目的:研究子宫腺肌病患者置左炔诺孕酮宫内缓释系统(LNG-IUS)前后血浆前列腺素E2(PGE2)及子宫内膜组织中环氧化酶2(COX-2)的表达,探索LNG-IUS缓解子宫腺肌病痛经症状的机制。方法:采用视觉模拟评分法(VAS)和口述评分法(VRS)评定患者痛经的程度,ELISA法检测血浆PGE2含量;免疫组化法检测子宫内膜组织中COX-2的表达;Western blot法检测子宫内膜组织中COX-2蛋白含量。结果:放置LNG-IUS后,患者VAS评分及VRS评分均下降(VAS评分:22.96±21.09vs 83.81±9.82,VRS评分:0.67±0.48vs 1.41±0.64)(P<0.05)。置环后血浆PGE2水平较置环前降低[(18.83±23.97)pg/ml vs(5.76±2.62)pg/ml,P<0.05],子宫内膜组织中COX-2表达降低,置环前后COX-2表达阳性率分别为100%和66.7%(P<0.05),置环前后COX-2蛋白表达水平灰度值具有显著差异(1177312.68±356104.82vs 310510.22±215690.66)(P=0.046)。结论:LNG-IUS缓解子宫腺肌病患者痛经症状的机制可能与抑制COX-2合成、降低PGE2水平有关。 Objective: To investigate the expression of plasma prostaglandin E2 (PGE2) and endometrial tissue cyclooxygenase 2 (COX-2) in patients with adenomyosis after levonorgestrel-releasing intrauterine release system (LNG-IUS) Mechanism of LNG-IUS in relieving dysmenorrhea symptoms of adenomyosis. Methods: Visual analogue scale (VAS) and oral score (VRS) were used to evaluate the degree of dysmenorrhea. Plasma PGE2 levels were measured by ELISA. The expression of COX-2 in endometrium was detected by immunohistochemistry. Endometrial COX-2 protein content. Results: After placement of LNG-IUS, VAS score and VRS score decreased (VAS score: 22.96 ± 21.09 vs 83.81 ± 9.82, VRS score: 0.67 ± 0.48 vs 1.41 ± 0.64, P <0.05). The level of plasma PGE2 in the endometrium was significantly lower than that in the control group [(18.83 ± 23.97) pg / ml vs (5.76 ± 2.62) pg / ml, P <0.05] The positive rates of COX-2 expression were 100% and 66.7%, respectively (P <0.05). There was a significant difference in the gray value of COX-2 protein expression before and after the setting of loop (1177312.68 ± 356104.82 vs 310510.22 ± 215690.66) (P = 0.046). Conclusion: The mechanism of LNG-IUS relieving dysmenorrhea in patients with adenomyosis may be related to the inhibition of COX-2 synthesis and the decrease of PGE2 level.