左炔诺孕酮宫内节育系统治疗合并内科疾病月经过多的临床分析
发布时间：2019-06-05 21:53
【摘要】：背景与目的月经过多是育龄期女性最常见的一种临床表现,也是严重困扰育龄期女性的健康问题。某些内科疾病本身或治疗可引起月经过多,而且某些合并内科疾病月经过多患者有激素治疗禁忌或较高的手术治疗风险,因此其治疗方案选择受到限制。现临床上尝试应用左炔诺孕酮宫内节育系统治疗合并内科疾病月经过多患者,本研究通过回顾性分析,评估左炔诺孕酮宫内节育系统(LNG-IUS)治疗合并内科疾病的月经过多患者的有效性及探讨其临床应用价值。资料与方法收集整理2011年1月-2016年1月在郑州大学第一附属医院就诊的月经过多使用LNG-IUS治疗的住院患者临床资料,通过排除标准,纳入80例符合条件患者,其中合并内科疾病的月经过多患者36例,无合并症患者44例;合并内科疾病分别是:肾功能不全(6例)、血液系统疾病(5例)、系统性红斑狼疮(3例)、肝功能不全(5例)、乳癌术后(5例)、心脏病瓣膜置换术后(1例)、糖尿病(3例)、甲状腺疾病(8例)。通过门诊复查或电话询问放置LNG-IUS后3个月、6个月的患者月经量变化、血红蛋白水平、子宫内膜厚度、不良反应、满意度、妊娠情况、自身内科疾病进展等指标。结果1.合并内科疾病组患者入院时基线数据如下:年龄是(39.0±8.4)岁,体质量指数是(23.8±3.0)kg/m2,孕次是(2.92±1.42)次,产次是(1.56±0.94)次,血红蛋白水平是(85.2±13.0)g/L,子宫内膜厚度是(11.2±2.4)mm;无合并症组患者入院时基线数据如下:年龄是(42.3±5.9)岁,体质量指数是(23.4±2.3)kg/m2,孕次是(2.93±1.28)次,产次是(1.70±0.77)次,血红蛋白水平是(86.1±14.9)g/L,子宫内膜厚度是(11.0±2.3)mm;2组入院时年龄、体质量指数、孕次、产次、血红蛋白水平和子宫内膜厚度比较差异无统计学意义(P0.01)。2.合并内科疾病组放置LNG-IUS 3个月时,2例脱环,4例月经量多不改善,1例月经量多不改善因脱环引起,放置LNG-IUS 6个月时,1例脱环,2例月经量不改善;无内并症组放置LNG-IUS 3个月,2例脱环,2例月经量不改善,放置LNG-IUS 6个月,2例脱环,1例月经量不改善;放置LNG-IUS后3个月、6个月合并内科疾病组有效率分别为:86.1%和91.2%,无合并症组有效率分别为90.9%和92.2%,2组疗效比较差异无统计学意义(P0.05)。3.合并内科疾病组放置LNG-IUS前子宫内膜厚度:(11.2±2.4)mm,放置LNG-IUS后3个月、6个月分别是:(8.4±1.7)mm、(6.1±2.1)mm;无合并症组放置LNG-IUS前子宫内膜厚度:(11.0±2.3)mm;放置LNG-IUS 3个月、6个月分别是:(8.0±1.9)mm、(5.8±1.4)mm,2组放置LNG-IUS 3个月、6个月与放置LNG-IUS前相比,子宫内膜厚度差异比较均具有统计学意义(P0.05),但放置LNG-IUS 3个月、6个月时2组子宫内膜厚度比较差异无统计学意义(P0.05)。4.合并内科疾病组放置LNG-IUS前血红蛋白水平:(85.2±13.0)g/L,放置LNG-IUS 3个月、6个月分别是:(91.5±10.9)g/L、(101.5±7.9)g/L;无合并症组放置LNG-IUS前血红蛋白水平:(86.1±14.9)g/L,放置LNG-IUS 3个月、6个月分别是:(93.6±12.4)g/L、(102.3±9.0)g/L;2组放置LNG-IUS 3个月、6个月与放置LNG-IUS前相比,血红蛋白差异比较均具有统计学意义(P0.05),但放置LNG-IUS 3个月、6个月时2组血红蛋白水平比较差异无统计学意义(P0.05)。5.放置LNG-IUS后2组主要的不良反应是出现阴道点滴和不规则出血,合并内科疾病组放置LNG-IUS 6个月满意度是83.3%(30/36),无合并症组放置LNG-IUS 6个月满意度是79.5%(35/44)。6.合并内科疾病组所有患者放置LNG-IUS后均继续治疗原发内科疾病,在6个月随访期间无一原发内科疾病进展。7.2组所有患者放置LNG-IUS后的6个月随访期间无一例患者出现带器妊娠。结论1.左炔诺孕酮宫内节育系统能有效治疗月经过多。2.左炔诺孕酮宫内节育系统对治疗合并内科疾病月经过多也同样有效,且疗效与无合并症月经过多相当;其疗效显著、高效避孕、对原发内科疾病影响较小,患者满意度高,有望广泛用于合并内科疾病月经过多患者治疗。
[Abstract]:Background and objective are the most common clinical manifestations of women in the age of childbearing age, and are also a serious problem for women in the age of childbearing age. The choice of treatment options is limited by the fact that some of the internal medical conditions themselves or the treatment can cause excessive morbidity and that some of the patients with internal medical conditions have a hormone-treated contraindication or a higher risk of surgical treatment. The clinical application of levonorgestrel intrauterine birth control system in the treatment of large excess of patients with internal medical diseases is currently being tried, and this study is analyzed retrospectively. To evaluate the effectiveness of levonorgestrel in the treatment of combined internal medical diseases and to explore the value of its clinical application. Materials and Methods: From January 2011 to January 2016, the clinical data of the patients with excessive use of LNG-IUS in the first affiliated hospital of Zhengzhou University were collected and the clinical data of 80 eligible patients were included in the exclusion criteria, of which 36 patients with hypermenorrhea with internal medical condition were included. 