不同剂量米非司酮治疗子宫腺肌病238例临床观察

Clinical Observation on 238 Cases with Adenomyosis Treated with Mifepristone of Different Doses

目的:比较不同剂量米非司酮治疗子宫腺肌病的疗效及不良作用,并评估停药后复发的情况。方法:选取我院确诊为子宫腺肌病的238例患者作为研究对象,随机分为米非司酮40 mg·d^-1组(n=122例)和米非司酮20 mg·d^-1组(n=116例)两组,分别给予40 mg·d^-1米非司酮和20 mg·d^-1米非司酮进行口服治疗,连续服用9个月。用药前后经B超测量子宫体积的三维径线,评估患者血红蛋白浓度、子宫内膜情况等,并对患者进行9个月随访,观察子宫腺肌病复发情况。结果:两组剂量米非司酮均可改善子宫腺肌病患者的相关临床症状,缩小子宫体积并提高血红蛋白(P<0.05)。停药后比较两组患者3个月、6个月和9个月复发情况,差异均无统计学意义(P>0.05)。米非司酮20 mg·d^-1组发生子宫内膜异常增生率低于40 mg·d^-1组(P<0.05)。结论:米非司酮40 mg·d^-1和米非司酮20 mg·d^-1分别治疗子宫腺肌病,均能缩小子宫体积、改善临床症状,但以20 mg·d^-1剂量更安全。米非司酮治疗子宫腺肌病停药后复发率高,但可以用作术前辅助用药。

Objective:To compare the curative effects and adverse reactions of mifepristone of different doses in treatment of adenomyosis,evaluate the recurrence of adenomyosis after drug withdrawal.Methods:238 patients diagnosed with adenomyosis in our hospital were selected as subjects.They were randomly divided into mifepristone 40 mg·d^-1 group(n=122 cases)and mifepristone 20 mg·d^-1 group(n=116 cases),and treated with mifepristone of different doses for nine months.The three-dimensional diameters of uterus were measured by ultrasound before and after treatment.The serum hemoglobin concentration and endometrial conditions were evaluated.All the cases were followed up for 9 months,recurrence of adenomyosis was observed.Results:Mifepristone of different doses(40 and 20 mg·d^-1)can significantly improve the related clinical symptoms,increase the concentration of serum hemoglobin and reduce the volume of uterus,but there was no significant difference between the two groups(P>0.05).There was no significant difference in recurrence rate of adenomyosis 3,6 and 9 months after drug withdrawal between the two groups(P>0.05).The incidence of irregular hyperplasia of endometrium in 20 mg·d^-1 group was significantly lower than that in 40 mg·d^-1 group(P<0.05).Conclusion:Mifepristone of different doses(40 and 20 mg·d^-1)can reduce the volume of uterus and improve clinical symptoms,but mifepristone of 20mg·d^-1 is more safe.The recurrence rate of adenomyosis treated with mifepristone is high,but the use of mifepristone before operation is suggested.