结合雌激素片联合醋酸甲羟孕酮治疗围绝经期功能失调性子宫出血的疗效观察

Clinical observation of Conjugated Estrogens Tablets combined with medroxyprogesterone acetate in treatment of perimenopausal dysfunctional uterine bleeding

目的探讨结合雌激素片联合醋酸甲羟孕酮片治疗围绝经期功能失调性子宫出血的临床疗效。方法选取2015年1月—2016年2月中国人民解放军第313医院收治的围绝经期功能失调性子宫出血患者120例,按随机数字表法将所有患者分为对照组和治疗组,每组各60例。对照组在阴道出血第15天口服醋酸甲羟孕酮片,1片/次,3次/d,连续用药10 d。治疗组在对照组基础上在阴道撤退性出血第5天口服结合雌激素片,1片/次,1次/d,连续用药21 d。每个疗程21 d,两组均治疗6个疗程。观察两组的临床疗效,比较两组的促卵泡生成素(FSH)、促黄体生成素(LH)、孕酮(P)和雌二醇(E_2)、子宫内膜厚度和血红蛋白。结果治疗后,对照组和治疗组的总有效率分别为75.00%、91.67%,两组比较差异有统计学意义(P<0.05)。治疗后,两组FSH、LH、P和E_2水平均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组子宫内膜厚度均显著降低,而血红蛋白水平均显著升高,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。结论结合雌激素片联合醋酸甲羟孕酮片治疗围绝经期功能失调性子宫出血具有较好的临床疗效,可改善雌激素水平,降低子宫内膜厚度,升高血红蛋白水平,具有一定的临床推广应用价值。

Objective To investigate the clinical efficacy of Conjugated Estrogens Tablets combined with Medroxyprogesterone Acetate Tablets in treatment of perimenopausal dysfunctional uterine bleeding. Methods Patients （120 cases） with perimenopausal dysfunctional uterine bleeding in the No. 313 Hospital of PLA from January 2015 to February 2016 were randomly divided into control and treatment groups, and each group had 60 cases. Patients in the control group were po administered with Medroxyprogesterone Acetate Tablets on day 15 after vaginal bleeding, 1 tablet/time, once daily, treated for 10 d. Patients in the treatment group were po administered with Conjugated Estrogens Tablets on day 5 after vaginal withdrawal bleeding on the basis of the control group, 1 tablet/time, three times daily, treated for 21 d. Every course had 21 d, and patients in two groups were treated for 6 courses. After treatment, the clinical efficacies were evaluated, and FSH, LH, P, E2, endometrial thickness, and hemoglobin in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 75.00% and 91.67%, respectively, and there was difference between two groups （P 〈 0.05）. After treatment, the levels of FSH, LH, P, and E2 in two groups were significantly decreased, and the difference was statistically significant in the same group （P 〈 0.05）. And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups （P 〈 0.05）. After treatment, the endometrial thickness in two groups was significantly decreased, but the hemoglobin levels in two groups were significantly increased, and the difference was statistically significant in the same group （P 〈 0.05）. And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups （P 〈 0.05）.Conclusion Conjugated Estrogens Tablets combined with Medroxyprogesterone Acetate Tablets has clinical curative effect in treatment of perimenopausal dysfunctional uterine bleeding, can improve estrogen level, decrease the endometrial thickness, and increase hemoglobin level, which has a certain clinical application value.