Zhang H Y, Zhu S, Xu W, Wang A Q, Wang X L
Department of Obstetrics and Gynecology, the First Clinical School of Medicine, Nanjing Medical University, Nanjing 210029, China.
Department of Gynecology, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210036, China.
Zhonghua Fu Chan Ke Za Zhi. 2022 Nov 25;57(11):856-863. doi: 10.3760/cma.j.cn112141-20220520-00336.
To investigate the efficacy and safety of dienogest (DNG) alone and gonadotropin-releasing hormone agonist (GnRH-a) combined with DNG sequential treatment to adenomyosis. The clinical data of 110 patients with adenomyosis attending the First Affiliated Hospital of Nanjing Medical University from December 2019 to March 2022 were retrospectively analyzed, including 40 patients treated with DNG (2 mg/day) alone (DNG group) and 70 patients treated with sequential DNG (2 mg/day) after 3-6 injections of GnRH-a (GnRH-a+DNG group). The clinical data before and after treatment were compared between the two groups. (1) The dysmenorrhea visual analogue scale (VAS) scores, cancer antigen 125 (CA) and cancer antigen 19-9 (CA) levels at different time periods after treatment were significantly lower than before treatment in both groups (median before treatment: DNG group 70.0 mm, 68.55 kU/L, 22.45 kU/L respectively, GnRH-a+DNG group 80.0 mm, 151.50 kU/L, 20.44 kU/L respectively; all <0.001). (2) The hemoglobin (Hb) levels of patients in both groups at different time periods after treatment were significantly higher than those before treatment (median: DNG group 102.00 g/L, GnRH-a+DNG group 94.00 g/L; all <0.001). (3) Treatment with DNG alone did not have a significant effect on uterine volume in patients of DNG group (>0.05), and uterine volume decreased significantly in the 15th-24th months of GnRH-a+DNG group compared with that before treatment (median: 167.76 vs 227.77 cm; <0.05). (4) There were no significant differences in hepatic and renal function and coagulation indexes between the two groups before and after treatment (all >0.05), and no significant abnormal lesions were observed in breast tissue during the follow-up period. (5) The incidence of amenorrhea of GnRH-a+DNG group was higher than that of DNG group, and the incidences of irregular spotting bleeding and breakthrough hemorrhage were lower than those in DNG group. Whether DNG is used alone or in combination with GnRH-a in sequence, it could significantly relieve dysmenorrhea symptoms, improve the level of Hb, reduce the levels of CA and CA in patients with adenomyosis, with no adverse effects on coagulation and hepatic or renal function. GnRH-a sequential DNG therapy is superior to DNG alone in improving uterine bleeding patterns and controlling the growth of uterine volume in patients with adenomyosis.
探讨地诺孕素（DNG）单药及促性腺激素释放激素激动剂（GnRH-a）联合DNG序贯治疗子宫腺肌病的疗效及安全性。回顾性分析2019年12月至2022年3月在南京医科大学第一附属医院就诊的110例子宫腺肌病患者的临床资料，其中40例患者接受单药DNG（2mg/天）治疗（DNG组），70例患者在注射3 - 6次GnRH-a后序贯DNG（2mg/天）治疗（GnRH-a + DNG组）。比较两组治疗前后的临床资料。（1）两组治疗后不同时间段痛经视觉模拟评分（VAS）、癌抗原125（CA）和癌抗原19 - 9（CA）水平均显著低于治疗前（治疗前中位数：DNG组分别为70.0mm、68.55kU/L、22.45kU/L，GnRH-a + DNG组分别为80.0mm、151.50kU/L、20.44kU/L；均P < 0.001）。（2）两组患者治疗后不同时间段血红蛋白（Hb）水平均显著高于治疗前（中位数：DNG组102.00g/L，GnRH-a + DNG组94.00g/L；均P < 0.001）。（3）DNG组单药治疗对患者子宫体积无显著影响（P > 0.05），GnRH-a + DNG组在治疗第15 - 24个月时子宫体积较治疗前显著减小（中位数：167.76 vs 227.77cm³；P < 0.05）。（4）两组治疗前后肝肾功能及凝血指标差异均无统计学意义（均P > 0.05），随访期间乳腺组织未观察到明显异常病变。（5）GnRH-a + DNG组闭经发生率高于DNG组，不规则点滴出血和突破性出血发生率低于DNG组。DNG单药或与GnRH-a序贯联合使用均可显著缓解子宫腺肌病患者痛经症状，提高Hb水平，降低CA和CA水平，对凝血及肝肾功能无不良影响。GnRH-a序贯DNG治疗在改善子宫腺肌病患者子宫出血模式及控制子宫体积增长方面优于单药DNG治疗。
