High-risk Factor Analysis of Clinical Effect of Levonorgestrel Intrauterine System Combined with Dinorgestrel in the Treatment of Uterine Adenomy-osis

LUO Yelin; HUANG Zhuohua; LEI Jia; JIANG Buying; HUANG Tao

doi:10.3969/j.issn.1002-3429.2023.09.016

Abstract：Objective To investigate the high-risk factors of clinical effect of Levonorgestrel intrauterine system com-bined with Dinorgestrel in the treatment of uterine adenomyosis.Methods A total of 100 patients(a total of 99 valid ques-tionnaires were retrieved)with uterine adenomyosis treated from January 2020 to December 2022 were selected as the research subjects.All of them were treated with Levonorgestrel intrauterine system combined with Dinorgestrel.Multivariate Logistic re-gression was used to analyze the risk factors influencing the efficacy of uterine adenomyosis.The clinical prediction model was constructed.The visualization nomogram model was drawn by R language software and related software packages.Results At 3 months after treatment,the total effective rate of the patients with uterine adenomyosis was 79.80%(79/99),and the men-strual volume,uterine volume,endometrial thickness and scores of visual analogue scale(VAS)at 3 months after treatment were better than those before treatment(P＜0.01).Anti-mullerian hormone(AMH),carbohydrate antigen 125(CA125),erythrocyte deposition rate(ESR),procalcitonin(PCT),C reactive protein(CRP),treatment-related adverse reactions,and endometriosis were high risk factors for the treatment failure of adenomyosis in patients with Levinorgestrel intrauterine birth control system combined with Dinorgestrel(P＜0.01).The overall accuracy rate of the clinical prediction model was 89.90%,and Omnibus test showed that the global test of the model had statistical significance(P＜0.05).The results of 5-fold cross-validation by R language3.4.0 showed that the prediction accuracy of the clinical prediction model was 75.60%,and the results of Omnibus test showed that the model was generally significant(P＜0.01).The visualization nomogram for predicting the efficacy of uterine adenomyosis was established,which could be used to predict the probability of treatment fail-ure of uterine adenomyosis.Conclusion The high-risk factors for the efficacy of Levonorgestrel intrauterine system combined with Dinorgestrel in the treatment of uterine adenomyosis are AMH,CA125,ESR,PCT,and CRP.The construction of clini-cal prediction model and visual nomogram based on the above high-risk factors has good predictive efficacy,and can be used as a tool for predicting the efficacy of uterine adenomyosis.