雷公藤多甙治疗子宫肌瘤的临床研究

Clinical Study on Effect of Tripterygium Wilfordii Hook. f. on Uterin Leiomyoma

目的 观察雷公藤多甙治疗子宫肌瘤的疗效及副作用。方法 随机将患者分为两组 ,实验组服用雷公藤多甙 40mg/d治疗 3～ 6个月 ,对照组服用米非司酮 2 5mg/d治疗 3个月。治疗前后均用B超测量子宫及其肌瘤大小 ,用放射免疫法 (RIA)测血清促卵泡素 (FSH)、促黄体生成素 (LH)、垂体催乳素 (PRL)、雌二醇 (E2 )、孕酮 (P)和睾酮 (T)水平。结果 实验组患者子宫肌瘤于服药 3～ 4个月时缩小 (2 7.84± 3.6 9) % ,5～ 6个月时缩小 (5 1.6 0± 3.92 ) % ,呈时间依赖关系。治疗 3～ 4个月后6 0 .0 %患者治疗有效 ,而治疗达 5～ 6个月的 40例患者中 70 .0 %治疗有效。治疗后 3～ 4个月和 5～ 6个月后 ,分别与治疗前比较 ,外周血E2 、P水平明显下降 (P <0 .0 1,P <0 .0 5 ) ;FSH和LH水平明显上升 (P均 <0 .0 1) ;T和PRL治疗前后无明显变化 (P均 >0 .0 5 )。上述性激素水平在停药后 1～ 3个月内均恢复正常。实验组患者服药期间出现轻微胃部不适 ,均能自行缓解。结论 雷公藤多甙 40mg/d的剂量 ,治疗子宫肌瘤有效 ,且副作用不明显。雷公藤多甙对性腺轴有可逆性的抑制作用 。

Objective To observe the therapeutic effect of Tripterygium wilfordii Hook. f. on patients with uterine leiomyoma. Methods Baseline ultrasound examinations of myomas and uterine were obtained and repeated three months, six months after treatment. Blood samples were collected in the mid follicular or mid luteal phase of the menstrual cycle before initiation of Tripterygium wilfordii Hook. f. therapy and after treatment 3～4 months and 5～6 months, for determination of estradiol, progesteron, testosterone, follicle stimulating hormone, luteinizing hormone and prolactin by radioimmunoassay. Results Significant decrease in leiomyoma volume was detected in 39 of 65 (60.0%) patients after 3～4 months of Tripterygium wilfordii Hook. f. treatment and 28 of 40 (70.0%) patients after 5～6 months of treatment. The decrease in leiomyoma volume with Tripterygium wilfordii Hook.f. treatment was time dependent while 27.84% in 3～4 months, 51.6% in 5～6 months. 25 of 65 patients were amenorrheic during the course of treatment. Compared with pretreatment values, Tripterygium wilfordii Hook.f.treatment induced an increase in mean luteinizing hormone, fdlicle stimulating hormone levels and a decrease in mean estradiol, progesterone levels. Conclusions Tripterygium wilfordii Hook.f. may be an effective therapeutic agent for leiomyomas with fewer side effects. Tripterygium wilfordii Hook.f. treatment showed a reversibly inhibitory effect on the ovary. It may be one of the mechanisms of Tripterygium wilfordii Hook.f. in decreasing leiomyoma volume.