Influence of High-intensity Focused Ultrasound Combined with Leuprorelin and Mirena on Sex Hormones CA125 and AMH Levels in Patients with Adenomyosis
Objective:To investigate the influence of high-intensity focused ultrasound(HIFU)com-bined with leuprorelin and Mirena(levonorgestrel intrauterine system)on the levels of sex hormones,cancer antigen(CA125)and anti-mullerian hormone(AMH)in patients with adenomyosis(AM).Methods:A to-tal of 182 patients with AM were enrolled in this study from June 2021 to June 2022.They were divided into HIFU group(n=20,receiving HIFU treatment,refusing to inject leuprorelin and placing Mirena)and HIFU+leuprorelin group(n=61,receiving HIFU combined with leuprorelin treatment,and refusing to place Mire-na),HIFU+leuprorelin+Mirena group(n=101,receiving HIFU combined with leuprorelin and Mirena treatment).Three groups of patients were treated with HIFU once and followed up for 2 years.The clinical ef-ficacy,sex hormones levels[estradiol(E2),luteinizing hormone(LH),follicle stimulating hormone(FSH)],CA125,AMH,C-reactive protein(CRP),uterine volume,menstrual volume,endometrial thick-ness and pain score(VAS)before and after treatment and incidence rates of adverse reactions during treat-ment were compared among the three groups.Results:The HIFU+leuprorelin+Mirena group had higher to-tal clinical effective rate after treatment than the HIFU+leuprorelin group and HIFU group(P<0.05).Be-fore treatment,the E2,LH and FSH levels among the three groups were not statistically different(P>0.05).The levels of E2,LH and FSH in the three groups were obviously declined after treatment than those before treatment(P<0.05).After treatment,the differences of E2,LH and FSH were greater in HIFU+leuprorelin+Mirena groupthan those in HIFU+leuprorelin group and HIFU group,and were greater in HIFU+leuprore-lin group than those in HIFU group(P<0.05).The levels of CA125,CRP and AMH were not statistically different among the three groups before treatment(P>0.05).After treatment,the CA125 and CRP levels in the three groups were lowered significantly(P<0.05),but the AMH level was not obviously changed after treatment(P>0.05).The differences of CA125 and CRP in HIFU+leuprorelin+Mirena group after treat-ment were greater than those in HIFU+leuprorelin and HIFU groups,and the differences in HIFU+leuprore-lin group were greater than those in HIFU group(P<0.05).Before treatment,no statistical differences were shown in uterine volume,menstrual volume,endometrial thickness and VAS score among the three groups(P>0.05).After treatment,the uterine volume,menstrual volume,endometrial thickness and VAS score were significantly reduced in the three groups compared with those before treatment(P<0.05).The differences of uterine volume,menstrual volume,endometrial thickness and VAS score in HIFU+leuprorelin+Mirena group after treatment were greater than those in HIFU+leuprorelin group and HIFU group,and were greater in HIFU+leuprorelin group than those in HIFU group(P<0.05).During treatment,there were no statistical differ-ences in the incidence rates of adverse reactions among the three groups(P>0.05).After 2 years of follow-up,3 patients in HIFU group had recurrence symptoms,mainly manifested as increased menstrual volume and aggravated dysmenorrhea.The efficacy in HIFU+leuprorelin+Mirena group was higher than that in HIFU+leuprorelin group and HIFU group(P<0.05).Conclusion:HIFU combined with leuprorelin and Mirena can enhance the therapeutic effect of AM patients,effectively regulate the levels of sex hormones and serum indica-tors,reduce the uterine volume and endometrial thickness,lower the menstrual volume,and relieve the pain,and it has no significant damage to ovarian reserve function,with good safety.
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