自拟加味生化汤联合不同剂量米非司酮治疗围绝经期功能失调性子宫出血的效果及对性激素水平的影响

Clinical Efficacy of Self-made Modified Shenghua Decoction Combined with Different Doses of Mifepristone in Treatment of Patients with Perimenopausal Dysfunctional Uterine Bleeding and Its Effect on Sex Hormone Level

目的探讨不同剂量米非司酮联合自拟加味生化汤治疗围绝经期功能失调性子宫出血(P-DUB)的效果及对性激素水平的影响。方法选取2019年6月—2020年6月本院收治的111例P-DUB,根据治疗方法的不同分成3组,3组均给予自拟加味生化汤治疗,在此基础上,A组37例加用米非司酮10 mg/d,B组37例加用米非司酮15 mg/d,C组37例加用米非司酮20 mg/d,疗程均为3个月。比较3组临床疗效、性激素水平、子宫内膜厚度、子宫体积及不良反应。结果B、C组总有效率均高于A组(P<0.05,P<0.01)。3组治疗后促卵泡生成素(FSH)、促黄体生成素(LH)、泌乳素(PRL)、雌二醇(E_(2))水平均降低(P<0.05),且B、C组治疗后FSH、LH、PRL、E_(2)水平均低于A组(P<0.05)。3组治疗后子宫内膜厚度减小(P<0.05),子宫体积无明显改变(P>0.05);B、C组治疗后子宫内膜厚度均小于A组(P<0.05)。C组不良反应发生率高于A、B组(P<0.05)。结论15 mg/d米非司酮联合自拟加味生化汤治疗P-DUB的效果显著,能下调FSH、LH、PRL、E_(2)水平,减小子宫内膜厚度,且不良反应少。

Objective To investigate clinical efficacy of self-made modified Shenghua Decoction combined with different doses of Mifepristone in treatment of patients with perimenopausal dysfunctional uterine bleeding(P-DUB)and its effect on sex hormone level.Methods A total of 111 patients with P-DUB admitted between June 2019 and June 2020 were divided into three groups according to different therapeutic methods.All the three groups were treated with self-made modified Shenghua Decoction.On this basis,group A(n=37)was treated with 10 mg/d Mifepristone,while group B(n=37)was treated with 15 mg/d Mifepristone,and group C(n=37)was treated with 20 mg/d Mifepristone,and courses of treatment were all for 3 months.Clinical efficacy,sex hormone level,endometrial thickness,uterine volume and adverse reactions were compared among three groups.Results The total effective rates in group B and C were significantly higher than that in group A(P<0.05,P<0.01).After treatment,levels of follicle stimulating hormone(FSH),luteinizing hormone(LH),prolactin(PRL)and estradiol(E_(2))were significantly decreased among three groups(P<0.05),and levels of FSH,LH,PRL and E_(2) in group B and C were significantly lower than those in group A(P<0.05).After treatment,values of endometrial thickness were significantly decreased(P<0.05),but the uterine volumes did not change significantly among three groups(P>0.05).Values of endometrial thickness in group B and C were less than that in group A after treatment(P<0.05).The incidence rate of adverse reactions in group C was significantly higher than those in group A and B(P<0.05).Conclusion The 15 mg/d Mifepristone combined with self-made modified Shenghua Decoction may achieve significantly clinical efficacy,down-regulate levels of FSH,LH,PRL and E_(2) and reduce endometrial thickness with few adverse reactions in treatment of patients with P-DUB.