40岁以上高龄女性使用左炔诺孕酮宫内缓释系统的临床分析

Clinical effect of levonorgestrel-releasing intrauterine system in women aged above 40 years old

摘要:

目的：对40岁以上高龄女性放置左炔诺孕酮宫内缓释系统（levonorgestrel- releasing intrauterine system，LNG-IUS）的临床资料进行回顾分析。方法：收集2002至2017年在本院使用LNG-IUS的高龄女性共1459例（高龄组），随机抽取同期使用LNG-IUS的20~40岁女性1501例（生育年龄组）。对比分析放置LNG-IUS的适应证、放置时间和临床效果，以及放置后的闭经、阴道点滴出血和激素副反应等发生率。结果：2组病例放置LNG-IUS的原因（Z=50.120，P=0.000）和时间（Z=33.996，P=0.000）不同；生育年龄组主要因避孕而安环（55.76%），高龄组因痛经安环者更多（36.81%）；2组多选择在经期安环（65.77% vs. 72.41%）；2组避孕成功率（100% vs. 100%，P=1.000）、月经量改善率（93.52% vs. 93.59%，P=0.289）无统计学差异；但高龄组痛经缓解率不如生育年龄组（89.57% vs. 91.50%，P=0.040）；2组闭经（25.32% vs. 24.49%，P=0.501）、阴道点滴出血（27.32% vs. 29.95%，P=0.141）和激素副反应（14.26% vs. 13.23%，P=0.070）的发生率无统计学差异。结论：高龄女性放置LNG-IUS后治疗效果好，闭经及阴道点滴出血等副作用发生率低，是使用LNG-IUS的适宜人群。

Abstract:

Objective：To investigate the clinical effect of levonorgestrel-releasing intrauterine system（LNG-IUS） in women aged above 40 years old. Methods：A retrospective analysis was performed for the clinical data of 1 459 women aged above 40 years old（senior group） and 1 501 aged 20-40 years old（childbearing age group） who underwent the placement of LNG-IUS in our hospital from 2002 to 2017. The two groups were compared in terms of the indications，time，and clinical effect of LNG-IUS placement and in－cidence rates of amenorrhea，slight vaginal bleeding，and hormone-related side effects after placement. Results：There were signifi－cant differences between the two groups in the reason for LNG-IUS placement（Z=50.120，P=0.000） and time of placement（Z=33.996，P=0.000）；most patients in the childbearing age group（55.76%） underwent LNG-IUS placement for contraception，while most patients in the senior group（36.81%） underwent placement due to dysmenorrhea. Most patients in these two groups underwent place－ment during the menstrual period（65.77% vs. 72.41%）. There were no significant differences between the two groups in the success rate of contraception（100% vs. 100%，P=1.000） and improvement rate of menstrual volume（93.52% vs. 93.59%，P=0.289），but the senior group had a lower remission rate of dysmenorrhea than the childbearing age group（89.57% vs. 91.50%，P=0.040）. There were no significant differences between the two groups in the incidence rates of amenorrhea（25.32% vs. 24.49%，P=0.501），slight vaginal bleeding（27.32% vs. 29.95%，P=0.141），and hormone-related side effects（14.26% vs. 13.23%，P=0.070）. Conclusion：LNG-IUS placement has a good therapeutic effect in women aged above 40 years old with low incidence rates of amenorrhea，slight vaginal bleeding，and other side effects. Therefore，such women are suitable for LNG-IUS placement.