米非司酮对子宫肌瘤及子宫肌层组织雌、孕激素受体的影响

Effects of Mifepristone on Estrogen and Progestin Receptors in Human Uterine Leiomyoma

目的 了解米非司酮对子宫肌瘤及子宫肌层组织中雌激素受体 (ER)、孕激素受体 (PR)的影响。方法 对 2 0例临床诊断为子宫肌瘤并有手术指征、无内科合并症患者 (服药组 ) ,从月经第 1天起予米非司酮每日 2 5mg口服 ,连续 90d ,应用彩色超声检查服药前、后子宫肌瘤的变化 ,以及血清激素水平、血脂、肝肾功能、电解质、血常规的变化。停药后立即手术 ,并配对选 2 0例临床情况相似的子宫肌瘤患者作为对照组 ,用ER、PR单克隆抗体免疫组织化学法检测子宫肌瘤及部分肌层组织的ER、PR水平。结果 服药后子宫肌瘤平均缩小 (37.3± 19.0 ) % ( x±s,下同 ) ,子宫体积平均缩小(2 7.4± 2 1.9) % ,血清激素水平仍维持卵泡期水平 ,服药组子宫肌瘤组织中ER、PR均明显低于对照组(P <0 .0 0 1) ,而肌层组织中无明显差异 (P >0 .0 5 ) ;对照组ER、PR及服药组PR在肌瘤组织中均高于肌层组织 (P <0 .0 5 ) ,而服药组ER在肌瘤与肌层组织中相近 (P >0 .0 5 )。结论 米非司酮是安全有效的治疗子宫肌瘤的药物 ,可明显降低子宫肌瘤组织中的ER、PR ,而对子宫肌层组织无明显影响。

Objectives To study the effects of mifepristone on estrogen receptors (ER) and progestin receptors (PR) in human uterine leiomyoma and myometrium. Methods 20 patients with uterine leiomyoma who had surgical indication received 25 mg of mifepristone daily for 90 days beginning on the first day of menstrual cycle. Ultrasound examination,serum hormonal parameters, liver and renal function, electrolyte, complete blood count were monitored prior to and at the end of treatment. Hysterectomy or myomectomy was performed just when the treatment finished. Leiomyomata and myometrial tissue were obtained for immunohistochemical ER and PR analyses using monoclonal antibody. Control group included 20 patients who had matched age, weight, size and position of leiomyoma, and operated in the follicular phase of the cycle. Results After 90 days of mifepristone treatment, the leiomyoma volume decreased by (37.3±19.0)% and the uterine volume decreased (27.4± 21.9)%. Hormonal parameters were within the levels of follicular phase. ER and PR positive rate in leiomyoma but not in myometrium of study group were significantly less than those of control group ( P <0.001). The positive rate of ER and PR of control group and PR of study group in leiomyoma were significantly higher than those in myometrial tissue of both groups( P <0.05). ER of study group in leiomyoma was similar to myometrial tissue ( P >0.05). Conclusions Mifepristone is a safe and effective drug for treating uterine leiomyoma. It can significantly decrease ER and PR in leiomyoma but not in myometrial tissue.