妈富隆和米非司酮治疗围绝经期功能失调性子宫出血的临床疗效及对性激素浓度的影响

Effects of marvelon and mifepristone on peri-menopausal uterine bleeding and sex hormones

目的观察妈富隆治疗围绝经期功能性子宫出血的临床疗效及对血清性激素浓度的影响。方法 100例围绝经期功能失调性子宫出血患者随机分为治疗组和对照组,对照组在诊断性刮宫术后3 d给予米非司酮治疗,治疗组在诊断性刮宫术后3d给予妈富隆治疗。采用放射免疫法测定患者治疗前后3项血清性激素浓度,包括促卵泡生成素(follicle stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、雌激素(estradiol,E2);记录两组控制出血时间和完全止血时间,B超检查子宫内膜厚度,病理检查观察子宫内膜病理改变,观察不良反应;随访结束后评价临床疗效。结果治疗组临床疗效总有效率为98.0%,显著高于对照组(88.0%),差异有统计学意义(P<0.05);治疗组控制出血时间和完全止血时间均低于对照组,差异有统计学意义(P<0.05);治疗后,治疗组FSH、LH、E2浓度下降,与治疗前和对照组比较差异均有统计学意义(P<0.05);而治疗前后对照组血清性激素浓度比较差异无统计学意义(P>0.05);治疗后,治疗组子宫内膜为(4.04±0.41)mm,对照组为(6.69±0.78)mm,2组相比较差异有统计学意义(P<0.05)。治疗后,治疗组均为正常子宫内膜,而对照组有11例病理检查结果仍为简单型增生过长,2组病理结果比较差异有统计学意义(P<0.05)。2组不良反应轻微。结论妈富隆治疗围绝经期功能失调性子宫出血能够抑制血清FSH的释放,使内源性E2和LH下降,临床疗效显著,安全可靠,值得临床推广应用。

Objective To observe the effect of marvelon and mifepristone on sex hormones and peri-menopausal dysfunctional uterine bleeding（PDUB） in patients with PDUB.Methods Totally 100 cases of patients with PDUB were randomly divided into treatment group and control group.The control group was treated using mifepristone starting from the third day after diagnostic curettage,and the treatment group was treated using marvelon from the third day after diagnostic curettage.The levels of serum sex hormones,including follicle stimulating hormone（FSH）,luteinizing hormone（LH） and estradiol（E2）,were detected by radioimmunoassay.The time to control of the bleeding and complete stop of bleeding in the two groups was recorded,the adverse reaction was observed.The clinical efficacy was evaluated at the end of follow-up.Results The total clinical effective rate of the marvelon group was 98.0%,which was significantly higher than that of the control group（88.0%）（P0.05）.After treatment,the FSH,LH and E2 levels of the treatment group significantly decreased compared with the control group（P0.05）;The FSH,LH and E2 levels of the control group between the prior-treatment and post-treatment was no significant difference（P0.05）;After treatment,the thickness of endometrium of the treatment group was（4.04±0.41） mm,that of the control group was（6.69±0.78） mm,the difference was significant（P0.05）.After treatment,the endometrium of the treatment group was normal,while in control group the endometrium of 11 cases still had simple hyperplasia,the pathological results of the two groups were significantly different（P0.05）.There was no obvious adverse reaction in the two groups.Conclusion The marvelon in treatment of PDUB can inhibit the release of serum FSH,and prompt the declining of endogenous E2 and LH.It is effective,safe,reliable and worthy of clinical application.