连续口服小剂量米非司酮对卵巢功能及子宫内膜发育的影响

Effects of Continuous Low Dose Mifepristone on Ovarian Function and the Development of Uterine Endometrium

目的 探讨连续 (每天 )口服小剂量米非司酮对卵巢功能、子宫内膜发育的影响 ,对服药妇女月经周期、各脏器功能的影响及副作用 ,及其作为口服避孕药的可能。方法 40名有正常月经周期的健康妇女 ,随机分成两组 ,每组 2 0名。Ⅰ组口服 2mg/d米非司酮 ;Ⅱ组口服 5mg/d米非司酮 ,共 12 0d。在服药前后 30d和服药期内每周留 1次晨尿 ,检测E、P2 并发月经卡 ,每天记录阴道流血情况。每 30d随访检测肝肾功能、血常规、血糖、血脂、电解质、E2 、P、FSH、LH、PRL等 ,并阴道超声检测卵泡发育、子宫内膜厚度等。服药前月经周期中期 (月经第 10～ 12天 ) ,服药第 6 0天及服药第 12 0天共 3次活检子宫内膜标本作病理检查 ,包括HE染色、雌孕激素受体染色。结果 服药期间肝肾功能、电解质、脂质代谢、血糖等无明显异常改变 ,无严重副反应。Ⅰ组 80 %妇女闭经 ,Ⅱ组 90 %闭经 ;服药 80个月经周期中 ,Ⅰ组仅 2个周期 (2 / 80 )有排卵 ,Ⅱ组仅 1个周期 (1/ 80 )有排卵。无一例妇女妊娠。大部分子宫内膜处于持续增生期并逐渐增厚 ,未发现子宫内膜有增生过长或不典型增生。结论 ①连续口服 2mg或 5mg米非司酮可以抑制卵泡发育、排卵 ,阻碍子宫内膜发育成熟 ;②连续口服 2mg或 5mg米非司酮对妇女的肝肾功能、电解质、脂?

Purpose. To study the effects of continuous low dose mifepristone on ovarian function and endometrial development, and the effects on women's menstrual cycle, the function of organs and side effects. To explore the possibility of low dose mifepristone would-be a kind of pill. Methods. Study was a double-blind randomized comparative trial. Forty women who had good health and normal menstrual cycle were divided into 2 groups randomly. Twenty women took 2 mg mifepristone daily in group I, another twenty women took 5 mg mifepristone daily in group II. Women were asked to keep urine specimen once a week to measure E, P2. We gave women a card to record vaginal bleeding everyday. In every visit we got women's blood sample to measure ALT, Cr, Bun, Hb, BPC, E2, P, FSH, LH, PRL, ACTH, Cortisol, K +, Na+, Cl-, etc. Women's ovary follicle and endometrial thickness were examined by vaginal ultrasound. We did three times of endometrium biopsy. The first time was in the middle of pretreatment cycle. The second time was at the 60th day of the treatment cycle. The third time was at 120th day of the treatment cycle. Endometrium were evaluated for histology and immunolocalization of oestrogen receptors (ER), progesterone receptors (PR). Results. In the treatment cycle, women's liver, kidney function, fat metabolism and serum glucose level were normal. No severe side effect. In the treatment cycle, 80% women of group I got amenorrhea, 90% women of group II got amenorrhea. No women got pregnancy. Most women's endometrium were in the proliferous period continually. None of them had endometrial hyperplasia and endometrial atypical hyperplasia. Conclusions. 1 Daily oral 2 or 5 mg mifepristone can inhabit follicle development and ovulation, obstruct endometrial development; (2) Daily oral 2 of 5 mg mifepristone is harmless to women's liver, kidney function, fat metabolism, serum glucose level; (3) It showed that the low dose mifepristone may be hopeful to become a pill. But about accurate method and dose, further research will be continued.