糖皮质激素联合醋酸亮丙瑞林微球对子宫内膜异位症腹腔镜手术患者的疗效及预后分析

Efficacy of glucocorticoid combined with leuprorelin acetate microspheres in treating patients with endometriosis undergoing laparoscopic surgery and prognostic analysis

摘要:

目的 分析糖皮质激素联合醋酸亮丙瑞林微球对子宫内膜异位症（EMS）腹腔镜手术患者的疗效及预后的影响。方法 选取2020年2月—2022年3月青岛大学附属青岛市海慈医院收治的228例EMS患者，以随机数字表法分为对照组和研究组，每组114例。两组患者均接受腹腔镜手术治疗，对照组腹部皮下注射醋酸亮丙瑞林微球，研究组在对照组基础上口服糖皮质激素，持续治疗3个月评价疗效。对比两组临床疗效、子宫内膜动脉血流动力学、性激素、炎症因子及药物不良反应，比较两组随访期间复发及妊娠成功情况。结果 研究组总有效率高于对照组（P <0.05）。研究组治疗前后子宫动脉收缩期峰值流速、搏动指数、阻力指数、雌二醇、黄体生成素、促卵泡生成素、白细胞介素-4、肿瘤坏死因子-α、白细胞介素-17的差值均高于对照组（P <0.05）。两组总不良反应发生率比较，差异无统计学意义（P >0.05）。研究组复发率低于对照组（P <0.05），妊娠成功率高于对照组（P <0.05）。结论 糖皮质激素联合醋酸亮丙瑞林微球用于EMS腹腔镜手术患者可增强疗效，改善子宫内膜动脉血流动力学及性激素水平，抑制炎症因子表达，提高术后妊娠率，降低复发风险，且安全性良好。

Abstract:

Objective To analyze the effects of glucocorticoid combined with leuprorelin acetate microspheres on the clinical efficacy and prognosis of patients with endometriosis (EMS) undergoing laparoscopic surgery.Methods A total of 228 EMS patients admitted to our hospital from February 2020 to March 2022 were selected and divided into the control group and the study group by random number table method, each with 114 cases. Both groups of patients received laparoscopic surgery. The control group was given leuprorelin acetate microspheres via a subcutaneous injection on the abdomen, and the study group was additionally given oral glucocorticoid. The clinical efficacy was evaluated after 3 months of continuous treatment. The clinical efficacy, uterine artery hemodynamics, sex hormones, inflammatory factors and adverse drug reactions were compared between the two groups. The rates of disease recurrence and successful pregnancy during follow-up were compared between the two groups.Results The overall effective rate of the study group was higher than that of the control group (P < 0.05). The differences of uterine artery peak systolic velocity (PSV), pulsation index (PI) and resistance index (RI), and those of the levels of estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH), interleukin-4 (IL-4), tumor necrosis factor-α (TNF-α) and IL-17 before and after treatment in the study group were greater than those in the control group (P < 0.05). There was no difference in the overall incidence of adverse reactions between the two groups (P > 0.05). The recurrence rate of the study group was lower than that of the control group, and the success rate of pregnancy of the study group was higher than that of the control group (P < 0.05).Conclusions In EMS patients undergoing laparoscopic surgery, glucocorticoid combined with leuprorelin acetate microspheres can enhance the therapeutic efficacy, improve the uterine artery hemodynamics and the levels of sex hormones, inhibit the expressions of inflammatory factors, increase the postoperative success rate of pregnancy, and reduce the risk of disease recurrence with few safety concerns.