雌激素联合醋酸甲羟孕酮治疗功能失调性子宫出血患者的临床研究

Estrogen in combination with medroxyprogesterone acetate in the treatment of dysfunctional uterine bleeding

目的探讨雌激素联合醋酸甲羟孕酮对功能失调性子宫出血(DUB)患者促卵泡成熟素(FSH)、雌二醇(E2)、促黄体生成素(LH)及子宫内膜厚度的影响。方法将DUB患者60例随机分为对照组和试验组,每组30例。对照组患者给予醋酸甲羟孕酮片治疗,10 mg,qd,维持到止血后20 d;试验组患者在对照组基础上加用戊酸雌二醇片治疗,每次2 mg,tid,DUB出血量减少后,每隔3 d递减1/3量,维持至1 mg,qd,共用药3个月。观察2组患者的临床疗效、止血效果、子宫内膜厚度及性激素指标水平。结果治疗后,试验组和对照组的临床总有效率分别为93.33%,70.00%,差异有统计学意义(P<0.05)。治疗后,试验组和对照组控制出血时间分别为(25.37±8.62),(39.41±9.13)h;完全止血时间分别为(43.86±11.91),(55.73±18.64)h;子宫内膜厚度分别为(7.06±0.81),(8.37±0.87)mm;促卵泡成熟素(FSH)分别为(5.69±0.91),(8.21±1.26)mIU·mL^-1;雌二醇(E2)分别为(0.24±0.05),(0.33±0.06)mmol·L^-1;促黄体生成素(LH)分别为(8.14±2.32),(9.43±2.51)mIU·mL^-1,差异均有统计学意义(均P<0.05)。试验组和对照组的药物不良反应发生率分别为26.67%,23.33%,差异无统计学意义(P>0.05)。结论雌激素联合醋酸甲羟孕酮治疗DUB效果显著,可缩短子宫出血时间,同时有效降低子宫内膜厚度与血清FSH、E2、LH水平,且安全性好。

Objective To explore the effects of estrogen combined with medroxyprogesterone acetate on follicle stimulating hormone(FSH),estradiol(E2),luteinizing hormone(LH)and endometrial thickness in patients with dysfunctional uterine bleeding(DUB).Methods A total of 60 DUB patients were randomly assigned the control group and the treatment group,with 30 patients in each group.Patients in the control group were treated with medroxyprogesterone acetate tablets,10 mg,qd,maintained until 20 d after hemostasis;Patients in the treatment group were treated with estradiol valerate on the basis of the control group,2 mg per time,tid,after the DUB bleeding volume was reduced,the amount was decreased by 1/3 every 3 d and maitained at the dose of 1 mg,qd for 3 months.The clinical efficacy,hemostatic effect,endometrial thickness and sex hormone index levels of the 2 groups were observed.Results After treatment,the total clinical effective rates of the treatment group and the control group were 93.33% and 70.00%,respectively,and the difference was statistically significant(P<0.05).After treatment,there were statistically significant differences between the treatment group and the control group in the controlled bleeding time[(25.37±8.62)h vs(39.41±9.13)h],complete hemostasis time[(43.86±11.91)h vs(55.73±18.64)h],the endometrial thickness[(7.06±0.81)mm vs(8.37±0.87)mm],the levels of follide stimulating hormone(FSH)[(5.69±0.91)mIU·mL^-1 vs(8.21±1.26)mIU·mL^-1],the levels of estradiol(E2)[(0.24±0.05)mmol·L^-1 vs(0.33±0.06)mmol·L^-1],and the levels of luteinizing hormone(LH)[(8.14±2.32)mIU·mL^-1 vs(9.43±2.51)mIU·mL^-1](P>0.05).The incidence of adverse drug reactions in the treatment group and the control group were 26.67% and 23.33%,respectively,with no statistically significant difference(P>0.05).Conclusion Estrogen combined with medroxyprogesterone acetate has a significant effect on the treatment of DUB,which can shorten the uterine bleeding time,and effectively reduce the endometrial thickness and serum FSH,E2,LH levels,and has good safety.