单用地诺孕素与 GnRH‑a 联合地诺孕素序贯治疗子宫腺肌病的疗效比较

Objective To investigate the efficacy and safety of dienogest (DNG) alone and gonadotropin‑releasing hormone agonist (GnRH‑a) combined with DNG sequential treatment to adenomyosis. Methods The clinical data of 110 patients with adenomyosis attending the First Affiliated Hospital of Nanjing Medical University from December 2019 to March 2022 were retrospectively analyzed, including 40 patients treated with DNG (2 mg/day) alone (DNG group) and 70 patients treated with sequential DNG (2 mg/day) after 3-6 injections of GnRH‑a (GnRH‑a+DNG group). The clinical data before and after treatment were compared between the two groups. Results (1) The dysmenorrhea visual analogue scale (VAS) scores, cancer antigen 125 (CA₁₂₅) and cancer antigen 19‑9 (CA_19‑9) levels at different time periods after treatment were significantly lower than before treatment in both groups (median before treatment: DNG group 70.0 mm, 68.55 kU/L, 22.45 kU/L respectively, GnRH‑a+DNG group 80.0 mm, 151.50 kU/L, 20.44 kU/L respectively; all P< 0.001). (2) The hemoglobin (Hb) levels of patients in both groups at different time periods after treatment were significantly higher than those before treatment (median: DNG group 102.00 g/L, GnRH‑a+DNG group 94.00 g/L; all P<0.001). (3) Treatment with DNG alone did not have a significant effect on uterine volume in patients of DNG group (P>0.05), and uterine volume decreased significantly in the 15th-24th months of GnRH‑a+DNG group compared with that before treatment (median: 167.76 vs 227.77 cm³; P<0.05). (4) There were no significant differences in hepatic and renal function and coagulation indexes between the two groups before and after treatment (all P> 0.05), and no significant abnormal lesions were observed in breast tissue during the follow‑up period. (5) The incidence of amenorrhea of GnRH‑a+DNG group was higher than that of DNG group, and the incidences of irregular spotting bleeding and breakthrough hemorrhage were lower than those in DNG group. Conclusions Whether DNG is used alone or in combination with GnRH‑a in sequence, it could significantly relieve dysmenorrhea symptoms, improve the level of Hb, reduce the levels of CA₁₂₅ and CA_19‑9 in patients with adenomyosis, with no adverse effects on coagulation and hepatic or renal function. GnRH‑a sequential DNG therapy is superior to DNG alone in improving uterine bleeding patterns and controlling the growth of uterine volume in patients with adenomyosis.