奥美昔芬对围绝经期功能失调性子宫出血患者ER、PR和VEGF阳性率的影响

Effect of ormeloxifene on the ER, PR and VEGF positive rates for the patients with perimenopausal dysfunctional uterine bleeding

目的研究奥美昔芬对围绝经期功能失调性子宫出血(DUB)患者雌激素受体(ER)、孕激素受体(PR)和血管内皮生长因子(VEGF)阳性率的影响。方法选取2012年1月至2013年1月于本院治疗的围绝经期DUB患者60例,随机分为对照组和观察组,每组30例。对照组给予左炔诺孕酮,观察组给予奥美昔芬。采用免疫化学方法检测治疗前后子宫内膜ER、PR和VEGF的阳性率。记录治疗前后子宫内膜厚度、血红蛋白水平、月经失血图(PBAC)评分及不良反应情况。跟踪随访6个月后患者DUB的复发情况。结果治疗后两组患者ER和PR阳性率均降低,而VEGF阳性率升高,其中观察组较对照组变化更为显著,分别为(34.48%对55.37%),(25.12%对42.84%),(78.31%对63.85%),差异均具有统计学意义(P<0.05)。患者子宫内膜厚度和PBAC评分均低于治疗前,血红蛋白水平高于治疗前,观察组较对照组变化更为显著,分别为[(5.76±0.89)对(7.14±1.10)]mm,(74对97)分,(121.17对91.22)g/L,差异均具有统计学意义(P<0.05)。随访结果表明,对照组复发率高于观察组(20.0%对6.7%),且对照组复发患者ER和PR阳性率高于观察组复发患者(67.18%对35.59%)和(69.33%对37.24%),VEGF阳性率低于观察组(35.26%对62.32%),差异均具有统计学意义(P<0.05)。此外,对照组不良反应发生率高于观察组(13.33%对6.67%),差异具有统计学意义(P<0.05)。结论奥美昔芬治疗围绝经期DUB的效果优于左炔诺孕酮,可降低ER和PR阳性率,升高VEGF阳性率。

Objective To observe the effect of ormeloxifene on the positive rates of estrogen receptor （ER）, progesterone receptor （PR） and vascular endothelial growth factor （VEGF） in perimenopausal dysfunctional uterine bleeding （DUB） patients. Methods A total of 60 cases with perimenopausal DUB patients from January 2012 to January 2013 in our hospital were selected and divided into control group and observation group with 30 cases in each group. The control group patients were treated with levonorgestrel, and the observation group treated with ormeloxifene. The immunochemical tests were used to detect the positive rates of ER, PR and VEGF in both two groups. The endometrial thickness, hemoglobin level, PBAC scores and adverse reactions before and after treatment were recorded. While 6 month following, the detection on DUB recurrence were performed. Results The positive rates of ER and PR in the two groups after treatment were decreased, while the positive rate of VEGF was increased. All those in observation group were more obvious, and there were （34.48% vs 55.37%）, （25.12% vs 42.84%）, （78.31% vs 63.85%） respectively, and the differences were significant （P〈0.05）. The endometrial thickness and PBAC scores in two groups were lower than before treatment, and hemoglobin levels were higher. All those in observation group were more obvious, and there were [（5.76±0.89） vs （7.14±1.10）] mm, （74 vs 97） and （121.17vs 91.22） g/L respectively, and the differences were significant （P〈0.05）. The DUB recurrence rate in control group was higher than those in observation group （20.0% vs 6.7%）, and the positive rates of ER and PR of recurrence patients in control group were higher, while VEGF was lower than those of recurrence patients in observation group and there were （67.18% vs 35.59%）, （69.33% vs 37.24%）, and （35.26% vs 62.32%） respectively. The adverse reaction rate in control group was higher than that in observation group （13.33% vs 6.67%）, and the difference was significant （P〈0.05）. Conclusion Ormeloxifene can inhibit the positive rates of ER and PR and promote the positive rate of VEGF, and the effect is better than levonorgestrel in the treatment ofperimenopausal DUB.