Efficacy of the levonorgestrel-releasing intrauterine device is associated with different subtypes of adenomyosis: a retrospective study.
Efficacy of the levonorgestrel-releasing intrauterine device is associated with different subtypes of adenomyosis: a retrospective study.
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左炔诺孕酮宫内节育器的疗效与不同亚型的子宫腺肌病相关：一项回顾性研究
DOI：
10.21037/atm-20-3420
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发表时间：
2020-11
影响因子：
--
通讯作者：
Zhang X
中科院分区：
文献类型：
--
作者：
Chen S;Wang J;Sun W;Zhu L;He J;Zhang X
背景：虽然释放左旋诺孕酮宫内节育器(LNG-IUD)已广泛应用于子宫腺肌病的治疗，但并不是所有患者都对其疗效满意。本研究旨在探讨LNG-IUD治疗不同亚型子宫腺肌病的疗效。方法选择浙江大学医学院妇科医院2013年6月至2016年6月收治的放置LNG宫内节育器的患者207例。将子宫腺肌病患者分为3组(I亚型70例，内源性70例；II亚型73例，外源性73例；IV亚型73例，)。对不同组间的多变量进行比较。结果比较三种亚型患者的人口学特征、临床特点及放置LNG-IUD的疗效。三种亚型患者放置宫内节育器后的数字评分和图形失血量评定表评分均较术前明显降低(P<；0.001)。IV型子宫腺肌病患者的有效率低于其他两型，而自发脱落率高于其他两型(P<；0.05)。I型[P=0.029，危险性比(HR)：3.37，95%可信区间(CI)：1.0 9~6.88]和IV型(P=0.045，HR：1.0 2，95%CI：1.0 1~1.2 1)子宫腺肌病患者放置宫内节育器前子宫大小和放置宫内节育器后出血量是子宫腺肌病患者自然排出系统的独立因素。结论LNG-IUD是治疗I、II型子宫腺肌病的有效方法。然而，由于治疗失败和驱逐的高发生率，有必要进一步研究探索更合适的方案来治疗这种IV型子宫腺肌病。
Background Although the levonorgestrel-releasing intrauterine device (LNG-IUD) has been widely applied in the treatment of adenomyosis, not all the patients are satisfied with its efficacy. The present retrospective study aimed to investigate the efficacy of LNG-IUD on different subtypes of adenomyosis. Methods The study comprised a cohort of 207 patients who received the LNG-IUD at the Women’s Hospital, Zhejiang University School of Medicine, China, from June 2013 to June 2016. Different subtypes of adenomyosis were classified by magnetic resonance imaging (MRI) and patients were subcategorized into three groups (subtype I: intrinsic, n=70; subtype II: extrinsic, n=73; subtype IV: indeterminate, n=64). Multiple variables were compared among the different groups. Results Patient demographics, clinical features and the treatment effects of the LNG-IUD were compared between the three subtype groups. The numeric rating scale (NRS) and pictorial blood loss assessment chart (PBAC) score markedly decreased after insertion of the LNG-IUD compared with baseline in all patients in the three subtype groups (P<0.001 for all groups). Compared to the other two subtypes, the efficacy rate was lower and the spontaneous expulsion rate was higher in subtype IV adenomyosis patients than that in other two groups (P<0.05). The independent factor associated with the spontaneous expulsion of the system was suggested to be uterine size before IUD placement and bleeding amount after LNG-IUD treatment in the subtype I [P=0.029, hazards ratio (HR): 3.37, 95% confidence interval (CI): 1.09–6.88] and IV (P=0.045, HR: 1.02, 95% CI: 1.01–1.21) adenomyosis patients respectively. Conclusions The LNG-IUD is proved to be an effective approach to treat subtype I and II adenomyosis. However, further study is warranted to explore a more suitable protocol to treat this subtype IV adenomyosis due to the high incidence of treatment failure and expulsion.
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