米非司酮联合地屈孕酮片序贯治疗子宫腺肌症研究

Sequential treatment of adenomyosis with mifepristone combined with dydrogesterone tablets

目的研究小剂量米非司酮联合地屈孕酮片序贯治疗子宫腺肌症(AM)的临床效果。方法于2014年6月至2017年6月选取上海市复旦大学附属妇产科医院就诊的60例AM患者,利用随机数字表法分为对照组(n=30)和研究组(n=30)。对照组采用左炔诺孕酮宫内节育系统治疗,研究组采用左炔诺孕酮宫内节育系统+小剂量米非司酮联合地屈孕酮片序贯治疗。对比两组治疗效果及治疗1个序贯周期后血清性激素指标[卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)]水平、糖类抗原125(CA125)、血管内皮生长因子(VEGF)水平、子宫内膜厚度、子宫体积、月经量、痛经程度变化情况及不良反应发生情况。结果研究组治疗总有效率(93.33%)与对照组(83.33%)差异无统计学意义(χ^2=1.456,P>0.05)。治疗1个序贯周期后,研究组血清FSH、LH水平与对照组差别无统计学意义(t1=0.238,t2=0.349,均P>0.05),研究组血清E2水平高于对照组(t=4.073,P<0.01),研究组血清CA125、VEGF水平均低于对照组(t1=2.291,t2=5.106,均P<0.05),研究组子宫内膜厚度、子宫体积、月经量、痛经程度值均低于对照组(t1=7.156,t2=5.584,t3=4.477,t4=4.060,均P<0.01)。研究组不良反应总发生率(43.33%)低于对照组(80.00%)(χ^2=8.531,P<0.01)。结论采用小剂量米非司酮联合地屈孕酮片序贯治疗AM,能有效缩小子宫体积,降低内膜厚度,改善月经,且维持E2水平,不引起低雌激素症状,降低血清CA125、VEGF水平,不良反应少,安全性高。

Objective To observe the clinical effect of low-dose mifepristone combined with dydrogesterone tablets in the treatment of adenomyosis(AM).Methods 60 patients admitted for AM during the period from June 2014 to June 2017 were randomly divided into the control group(n=30) and the study group(n=30).The control group was treated with levonorgestrel intrauterine system,and the study group was treated with levonorgestrel intrauterine system plus small dose of mifepristone combined with dydrogesterone tablets.Compared were the therapeutic effects of the two groups and the serum sex hormone index [follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2)]level,carbohydrate antigen 125(CA125),vascular endothelium after one sequential cycle,growth factor(VEGF) levels,endometrial thickness,uterine volume,menstrual flow,changes in dysmenorrhea and adverse events.Results There was no significant difference in the total effective rate(93.33%) between the study group and the control group(83.33%)(χ^2=1.456,P>0.05).After one sequential cycle of treatment,there was no significant difference in serum FSH and LH levels between the study group and the control group(t1=0.238,t2=0.349,P>0.05 for both).The serum E2 level of the study group was higher than that of the control group(t=4.073,P<0.01),the serum levels of CA125 and VEGF in the study group were lower than those in the control group(t1=2.291,t2=5.106,P<0.05 for all).The endometrial thickness,uterine volume,menstrual volume and dysmenorrhea value of the study group all were lower than those of the control group(t1=7.156,t2=5.584,t3=4.477,t4=4.060, P<0.01 for all).The total incidence of adverse reactions in the study group(43.33%) was lower than that in the control group(80.00%)(χ^2=8.531,P<0.01).Conclusion Sequential treatment of AM with low-dose mifepristone combined with dydrogesterone tablets can effectively reduce uterine volume,reduce intima thickness,improve menstruation,and maintain E2 levels without causing low estrogen symptoms and lowering serum CA125 and VEGF levels,fewer adverse reactions and high safety.