44 cases with no co-morbidities; the combined internal medicine diseases were: renal insufficiency (6 cases), blood system diseases (5 cases), systemic lupus erythematosus (3 cases), hepatic insufficiency (5 cases), breast cancer operation (5 cases), and heart valve replacement (1 case). Diabetes (3 cases), thyroid disease (8 cases). The changes of menstrual flow, hemoglobin level, endometrial thickness, adverse reaction, degree of satisfaction, pregnancy and the progress of internal medical conditions were measured by out-patient review or telephone interrogation for 3 months after the placement of the LNG-IUS. Results 1. The baseline data were as follows: age (39.0-8.4), body mass index (23.8-3.0) kg/ m2, pregnancy (2.92-1.42) times, birth time (1.56-0.94) times, hemoglobin level (85.2-13.0) g/ L, and endometrial thickness (11.2-2.4) mm; The baseline data for patients with no co-morbidities were as follows: age (42.3-5.9) years, body mass index (23.4-2.3) kg/ m2, gestational time (2.93-1.28) times, birth time (1.70-0.77) times, hemoglobin level (86.1-14.9) g/ L, and endometrial thickness (11.0-2.3) mm; There was no significant difference in age, body mass index, gestational age, birth time, hemoglobin level and endometrial thickness in group 2 (P0.01). In the combined internal medical condition group, when the LNG-IUS was placed for 3 months,2 cases of dering and 4 cases of menoxenia were not improved, one case was not improved due to the removal of the ring, and when the LNG-IUS was placed for 6 months, one case was de-ring, and 2 cases were not improved; in the absence of the internal and the treatment group, the LNG-IUS was placed for 3 months,2 cases were de-ring, and the amount of the 2 cases was not improved. The effective rate was 86.1% and 91.2% in 6 months after the LNG-IUS was placed, and the effective rate was 90.9% and 92.2%, respectively. There was no significant difference between the two groups (P0.05). The thickness of the pre-endometrial thickness of the LNG-IUS was (11.2-2.4) mm in combination with the internal medical condition group,3 months after the placement of the LNG-IUS,6 months were: (8.4-1.7) mm, (6.1-2.1) mm, and no co-morbidities were placed in the pre-endometrial thickness of the LNG-IUS: (11.0-2.3) mm; the LNG-IUS was placed for 3 months and the 6-month period was: (8.0-1.9) mm, (5.8-1.4) mm,2 groups were placed in the LNG-IUS for 3 months and 6 months in comparison with the placement of the LNG-IUS, the difference in the thickness of the endometrium was statistically significant (P0.05), but the difference of the thickness of the endometrium in the two groups was not statistically significant at 6 months (P0.05). The level of hemoglobin-IUS pre-hemoglobin was placed in the combined internal medicine disease group: (85.2-13.0) g/ L, and the LNG-IUS for 3 months and 6 months were: (91.5-10.9) g/ L, (101.5-7.9) g/ L, and no-complication group was placed in the pre-determined hemoglobin level of the LNG-IUS: (86.1-14.9) g/ L, and the LNG-IUS for 3 months and 6 months were respectively: (93.6-12.4) g/ L, (102.3-9.0) g/ L, and the difference of hemoglobin in group 2 was statistically significant (P0.05). The main adverse reactions in the 2 groups after the LNG-IUS were placed were vaginal drop and irregular hemorrhage. The satisfactory degree of satisfaction was 83.3% (30/36) in the combined internal medical condition group and 79.5% (35/44). All patients in the combined internal medical disease group continued to treat the primary internal medical condition following the placement