴出血时间，值得临床推广应用。

Objective To explore the clinical efficacy of drospirenone ethinylestradiol combined with levonorgestrel intrauterine releasing system (LNG-IUS) in the treatment of adenomyosis, and the related hormone level was detected. Methods Patients (150 cases) with adenomyosis for the treatment in Junxian People's Hospital from June 2009 to June 2013 were randomly divided into treatment (75 cases) and control (75 cases) groups. The patients in the control group were placed LNG-IUS by specialized medical personnel in 3 d of menstrual period. The patients in the treatment group were po administered with Drospirenone Ethinylestradiol Tablets on the basis of the control group when LNG-IUS was placed, 1 tablet/d. Each cycle was 21 d, and patients took one cycle then stopped, without treatment for 7 d. The patients in two groups were treated for three cycles. Dysmenorrhea, menstrual volume, uterus volume, and bleeding time of vaginal intravenous drip in two groups were compared. And the levels of progesterone (PRL), estradiol (E₂), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were determined in two groups before and after the treatment. Results After treatment, the score of dysmenorrheal and menstrual volume were significantly improved, and the differences was statically significant in the same group before and after treatment (P < 0.05). Dysmenorrhea and PBAC scores in the treatment group were significantly lower than those in the control group followed up for 1 and 3 months, with significant difference between the two groups (P < 0.05). After treatment, the uterine volumes in two groups were significantly decreased, and the difference was statically significant in the same group before and after treatment (P < 0.05). The uterine volume in treatment group was significantly less than that in control group followed up for 1, 3, and 6 months, with significant difference between the two groups (P < 0.05). After treatment, bleeding time of vaginal intravenous drip in treatment group was lower than that in control group (P < 0.05). After treatment, E₂ in treatment group was significantly higher, while the levels of FSH and LH were significantly reduced, and the difference was statistically significant before and after treatment. After treatment, these indicators in treatment group were statistically significant compared with the control group (P < 0.05). Conclusion Drospirenone ethinylestradiol combined with LNG-IUS has a good clinical efficacy in the treatment of adenomyosis, can significantly improve the dysmenorrhea, and reduce menstrual volume and bleeding time of vaginal intravenous drip, which is worthy of clinical application.

国家自然科学基金资助项目（30973179）