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子宮内膜ポリープの治療における子宮鏡下プロゲステロンホルモン療法の検討
Post hysteroscopic progesterone hormone therapy in the treatment of endometrial polyps.
PMID: 30344589
抄録
目的:
子宮内膜ポリープの治療における子宮鏡下プロゲステロンホルモン療法の臨床効果と子宮内膜血管内皮増殖因子（VEGF）発現を明らかにすることである。
OBJECTIVE: To find out the clinical effects of post hysteroscopic progesterone hormone therapy in the treatment of endometrial polyps in terms of clinical outcome and the expression of endometrial Vascular Endothelial Growth Factor (VEGF).
方法:
2014年4月から2016年12月までに当院で子宮内膜ポリープと確認された患者98名を抽出し、乱数表を用いて治療群と対照群に分け、各群49名ずつを対象とした。両群の患者には子宮鏡下手術を行った。治療群の患者には子宮鏡手術後にプロゲステロンホルモン製剤を投与し、対照群の患者にはプロゲステロンホルモンを投与しなかった。治療後の月経血量、月経周期、VEGFの発現量の変化を両群間で比較し、治療後1年経過した時点で再発状況、子宮内膜厚、ヘモグロビンの変化を追跡調査した。
METHODS: Ninety-eight patients who were confirmed as endometrial polyp in the hospital from April 2014 and December 2016 were selected and divided into treatment group and a control group using random number table, 49 in each group. Patients in both groups were given hysteroscopic operation. Patients in the treatment group were treated by progesterone hormone drugs after hysteroscopic operation, while patients in the control group were not given progesterone hormone. The changes of menstrual blood volume, menstrual cycle and expression of VEGF were compared between the two groups after treatment, and the recurrence condition, thickness of endometrium and hemoglobin were followed up one year after treatment.
結果:
両群の患者の絵入り出血評価表（PBAC）スコアは、治療前に有意差はなかったが（P>0.05）、治療群のスコアは対照群よりはるかに低かった。治療群の月経周期の改善率は対照群よりはるかに高く、その差は統計的に有意であった（P<0.05）。治療前と比較して、治療後1ヶ月、3ヶ月、6ヶ月の血清VEGF値は両群とも顕著に低下し、その差は統計学的に有意であった（P<0.05）。治療後1カ月と3カ月における両群の血清VEGF値の差は、統計的に有意ではなかった（P>0.05）。治療群の血清VEGF値は治療後6ヶ月で対照群より顕著に低下し、その差は統計的に有意であった（P＜0.05）。追跡調査の結果、治療群は対照群に比べ子宮内膜の厚さが薄く、ヘモグロビン値が高く、治療群の再発率は対照群に比べ低かった（P＜0.05）。
RESULTS: The pictorial blood loss assessment chart (PBAC) scores of patients in the two groups had no significant difference before treatment (P>0.05); but the score of the treatment group was much lower than that of the control group. The improvement rate of menstrual cycle of the treatment group was much higher than that of the control group, and the difference had statistical significance (P<0.05). Compared to before treatment, the serum VEGF level of the patients in both groups had a remarkable decline in the 1, 3 and 6 month after treatment, and the difference had statistical significance (P<0.05). The difference of the serum VEGF level between the two groups in the 1 and 3 month after treatment had no statistical significance (P>0.05). The serum VEGF level of the treatment group was notably lower than that of the control group six months after treatment, and the difference had statistical significance (P<0.05). The follow-up results demonstrated that the treatment group had smaller thickness of endometrium and higher level of hemoglobin compared to the control group, and the recurrence rate of the treatment group was lower than that of the control group (P<0.05).
結論:
子宮鏡下プロゲステロンホルモン療法は、子宮内膜ポリープの再発防止、ヘモグロビン値の緩和、子宮内膜の厚みの減少に効果的であり、子宮内膜ポリープの治療において良好な臨床効果を示すことが示された。
CONCLUSION: Post hysteroscopic progesterone hormone therapy has favorable clinical effect in treating endometrial polyps as it can effectively prevent the recurrence of endometrial polyps, relieve the level of hemoglobin and reduce endometrial thickness.