of the LNG-IUS and none of the primary internal medical conditions progressed during the 6-month follow-up. There was no one patient with a belt pregnancy during the 6-month follow-up period following the placement of the LNG-IUS in all patients in the group. Conclusion 1. The levonorgestrel intrauterine system is effective in treating hypermenorrhea. The levonorgestrel intrauterine birth control system is also effective in the treatment of the hypermenorrhea of the combined internal medicine, and the curative effect is equivalent to that of the non-co-morbidities; and the levonorgestrel intrauterine device has the advantages of remarkable curative effect, high-efficiency contraception, small influence on the primary internal medicine disease and high patient satisfaction, Is expected to be widely used in the treatment of patients with excessive internal medical diseases.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.51
，
本文编号：2493850
[Abstract]:Background and objective are the most common clinical manifestations of women in the age of childbearing age, and are also a serious problem for women in the age of childbearing age. The choice of treatment options is limited by the fact that some of the internal medical conditions themselves or the treatment can cause excessive morbidity and that some of the patients with internal medical conditions have a hormone-treated contraindication or a higher risk of surgical treatment. The clinical application of levonorgestrel intrauterine birth control system in the treatment of large excess of patients with internal medical diseases is currently being tried, and this study is analyzed retrospectively. To evaluate the effectiveness of levonorgestrel in the treatment of combined internal medical diseases and to explore the value of its clinical application. Materials and Methods: From January 2011 to January 2016, the clinical data of the patients with excessive use of LNG-IUS in the first affiliated hospital of Zhengzhou University were collected and the clinical data of 80 eligible patients were included in the exclusion criteria, of which 36 patients with hypermenorrhea with internal medical condition were included. 44 cases with no co-morbidities; the combined internal medicine diseases were: renal insufficiency (6 cases), blood system diseases (5 cases), systemic lupus erythematosus (3 cases), hepatic insufficiency (5 cases), breast cancer operation (5 cases), and heart valve replacement (1 case). Diabetes (3 cases), thyroid disease (8 cases). The changes of menstrual flow, hemoglobin level, endometrial thickness, adverse reaction, degree of satisfaction, pregnancy and the progress of internal medical conditions were measured by out-patient review or telephone interrogation for 3 months after the placement of the LNG-IUS. Results 1. The baseline data were as follows: age (39.0-8.4), body mass index (23.8-3.0) kg/ m2, pregnancy (2.92-1.42) times, birth time (1.56-0.94) times, hemoglobin level (85.2-13.0) g/ L, and endometrial thickness (11.2-2.4) mm; The baseline data for patients with no co-morbidities were as follows: age (42.3-5.9) years, body mass index (23.4-2.3) kg/ m2, gestational time (2.93-1.28) times, birth time (1.70-0.77) times, hemoglobin level (86.1-14.9) g/ L, and endometrial thickness (11.0-2.3) mm; There was no significant difference in age, body mass index, gestational