Efficacy analysis of gonadotropin releasing hormone analogue combined with low dosage estrogen for preventing recurrence of moderate or severe intrauterine adhesion

doi:10.3877/cma.j.issn.1673-5250.2017.04.011

Objective

To evaluate the efficacy of gonadotropin releasing hormone analogue (GnRHa) combined with low dosage estradiol valerate for preventing the recurrence of moderate or severe intrauterine adhesion (IUA) after hysteroscopic adhesiolysis.

Methods

A total of 115 patients with moderate or severe IUA who underwent transcervical resection of adhesions (TCRA) by hysteroscopy treatment at the Center of Reproductive Medicine, Renmin Hospital of Wuhan University, from January to June 2015 were selected as research subjects. And patients were divided into GnRHa group (n=48) and control group (n=67) according to the prevention method of IUA recurrence after TCRA. GnRHa group patients were given GnRHa and low dosage estradiol valerate tablets (2 mg/d×90 d) after TCRA. And control group patients were given high dosage estradiol valerate tablets (6-9 mg/d) and progesterone soft capsules 100 mg/d for consecutive treatment with 90 d. Second-look hysteroscopic examination was performed on all patients at 3 months after TCRA treatment to evaluate the effective rate of prevention of IUA recurrence in two groups. And 6-month follow-up after TCRA treatment was taken to investigate menstrual recovery and endometrial thickness. Statistical methods were used to compare the effective rates of prevention of IUA recurrence, improvement rates of menstrual flow, thickness of endometrium and adverse reactions rates of two groups after TCRA treatment and receiving the prevention method of IUA recurrence. The study was approved by the Medical Ethics Committee of Renmin Hospital of Wuhan University. All the patients signed the written informed consent forms.

Results

①There were no significant differences between GnRHa group and control group in the age, body mass index (BMI), course of disease, the ratio of menstruation to amenorrhea and the ratio of moderate or severe IUA before TCRA treatment (P>0.05). ②The effective rate of prevention of IUA recurrence after TCRA treatment was 87.5% (42/48) in GnRHa group, which was significantly higher than that of control group (61.2%, 41/67), and the difference was statistically significant (χ²=9.636, P=0.002). There was no significant difference in the improvement rate of menstrual flow after TCRA treatment and receiving prevention treatment for IUA recurrence between GnRHa group and control group which was 75.0% (36/48) and 67.2% (45/67), respectively (χ²=0.825, P=0.364). There was no significant difference in the thickness of endometrium after TCRA treatment and receiving prevention treatment for IUA recurrence between the two groups (t=1.278, P=0.204). ③The postoperative adverse reaction rate after TCRA treatment and receiving prevention treatment for IUA recurrence was 10.4% (5/48) in GnRHa group, which was significantly lower than that of control group (26.9%, 18/67), and the difference was statistically significant (χ²=4.729, P=0.030).

Conclusions

GnRHa combined with low dosage estradiol valerate is an effective and safe treatment for preventing the recurrence of moderate or severe IUA after TRCA treatment. As the sample size in this study is relatively small, whether this treatment method is worthy of further promotion, it remains to be further confirmed.

Key words: Intrauterine adhesion, Gonadotropin releasing hormone analogue, Estradiol valerate, Adhesiolysis, Recurrence, Treatment outcome, Women

表1 2组中、重度IUA患者一般临床资料比较

组别	例数	年龄(岁，±s)	BMI (kg/m²，±s)	病程(月，±s)	TCRA治疗前月经异常情况[例数(%)]		TCRA治疗前IUA分度[例数(%)]
组别	例数	年龄(岁，±s)	BMI (kg/m²，±s)	病程(月，±s)	月经过少	闭经	中度	重度
GnRHa组	48	32.2±4.3	23.7±4.6	11.7±4.9	37(77.1)	11(22.9)	23(60.4)	19(39.6)
对照组	67	33.4±5.1	22.6±5.7	13.5±8.9	49(73.1)	18(26.9)	41(61.2)	26(38.8)
检验值	?	t＝1.326	t＝1.180	t＝1.897	χ²＝0.231		χ²＝0.441
P值	?	0.188	0.240	0.060	0.631		0.507

表1 2组中、重度IUA患者一般临床资料比较

组别	例数	年龄(岁，±s)	BMI (kg/m²，±s)	病程(月，±s)	TCRA治疗前月经异常情况[例数(%)]		TCRA治疗前IUA分度[例数(%)]
组别	例数	年龄(岁，±s)	BMI (kg/m²，±s)	病程(月，±s)	月经过少	闭经	中度	重度
GnRHa组	48	32.2±4.3	23.7±4.6	11.7±4.9	37(77.1)	11(22.9)	23(60.4)	19(39.6)
对照组	67	33.4±5.1	22.6±5.7	13.5±8.9	49(73.1)	18(26.9)	41(61.2)	26(38.8)
检验值	?	t＝1.326	t＝1.180	t＝1.897	χ²＝0.231		χ²＝0.441
P值	?	0.188	0.240	0.060	0.631		0.507

表2 2组TCRA前为中、重度IUA患者，TCRA后接受预防IUA复发的治疗有效率、月经量改善率及子宫内膜厚度比较

组别	例数	治疗有效率[例数(%)]			月经量改善率[例数(%)]			子宫内膜厚度(mm，±s)
组别	例数	治愈	好转	合计	恢复正常	增多	合计	子宫内膜厚度(mm，±s)
GnRHa组	48	29(60.4)	13(27.1)	42(87.5)	22(45.8)	14(29.2)	36(75.0)	6.3±0.6
对照组	67	23(34.3)	18(26.9)	41(61.2)	25(37.3)	20(29.9)	45(67.2)	6.8±0.9
检验值	?	－	－	χ²＝9.636	－	－	χ²＝0.825	t＝1.278
P值	?	－	－	0.002	－	－	0.364	0.204

表2 2组TCRA前为中、重度IUA患者，TCRA后接受预防IUA复发的治疗有效率、月经量改善率及子宫内膜厚度比较

组别	例数	治疗有效率[例数(%)]			月经量改善率[例数(%)]			子宫内膜厚度(mm，±s)
组别	例数	治愈	好转	合计	恢复正常	增多	合计	子宫内膜厚度(mm，±s)
GnRHa组	48	29(60.4)	13(27.1)	42(87.5)	22(45.8)	14(29.2)	36(75.0)	6.3±0.6
对照组	67	23(34.3)	18(26.9)	41(61.2)	25(37.3)	20(29.9)	45(67.2)	6.8±0.9
检验值	?	－	－	χ²＝9.636	－	－	χ²＝0.825	t＝1.278
P值	?	－	－	0.002	－	－	0.364	0.204

表3 2组TCRA前为中、重度IUA患者，TCRA后接受预防IUA复发治疗的不良反应发生情况比较[例数(%)]

组别	例数	阴道不规则流血	胃肠道反应	乳房胀痛	合计
GnRHa组	48	4(8.3)	1(2.1)	0(0)	5(10.4)
对照组	67	11(16.4)	3(4.5)	4(6.0)	18(26.9)
χ²值	?	－	－	－	4.729
P值	?	－	－	－	0.030

表3 2组TCRA前为中、重度IUA患者，TCRA后接受预防IUA复发治疗的不良反应发生情况比较[例数(%)]

组别	例数	阴道不规则流血	胃肠道反应	乳房胀痛	合计
GnRHa组	48	4(8.3)	1(2.1)	0(0)	5(10.4)
对照组	67	11(16.4)	3(4.5)	4(6.0)	18(26.9)
χ²值	?	－	－	－	4.729
P值	?	－	－	－	0.030

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