目的 探討止痛化癥膠囊聯(lián)合左炔諾孕酮宮內(nèi)節(jié)育系統(tǒng)治療子宮腺肌病的臨床療效。方法 選取2020年3月—2021年12月鄭州市金水區(qū)總醫(yī)院收治的92例子宮腺肌病患者，根據(jù)隨機(jī)數(shù)字表法將所有患者分為對(duì)照組和治療組，每組各46例。對(duì)照組患者于月經(jīng)第5～7天將左炔諾孕酮宮內(nèi)節(jié)育系統(tǒng)放置于宮腔內(nèi)，一次放置，隨訪觀察6個(gè)月。治療組在對(duì)照組基礎(chǔ)上于飯后口服止痛化癥膠囊，4粒/次，3次/d，持續(xù)治療6個(gè)月。觀察兩組的臨床療效，比較兩組的血流動(dòng)力學(xué)、子宮體積、疼痛程度和血清指標(biāo)水平。結(jié)果 治療后，治療組的總有效率為95.65%，明顯高于對(duì)照組的總有效率80.43%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組的平均血流速度（V_m）、臍動(dòng)脈收縮期與舒張期的血流速度比值（S/D）、搏動(dòng)指數(shù)（PI）明顯低于治療前（P<0.05）；治療組的V_m、S/D、PI低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組的子宮體積、視覺模擬評(píng)分法（VAS）評(píng)分顯著降低（P<0.05），且治療組子宮體積、VAS評(píng)分較對(duì)照組降低更明顯（P<0.05）。治療后，兩組的血清趨化因子配體-12（CXCL-12）、胰島素樣生長因子-1（IGF-1）、轉(zhuǎn)化生長因子-β₁（TGF-β₁）水平低于治療前（P<0.05），且治療組血清CXCL-12、IGF-1、TGF-β₁水平較對(duì)照組更低（P<0.05）。結(jié)論 止痛化癥膠囊聯(lián)合左炔諾孕酮宮內(nèi)節(jié)育系統(tǒng)治療子宮腺肌病的療效確切，能夠降低疼痛程度，改善血流動(dòng)力學(xué)指標(biāo)，有助于抑制病灶生長。

Objective To investigate the clinical effect of Zhitong Huazheng Capsules combined with Levonorgestrel Intrauterine System in treatment of adenomyosis. Methods Patients (92 cases) with adenomyosis in the General Hospital of Jinshui District Zhengzhou City from March 2020 to December 2021 were divided into control and treatment groups according to the random number table method, and each group had 46 cases. Patients in the control group were placed the levonorgestrel intrauterine contraceptive system in the uterine cavity on the 5th to 7th day of menstruation, and were followed up for 6 months. Patients in the treatment group were po administered with Zhitong Huazheng Capsules after meals on the basis of the control group, 4 grains/time, three times daily, and continued the treatment for 6 months. After treatment, the clinical efficacies were evaluated, and hemodynamics, uterine volume, degree of pain, serum factors in two groups were compared. Results After treatment, total effective rate of the treatment group was 95.65%, which was significantly higher than 80.43% of the control group (P < 0.05). After treatment, the V_m, S/D, and PI of two groups were significantly lower than those before treatment (P < 0.05). The V_m, S/D, and PI of the treatment group were lower than those of the control group (P < 0.05). After treatment, the uterine volume and VAS score of two groups were significantly decreased (P < 0.05), and the uterine volume and VAS score of the treatment group were significantly lower than that of the control group (P < 0.05). After treatment, the serum levels of CXCL-12, IGF-1, and TGF-β₁ in the two groups were lower than those before treatment (P < 0.05), and the serum levels of CXCL -12, IGF-1, and TGF-β₁ in the treatment group were lower than those in the control group (P < 0.05). Conclusion Zhitong Huazheng Capsules combined with Levonorgestrel Intrauterine System has clinical curative effect in treatment of adenomyosis, which can reduce the degree of pain, improve the level of hemodynamics, help to inhibit the growth of lesions.

R984