Department of Obstetrics and Gynecology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, 14049-900, Brazil.
Contraception. 2010 Feb;81(2):117-22. doi: 10.1016/j.contraception.2009.08.003. Epub 2009 Sep 16.
The study was conducted to evaluate the cardiovascular risk markers associated with endometriosis and the influence of the levonorgestrel intrauterine system (LNG-IUS) compared with the GnRH analogue (GnRHa) leuprolide acetate on these risk markers after 6 months of treatment.
This was a randomized, prospective, open clinical study, with 44 patients with laparoscopically and histologically confirmed endometriosis. Patients were randomized into two groups: the LNG-IUS group, composed of 22 patients who underwent LNG-IUS insertion, and the GnRHa group, composed of 22 patients who received a monthly GnRHa injection for 6 months. Body mass index; systolic and diastolic arterial blood pressure; heart rate; and laboratory cardiovascular risk markers such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein (CRP), homocysteine (HMC), lipid profile, total leukocytes and vascular cell adhesion molecule (VCAM) were measured before and 6 months after treatment.
After 6 months of treatment, a significant reduction in pain score occurred in both groups with no significant difference in improvement between the two medications evaluated. In the LNG-IUS group, from pretreatment to posttreatment period, there was a significant reduction in the levels (mean+/-SD) of VCAM (92.8+/-4.2 to 91.2+/-2.7 ng/mL, p=.04), CRP (0.38+/-0.30 to 0.28+/-0.21 mg/dL, p=.03), total cholesterol (247.0+/-85.0 to 180.0+/-31.0 mg/dL, p=.0002), triglycerides (118.0+/- 76.0 to 86.5+/-41.5 mg/dL, p=.003), low-density lipoprotein cholesterol (160.5+/-66.0 to 114.5+/-25.5 mg/dL, p=.0005) and high-density lipoprotein cholesterol (63.0+/-20.5 to 48.5+/-10.5 mg/dL, p=.002). The GnRHa group showed an increase in HMC levels (11.5+/-2.9 to 13.0+/-2.7 mumol/L, p=.04) and a reduction in IL-6 levels (4.3+/-3.9 to 2.3+/-0.8 pg/mL, p=.005), VCAM (94.0+/-3.8 to 92.0+/-1.6 ng/mL, p=.03) and total leukocytes (7330+/-2554 to 6350+/-1778, p=.01). In the GnRH group, the remaining variables, including lipid profile, did not show any statistical difference.
This study shows that some cardiovascular risk markers are influenced by both GnRHa and the LNG-IUS, but the latter had a greater positive impact on the lipid profile, which could lead to a favorable effect during long-term treatment.
本研究旨在评估与子宫内膜异位症相关的心血管风险标志物，并比较左炔诺孕酮宫内节育系统（LNG-IUS）与促性腺激素释放激素类似物（GnRHa）亮丙瑞林对这些风险标志物的影响。治疗 6 个月后。
这是一项随机、前瞻性、开放的临床研究，共有 44 例经腹腔镜和组织学证实为子宫内膜异位症的患者。患者随机分为两组：LNG-IUS 组，22 例患者行 LNG-IUS 插入；GnRHa 组，22 例患者每月接受 GnRHa 注射 6 个月。治疗前和治疗 6 个月后测量体重指数；收缩压和舒张压；心率；和实验室心血管风险标志物，如白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、C 反应蛋白（CRP）、同型半胱氨酸（HMC）、血脂谱、总白细胞和血管细胞粘附分子（VCAM）。
两组治疗 6 个月后疼痛评分均显著下降，但两种药物的改善程度无显著差异。在 LNG-IUS 组，从治疗前到治疗后期间，VCAM（92.8+/-4.2 至 91.2+/-2.7 ng/mL，p=.04）、CRP（0.38+/-0.30 至 0.28+/-0.21 mg/dL，p=.03）、总胆固醇（247.0+/-85.0 至 180.0+/-31.0 mg/dL，p=.0002）、甘油三酯（118.0+/-76.0 至 86.5+/-41.5 mg/dL，p=.003）、低密度脂蛋白胆固醇（160.5+/-66.0 至 114.5+/-25.5 mg/dL，p=.0005）和高密度脂蛋白胆固醇（63.0+/-20.5 至 48.5+/-10.5 mg/dL，p=.002）水平显著降低。GnRHa 组 HMC 水平升高（11.5+/-2.9 至 13.0+/-2.7 mumol/L，p=.04），IL-6 水平降低（4.3+/-3.9 至 2.3+/-0.8 pg/mL，p=.005）、VCAM（94.0+/-3.8 至 92.0+/-1.6 ng/mL，p=.03）和总白细胞（7330+/-2554 至 6350+/-1778，p=.01）。在 GnRH 组中，包括血脂谱在内的其余变量均无统计学差异。
本研究表明，一些心血管风险标志物受 GnRHa 和 LNG-IUS 影响，但后者对血脂谱有更大的积极影响，这可能导致长期治疗中产生有利影响。
