米非司酮对早孕妇女内分泌的影响

Endocrinologic Effects of Mifepristone in Early-Pregnant Women

共征集２４名停经≤４９ｄ、要求中止妊娠的健康妇女，分４组，各组依次口服米非司酮５０ｍｇ（组Ⅰ）、５０ｍｇＱ１２ｈ×６（组Ⅱ）、２００ｍｇ（组Ⅲ）和６００ｍｇ（组Ⅳ），首次服药后７２ｈ行人流术（组Ⅰ）或阴道内放置卡前列甲酯栓（ＰＧ０５）１ｍｇ（组Ⅱ～Ⅳ）。结果显示各组之间临床效果及临床经过差异均无统计学意义（Ｐ＞０．０５）。血清β－ｈＣＧ、Ｅ２Ｐ变化趋势亦基本一致。β－ｈＣＧ在用药前２４ｈ内上升５０％～１００％（Ｐ＜０．０１），服药后至孕囊排出前仍呈上升趋势，口服首剂米非司酮后，各组Ｅ２水平亦持续高于服药前，而Ｐ水平则缓慢下降。妊娠中止后，上述三种激素急剧下降。服药期间，各组ＰＲＬ和皮质醇明显上升，孕囊排出后前者下降缓慢，而后者下降迅速，ＡＣＴＨ、Ｔ３、Ｔ４和ＴＳＨ变化均无统计学意义。本研究结果表明来非司酮（５０ｍｇＱ１２ｈ×６，２００ｍｇ和６００ｍｇ）抗早孕时无明显量效关系；其主要作用部位似不在卵巢和绒毛；但对垂体一肾上腺轴有一定影响，尤其是大剂量时；对垂体一甲状腺轴影响不明显；ＰＲＬ水平变化似为药物直接作用所致，其临床意义尚待进一步研究。

healthy female volunteers (amenorrhea≤seven weeks) asking for termination of pregnancy were divided into 4 groups(6 for each group) .The subjects wereorally administered with 50mg of RU486 (Group Ⅰ ), 50mg Q12h×6 (Group Ⅱ ),200mg(Group Ⅲ ) or 600mg (Group Ⅳ) Vacuum aspiration (Group Ⅰ ) or MethylOarprost Supporsitory (PG05 1.0mg) (Group Ⅱ￣Ⅳ ) was administrated 72h afterthe first dose .The serum levels of β-hCG, E2 P, PRL, ACTH, Cortisol, T3,T4 andTSH were measured for study the pharmacodynamics of RU486.In all four groups administration of different doses of RU486 resulted in theincrease of β-hCG and PRL levels, higher E, level, evidently enhanced cortisolleve land slightly decreased P level, which did not show any significant doseeffect relationship.After abortion, however, the serum β-hCG E2 and P levels declined dramatically, so were the cortisol levels,while PRL levels decreased gradually to nonpregnant range. The levels of AOTH, T3, T4, TSH were not significantly chanegdduring the treatment.This Study indicated that RU486 (50mg Q12h×6, 200mg and 600mg) has nosignificant dose-effect relationship when used for interruption of early pregnan-cy, its main action site seems in neither ovary nor villi. It might effecton pituitary-adrenal axis especially in large dosage, and did not obviouslyeffect on pituitary-thyroid axis.lt seems that the changes in PRL serum levelswere caused directly by the drug itself, its clinical significance should be furtherstudied.