小剂量米非司酮对女性生殖/内分泌系统的影响

The effect of low dose Mifepristone on female reproductive and endocrine system

目的探讨小剂量米非司酮对女性生殖/内分泌系统的影响。方法选取子宫腺肌病患者31例,服用米非司酮4个月。检测用药前后血雌二醇(estradiol,E2)、促卵泡素(Follicle-stimulating hormone,FSH)、谷丙转氨酶(glutamic-pyruvic transaminase,GPT)、肌酐(creatinine,Cr)及用药前后卵巢体积、子宫体积及子宫内膜增殖细胞核抗原(proliferation cell nuclear antigen,PCNA)指数。结果治疗后E2水平[(131.68±40.31)pmol/L]较治疗前E2水平[(255.90±152.61)pmol/L]明显下降,差异有统计学意义(P<0.05);治疗前后FSH水平差异无统计学意义(P>0.05)。②卵巢体积[(10.68±0.24)cm3]及子宫体积[(64.20±1.04)cm3]均小于治疗前[(14.25±0.51)cm3、(81.42±1.01)cm3],差异有统计学意义(P<0.05)。③治疗后内膜转化率为33.3%,部分内膜发生增生过长;治疗前后内膜PCNA指数差异无统计学意义(P>0.05)。④治疗前后血GPT、Cr差异无统计学意义(P>0.05)。结论小剂量米非司酮对垂体具有雌激素样的负反馈作用;同时通过抗雌激素样作用直接作用于卵巢,使卵巢激素缺乏周期性变化而出现闭经,并伴随卵巢、子宫缩小及更年期症状;还对子宫内膜具有微弱的雌激素样作用。

Objective To investigate the effect of low dose Mifepristone on female reproductive and endocrine system.Methods Thirty-one cases with adenomyosis were treated with Mifepristone for 4 months.Estradiol（E2）,Follicle stimulating hormone（FSH）,（glutamic-pyruvic transaminase（GPT）,creatinine（Cr）,Ovarian and uterine area and endometrial proliferation cell nuclear antigen（PCNA）index were tested before and after treatment.Results ①The level of E2 which was（131.68±40.31）pmol/L post-treatment decreased than that pre-treatment which was（255.90±152.61）pmol/L and the difference was statistically significant（P0.05）.FSH was no significant difference before and after treatment.②Ovarian volume[（10.68±0.24）cm3] and uterine volume[（64.20±1.04）cm3] were less than that before the treatment which were（14.25±0.51）cm3 and（81.42±1.01）cm3 respectively.The differences of ovarian volume and uterine volume were statistically significant（P0.05）.③Endometrial transformation after treatment was 33.3% and part of endometrial hyperplasia occurred.Endometrial positive expression rates of pre-treatment and post-treatment PCNA showed no significant differences（P0.05）.④ serum GPT and Cr level of pre-treatment and post-treatment showed no significant differences（P0.05）.Conclusion Low dose of Mifepristone have estrogenic effects of negative feedback on pituitary and Mifepristone with antiestrogen-like affects the direct role in the ovary so that ovarian hormone deficiency cyclical changes lead to amenorrhea and accompanied the ovary and uterus shrinking and menopausal symptoms.Mifepristone also has weak estrogenic effects on endometrium.