age, birth time, hemoglobin level and endometrial thickness in group 2 (P0.01). In the combined internal medical condition group, when the LNG-IUS was placed for 3 months,2 cases of dering and 4 cases of menoxenia were not improved, one case was not improved due to the removal of the ring, and when the LNG-IUS was placed for 6 months, one case was de-ring, and 2 cases were not improved; in the absence of the internal and the treatment group, the LNG-IUS was placed for 3 months,2 cases were de-ring, and the amount of the 2 cases was not improved. The effective rate was 86.1% and 91.2% in 6 months after the LNG-IUS was placed, and the effective rate was 90.9% and 92.2%, respectively. There was no significant difference between the two groups (P0.05). The thickness of the pre-endometrial thickness of the LNG-IUS was (11.2-2.4) mm in combination with the internal medical condition group,3 months after the placement of the LNG-IUS,6 months were: (8.4-1.7) mm, (6.1-2.1) mm, and no co-morbidities were placed in the pre-endometrial thickness of the LNG-IUS: (11.0-2.3) mm; the LNG-IUS was placed for 3 months and the 6-month period was: (8.0-1.9) mm, (5.8-1.4) mm,2 groups were placed in the LNG-IUS for 3 months and 6 months in comparison with the placement of the LNG-IUS, the difference in the thickness of the endometrium was statistically significant (P0.05), but the difference of the thickness of the endometrium in the two groups was not statistically significant at 6 months (P0.05). The level of hemoglobin-IUS pre-hemoglobin was placed in the combined internal medicine disease group: (85.2-13.0) g/ L, and the LNG-IUS for 3 months and 6 months were: (91.5-10.9) g/ L, (101.5-7.9) g/ L, and no-complication group was placed in the pre-determined hemoglobin level of the LNG-IUS: (86.1-14.9) g/ L, and the LNG-IUS for 3 months and 6 months were respectively: (93.6-12.4) g/ L, (102.3-9.0) g/ L, and the difference of hemoglobin in group 2 was statistically significant (P0.05). The main adverse reactions in the 2 groups after the LNG-IUS were placed were vaginal drop and irregular hemorrhage. The satisfactory degree of satisfaction was 83.3% (30/36) in the combined internal medical condition group and 79.5% (35/44). All patients in the combined internal medical disease group continued to treat the primary internal medical condition following the placement of the LNG-IUS and none of the primary internal medical conditions progressed during the 6-month follow-up. There was no one patient with a belt pregnancy during the 6-month follow-up period following the placement of the LNG-IUS in all patients in the group. Conclusion 1. The levonorgestrel intrauterine system is effective in treating hypermenorrhea. The levonorgestrel intrauterine birth control system is also effective in the treatment of the hypermenorrhea of the combined internal medicine, and the curative effect is equivalent to that of the non-co-morbidities; and the levonorgestrel intrauterine device has the advantages of remarkable curative effect, high-efficiency contraception, small influence on the primary internal medicine disease and high patient satisfaction, Is expected to be widely used in the treatment of patients with excessive internal medical diseases.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.51
，
本文编号：2493850
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