小剂量米非司酮治疗复发性子宫内膜异位症的疗效评价及卵巢功能和血皮质醇水平的变化

Clinic curative effects of low-dose mifepristone in treating recurrent endometriosis and changes in ovarian function and serum cortisol level

目的:探讨小剂量米非司酮治疗保守性手术后子宫内膜异位症复发的临床疗效、对卵巢功能及血皮质醇的影响。方法:选择经开腹或腹腔镜确诊的子宫内膜异位症复发患者126例,双盲随机分为米非司酮组(n=72)和达那唑组(n=54)。两组分别口服米非司酮和达那唑,治疗3个月后观察治疗前后症状、体征、卵巢功能及血皮质醇的变化。结果:两组间治疗后痛经、非经期下腹痛、性交痛、盆腔触痛、后陷凹结节、子宫活动受限、卵巢异位囊肿体积改善率比较差异均无显著性(P>0.05)。米非司酮组及达那唑组治疗后血清雌二醇(E2)值分别为(74.18±22.32)pmol·L-1和(24.96±3.94)pmol·L-1,两者比较差异有显著性(P<0.01)。米非司酮组及达那唑组停药后恢复月经平均日数分别为(27.0±8.9)d和(40.0±12.4)d,两组比较差异有显著性(P<0.01)。两组治疗前后血清皮质醇值比较差异无显著性(P>0.05)。结论:米非司酮组与达那唑组均能有效改善患者的症状及体征;米非司酮组血清E2保持在卵泡期水平,达那唑组血清E2处于绝经后水平,米非司酮组不出现雌激素缺乏症;停药后米非司酮组较达那唑组排卵功能恢复快,月经复潮时间短,有利于早日受孕;米非司酮与达那唑短期治疗对血清皮质醇均无明显影响。

Objective To investigate the clinic curative effects, serum cortisol and ovarian function after treated with low-dose mifepristone following conservative surgery in recurrent endometriosis. Methods One hundred twenty-six patients with recurrent endometriosis after abdominoscope diagnosis were divided into M and D groups, the patients in group M （n=72） were treated orally with mifepristone and group D （n=54） with danazol, the symptoms, signs, ovarian function and changes in blood cortisol 3 months after treatment were observed. Results The differences of remission rates after treatment on symptoms, dysmenorrhea, hypogastralgia during non menstrual period, sexual intercourse pain, pelvic cavity tenderness, rear excavation tuberosity, womb movement restriction, aberrant ovary cyst size between two groups were not significant （P〉0. 05）. After treatment, blood serum E2 level in group M was （74.18±22.32） pmol · L^-1 , whereas that in group D was （24. 96±3. 94） pmol · L^-1 , there was significant difference （P〈0. 01）. The differences of blood serum cortisol level between two groups hadno significant difference （P〉0.05）. Conclusion Clinical symptoms of patients with recurrent endometriosis in two groups are improved. Serum E2 level in group M remains postmenopausal range. Mifepristone does not result in lack of in group M compared with group D. Mifepristone and danazol in the follicular phase, but group D declines to estrogen, ovulation recovers rapidly after treatment have not obvious impact on blood serum cortisol.