不同方案治疗围绝经期功血的效果与安全性

Efficacy and safety of different regimens in the treatment of perimenopausal dysfunctional uterine bleeding

目的研究分析左炔诺孕酮行宫内缓释给药同米非司酮治疗围绝经期功能失调性子宫出血患者的临床效果和治疗安全性。方法选择2015年6月至2018年6月厦门市妇幼保健院诊治的268例围绝经期功能失调性子宫出血患者为研究对象,采用数字随机表法将其平均分为研究组和对照组,每组134例患者。研究组患者行左炔诺孕酮宫内缓释治疗,治疗前后统计患者血红蛋白浓度(Hb)、月经量和子宫内膜厚度,同时检测患者的性激素水平;对照组给予米非司酮治疗;评价2种治疗方案的有效性与可行性。结果治疗前,两组患者HB浓度、子宫内膜厚度和月经量比较,其差异均无统计学意义(均P>0.05);治疗后,研究组患者相关指标均优于对照组患者,其差异均具有统计学意义(均P<0.05)。治疗前后,两组患者自身性激素水平比较,其差异均具有统计学意义(均P<0.05)。治疗后,两组患者FSH、E2比较,其差异均无统计学意义(均P>0.05);同时,研究组患者P4、LH均高于对照组患者,其差异均具有统计学意义(均P<0.05);研究组患者治疗总有效率和并发症发生率均优于对照组患者,其差异均具有统计学意义(均P<0.05)。结论围绝经期功能失调性子宫出血患者应用左炔诺孕酮行宫内缓释给药或米非司酮治疗均有一定的效果,但前者临床效果和安全性更好,对患者的出血情况和相关指标的改善效果更具优势,可以作为首选治疗方案。

Objective To study the clinical effect and safety of levonorgestrel sustained-release intrauterine administration and mifepristone in the treatment of perimenopausal dysfunctional uterine bleeding. Methods 268 patients with perimenopausal dysfunctional uterine bleeding were selected from Xiamen Maternal and Child Health Hospital from June 2015 to June 2018. They were divided into study group and control group with 134 patients in each group by using digital random table method. The study group received levonorgestrel intrauterine sustained-release therapy. Before and after treatment, the blood hemoglobin concentration(Hb), menstrual volume and endometrial thickness were counted, and the sex hormone levels of the patients were measured. The control group was given mifepristone treatment. The effectiveness and feasibility of the two treatment schemes were evaluated. Results Before treatment, there was no statistically significant difference in HB concentration, endometrial thickness and menstrual volume between the two groups(all P>0.05), but after treatment, the related indicators of the study group were better than those of the control group, with statistically significant differences(all P<0.05). Before and after treatment, there were significant differences in the levels of sex hormones between the two groups(all P<0.05). After treatment, there was no significant difference in FSH and E2 between the two groups(all P>0.05). At the same time, levels of P4 and LH in the study group were higher than those in the control group, with statistically significant differences(all P<0.05). The total effective rate and the incidence of complications in the study group were better than those in the control group, with statistically significant differences(all P<0.05). Conclusions The application of levonorgestrel or mifepristone in the treatment of perimenopausal dysfunctional uterine bleeding has certain effect, but the former has better clinical effect and safety with more advantages in improving the bleeding situation and related indicators, so it can be used as the first choice of treatment.