棉酚片配伍安宫黄体酮治疗难治性功血的研究

A study on pharmacotherapy of intractable perimenopausal DUB with combination of gossypoi acetic acid and depogeston.

目的探讨复方醋酸棉酚片配伍安宫黄体酮治疗围绝经期难治性功血的临床效果。方法对2005年5月～2008年5月来西安市中心医院就诊的117例围绝经期功能失调性子宫出血的患者随机分为两组，研究组58例，连续应用安宫黄体酮3个月经周期，同时加服复方醋酸棉酚片，连服3个月；对照组59例，单纯应用安宫黄体酮治疗，连续用3个月经周期；两组患者均随访至其停药后半年，对两组的治疗效果进行对比分析。结果①用药3个月后，研究组发生闭经32例，月经量明显减少20例，月经转为正常6例；对照组发生闭经2例，月经量明显减少23例，月经量转为正常14例，7例患者因月经量多，经期长再次行诊刮术，13例患者于用药第2个月始因治疗效果不佳改用其他方法治疗。研究组治疗有效率明显高于治疗组（X2=23．71，P〈0．05）；②停药半年后，研究组得到42例随访患者，其中发生闭经者18例，月经稀发20例，月经转为正常4例，研究组治疗有效率明显高于对照组（X2=12．29，P〈0．05）。对照组有效治疗的39例患者中，月经稀发1例，月经量明显减少11例，月经转为正常者17例，有9例因月经量再次增多而行诊刮术，1例因月经量再次增多改用其它治疗方法；③研究组治疗后血清性激素水平显示、孕酮、雌二醇均有不同程度下降（t分别为6．74、4．32，P均〈0．05），促卵泡激素、黄体生成素则明显上升（t分别为13．98、12．75，P均〈0．01），对照组治疗前后性激素水平无明显变化（P〉0．05）；④研究组用药期间有3例发生低血钾，有13例（22．41％）出现恶心、纳差、呕吐等消化道症状。结论复方醋酸棉酚片配伍安宫黄体酮治疗围绝经期难治性功血疗效显著，副作用小，是一种可行的保守治疗方法。

Objective To observe therapeutic effect of gossypoi acetic acid combined with depogeston for intractable perimenopausal dysfunctional uterine bleeding （DUB）. Methods 117 patients with intractable perimenopausal DUB referred to Xi＇an Municipal Central Hospital over a period from May, 2005 to May,2008 were randomly divided into two groups： study group and control group. The patients in the control group（ n =59） received 8mg/d of depogeston for 21 days from the fifth day of menstrual cycle for 3 consecutive menstrual cycles. The patients in the study group （n = 58 ） were treated with same dosage of depogeston combined with 20mg/d of gossypoi acetic acid for 3 consecutive menstrual cycles. All the patients in the two groups were followed-up for 6 months after treatment and their therapeutic effects were assessed. Results （1）At the end of treatment, in the study group, 32 patients developed amenorrhoea, 20 patients had significant reduction in menstrual amount, menstruation of 6 patients returned to normal; While in the control group, 2 patients developed amenorrhoea, 23 patients had significant reduction in menstrual amount, the menstruation of 14 patients recovered normal, 7 patients received a diagnostic curettage because of delayed menstrual duration and increased menstrual amount, 13 patients terminated the treatment in the second month in consideration of unsatisfactory effects and started other therapies. The therapeutic effective rate in the study group was significantly higher than the control group （X2 = 23.71, P 〈 0.05 ） ; （2）At 6 months after the treatment, 42 patients were followed-up in the study group. Among them, 18 patients developed amenorrhoea, 20 patients developed oligomenorrhea, 4 patients had normal menstruation. Among 39 patients followed up in the control group, reduction in menstrual amount, 17 patients had normal menstruation, 9 1 patient developed oligomenorrhea, 11 patients had significant patients received a diagnostic curettage because of increased menstrual amount and 1 patient received other therapy because of hypermenorrhea. The therapeutic effective rate in the study group showed significantly higher than the control group（X2 = 12.29 ,P 〈 0.05 ） ; （3）Serum levels of gonadotrophin and ovarian hormones： There was no change in serum levels of sexual hormones observed in the control group after treatment （ P 〉 0.05 ）. In the study group, serum levels of progesterone （P） and estrogen （ E2 ） were decreased at different extent after treatment （t = 6.74 and 4.32 respectively, both P 〈0.05 ）, while the serum levels of FSH and LH were elevated after treatment than the control group （ t = 13.98 and 12.75 respectively, both P 〈 0.01 ） ; （4） In the study group, 3 patients had hypopotassemia and 13 patients had gastrointestinal symptoms such as nausea, vomiting, anorexia and so on. Conclusion Gossypoi acetic acid combined with depogeston is significantly effective in treatment of intractable perimenopausal DUB and no severe side effects are found. So, it is a feasible conservative treatment of perimenopausal DUB.