不同剂量米非司酮治疗围绝经期子宫小肌瘤临床效果及对血管内皮生长因子和其受体表达的影响

Clinical Effect of Different Doses of Mifepristone in Treatment of Premenopausal Hysteromyoma and Influence of the Expression of Vascular Endothelial Growth factor and Its Receptor

目的探讨不同剂量米非司酮治疗围绝经期子宫小肌瘤临床效果及其对血管内皮生长因子(VEGF)和其受体血管内皮生长因子受体(VEGFR)1和VEGFR2表达的影响。方法选择2011年10月—2012年12月攀枝花市中心医院妇产科收治的确诊为围绝经期子宫小肌瘤80例作为研究对象,据随机数字表法随机将其分为高剂量组和低剂量组两组,每组40例。高剂量组给予米非司酮每日25 mg口服,低剂量组给予米非司酮每日12.5 mg口服。观察比较两组治疗效果、治疗前后外周血VEGF及其受体VEGFR1、VEGFR2浓度及安全性。结果治疗过程中,高剂量组脱落1例,低剂量组脱落2例。治疗2个疗程后,高剂量组有效率84.62%,低剂量组有效率84.21%,两组比较差异无统计学意义(P>0.05)。治疗2个疗程后,两组子宫肌瘤体积均较治疗前显著缩小,外周血VEGF及其受体VEGFR1、VEGFR2浓度均较治疗前降低,差异均有统计学意义(P<0.05),但两组间治疗前及治疗2个疗程后子宫肌瘤体积、外周血VEGF及其受体VEGFR1、VEGFR2浓度比较差异均无统计学意义(P>0.05)。治疗2个疗程后不良反应发生率高剂量组为17.95%,低剂量组为5.26%,两组比较差异有统计学意义(P<0.05)。结论低剂量和高剂量米非司酮均可通过抑制围绝经期子宫小肌瘤患者外周血VEGF及其受体VEGFR1、VEGFR2表达,达到逐步缩小肌瘤体积、改善临床症状效果,但低剂量米非司酮不良反应发生率较低,安全性较好,可降低医药成本。

Objective To discuss the clinical effect of different doses of Mifepristone in treatment of premenopausal hysteromyoma and influence of the expression of vascular endothelial growth factor（ VEGF） and its receptor vascular endothelial growth factor receptor（ VEGFR） 1 and VEGFR2. Methods 80 cases of confirmed premenopausal hysteromyoma in the department of obstetrics and gynecology of Central Hospital of Panzhihua during October 2011 and December 2012 were selected as the research objects,and according to random number table method and registration order,divided into the high dose group and low dose group（ n = 40 in each group）. High dose group had 25 mg daily of oral Mifepristone,low dose group was given 12. 5 mg daily of oral Mifepristone. Therapeutic effect,concentration of VEGF and its receptor VEGFR1,VEGFR2 in peripheral blood before and after treatment and the safety rates were compared between the two groups. Results During the therapeutic process,1 case of the high dose group fell off,and 2 cases of the low dose group fell off. After two courses of treatment,the effective rate of high dose group was 84. 62%,while the effective rate in low dose group was 84. 21%,and there was no statistical significance between the two groups（ P〈0. 05）. After two courses of treatment,hysteromyoma volume of the two groups shrank significantly compared with that before treatment,while concentration of VEGF and its receptor VEGFR1,VEGFR2 in the peripheral blood were less than that before treatment,and the differences were statistically significant（ P〈0. 05）,but the differences between the two groups before and after 2 courses of treatment in the hysteromyoma volume,peripheral blood VEGF and its receptor VEGFR1,VEGFR2 concentration were of no statistical significance（ P〈0. 05）. After two courses of treatment,incidence rate of adverse reactions in the high dose group was 17. 95%,5. 26% in the low dose group,and difference was of statistical significance（ P〈0. 05）. Conclusion Both low dose and high dose Mifepristone can inhibit the expression of peripheral blood VEGF and its receptors VEGFR1,VEGFR2 in the patients with menopausal hysteromyoma,which can gradually shrink the tumors volume and improve the effect of clinical symptoms. But low dose Mifepristone has low incidence rate of adverse reaction,better safety and lower expense of medication.