围绝经期子宫异常出血患者应用炔雌醇环丙孕酮联合高低剂量米非司酮治疗效果观察

Effect of ethinylestradiol cyproterone combined with high and low dose mifepristone in treatment of perimenopausal abnormal uterine bleeding

目的比较围绝经期子宫异常出血患者应用炔雌醇环丙孕酮联合高低剂量米非司酮治疗的效果。方法将漯河市第三人民医院2018年1月—2019年10月期间收治的102例围绝经期子宫异常出血患者应用随机数字表法分为3组,高剂量组采用炔雌醇环丙孕酮片联合高剂量米非司酮治疗,低剂量组采用炔雌醇环丙孕酮片联合低剂量米非司酮治疗,对照组单用炔雌醇环丙孕酮片治疗,连续治疗6个月后随访6个月,比较三组患者治疗效果及血清性激素水平变化。结果高剂量组总有效率、止血时间和复发率分别为89.47%、(20.16±5.67)h和5.26%,低剂量组分别为64.71%,(31.87±9.06)h和17.65%,对照组分别为56.67%,(42.39±11.29)h和26.67%三组比较差异均有统计学意义(t/χ^(2)=9.136、10.052、7.102,P<0.05),治疗后三组患者子宫内膜厚度均明显较治疗前降低(均P<0.05)。组内比较结果显示,三组患者治疗后血清E、P、LH、FSH水平均明显降低,和治疗前比较差异均有统计学意义(均P<0.05),组间比较发现三组患者治疗前血清E、P、LH、FSH水平及治疗后血清P、LH、FSH水平均无明显差异(均P>0.05),治疗后血清E水平高剂量组最低,对照组最高,差异有统计学意义(P<0.05)。三组不良反应发生率无明显差异(均P>0.05)。结论 DUB患者采用炔雌醇环丙孕酮联合米非司酮可提高治疗效果,剂量越高,效果越好,且还不会增加不良反应发生率,对血清性激素水平也无明显恶劣影响。

Objective To compare the effect of ethinylestradiol and cyproterone combined with high and low dose mifepristone in the treatment of perimenopausal abnormal uterine bleeding.Methods Totally 102 cases of perimenopausal abnormal uterine bleeding in our hospital from January 2018 to October 2019 were randomly divided into three groups. The high-dose group was treated with ethinylestradiol cyproterone tablets combined with high-dose mifepristone;The low-dose group was treated with ethinylestradiol cyproterone tablets combined with low-dose mifepristone;The control group was treated with ethinylestradiol and cyproterone tablets alone, with 6 consecutive treatments After 6 months of follow-up, the treatment effect and serum sex hormone levels of the three groups were compared.Results The total effective rate, hemostasis time and recurrence rate of high-dose group were 89.47%,(20.16±5.67)h and 5.26%, respectively, while those of low-dose group were 64.71%,(31.87±9.06)h and 17.65%, respectively, and those of control group were 56.67%,(42.39±11.29)h and 26.67%, respectively. There were significant differences among the three groups(T/χ^(2) = 9.136, 10.052, 7.102, P<0.05)(All P<0.05). The results of intra group comparison showed that the levels of serum e, P, LH and FSH in the three groups after treatment were significantly lower than those before treatment(all P<0.05). There were no significant differences in serum e, P, LH, FSH levels before treatment and after treatment among the three groups(all P>0.05). After treatment, the serum E level of high-dose group was the lowest, while that of the control group was the lowest The difference was statistically significant(P<0.05). There were five significant differences in the incidence of adverse reactions among the three groups(all P>0.05).Conclusion ethinylestradiol and cyproterone combined with mifepristone can improve the therapeutic effect in patients with dub. The higher the dosage, the better the effect is. Moreover, it will not increase the incidence of adverse reactions and has no obvious adverse effect on serum sex hormone levels.