曼月乐环联合屈螺酮炔雌醇片对围绝经期功能失调性子宫出血患者内分泌及凝血功能的影响

Effects of Mirena Combined with Drospirenone Ethinylestradiol Tablets on Endocrine Level and Coagulation Function in Patients with Perimenopausal Dysfunctional Uterine Bleeding

目的探讨曼月乐环联合屈螺酮炔雌醇片对围绝经期功能失调性子宫出血患者内分泌及凝血功能的影响。方法回顾性分析2018年3月至2020年5月阜阳市人民医院确诊的60例围绝经期功能失调性子宫出血患者的临床资料,根据治疗方式不同分为对照组和观察组,每组30例。对照组应用米非司酮口服治疗,每次25 mg,每日1次,连续服用5 d,然后停用,在月经来潮第1天内再次服用该药物;观察组在对照组基础上应用曼月乐环联合屈螺酮炔雌醇片(每次1片,每日1次,连续服用21 d,之后停用7 d)治疗。比较两组患者的临床疗效,治疗前后内分泌指标(血清卵泡刺激素、催乳素、雌二醇、睾酮)、凝血功能指标(凝血酶原时间、纤维蛋白原)、子宫内膜厚度,以及不良反应发生情况。结果观察组总有效率高于对照组[93.33%(28/30)比70.00%(21/30)](χ^(2)=5.455,P=0.020)。治疗前后卵泡刺激素、催乳素、雌二醇、睾酮的主效应差异有统计学意义(P<0.05或P<0.01),两组间卵泡刺激素的主效应差异有统计学意义(P<0.01),催乳素、雌二醇、睾酮水平的主效应差异无统计学意义(P>0.05);卵泡刺激素的组间和时点间存在交互作用(P<0.01),催乳素、雌二醇、睾酮的组间和时点间不存在交互作用(P>0.05),治疗后,观察组卵泡刺激素、雌二醇高于对照组[(54.7±4.6)U/L比(49.2±2.4)U/L、(279±80)pmol/L比(239±71)pmol/L](P<0.05),但两组间催乳素、睾酮比较差异无统计学意义(P>0.05)。治疗前后凝血酶原时间、纤维蛋白原的主效应差异有统计学意义(P<0.01),两组间的主效应差异无统计学意义(P>0.05),组间和时点间无交互作用(P>0.05),治疗后,两组凝血酶原时间、纤维蛋白原比较差异无统计学意义(P>0.05)。子宫内膜厚度组间和时点间的主效应差异有统计学意义(P<0.01),组间和时点间存在交互作用(P<0.01),治疗后,观察组子宫内膜厚度小于对照组[(4.3±1.2)mm比(7.4±1.4)mm](P<0.05)。两组不良反应总发生率比较差异无统计学意义(P>0.05)。结论曼月乐环联合屈螺酮炔雌醇片治疗围绝经期功能失调性子宫出血效果显著,可改善患者内分泌环境,抑制子宫内膜增生,减少不良反应的发生,且不影响患者凝血功能。

Objective To investigate the effects of Mirena combined with drospirenone ethinylestradiol tablets on endocrine level and coagulation function in patients with dysfunctional uterine bleeding.Methods Clinical data of 60 patients with perimenopausal dysfunctional uterine bleeding diagnosed in Fuyang People′s Hospital from Mar.2018 to May 2020 were retrospectively analyzed,and the cases were divided into a control group and an observation group according to different treatment methods,with 30 cases in each group.The control group was treated with mifepristone orally,25 mg per time,once a day,for 5 consecutive days,then withdrawl,and the drug was taken again within the first day of menstruation.The observation group was treated with Mirena combined with drospirenone ethinylestradiol tablets(1 tablet per time,once a day,for 21 consecutive days,and then stopped for 7 days)on the basis of the control group′s regimen.The clinical efficacy,endocrine indexes(serum follicle-stimulating hormone,prolactin,estradiol,testosterone),coagulation function indexes(prothrombin time and fibrinogen),endometrial thickness and incidence of adverse reactions were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group[93.33%(28/30)vs 70.00%(21/30)](χ^(2)=5.455,P=0.020).There were significant differences in the main effects of follicle-stimulating hormone,prolactin,estradiol and testosterone before and after treatment(P<0.05 or P<0.01),there were significant differences in the main effects of follicle-stimulating hormone between the two groups(P<0.01),but no significant differences in the main effects of prolactin,estradiol and testosterone levels(P>0.05).There was interaction between groups and time points for follicle-stimulating hormone(P<0.01),but no interaction between groups and time points for prolactin,estradiol and testosterone(P>0.05).After treatment follicle-stimulating hormone and estradiol in the observation group were higher than those in the control group[(54.7±4.6)U/L vs(49.2±2.4)U/L,(279±80)pmol/L vs(239±71)pmol/L](P<0.05),but there was no significant difference in prolactin and testosterone between the two groups(P>0.05).There were statistically significant differences in the main effect of prothrombin time and fibrinogen before and after treatment(P<0.01),no statistically significant differences in the main effect between the two groups(P>0.05),and no interaction between the groups and time points(P>0.05).After treatment,there were no statistically significant differences in prothrombin time and fibrinogen between the two groups(P>0.05).The main effect difference of endometrial thickness between groups and time points was statistically significant(P<0.01),and there was interaction between groups and time points(P<0.01).After treatment,endometrial thickness in the observation group was less than that in the control group[(4.3±1.2)mm vs(7.4±1.4)mm](P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Mirena combined with drospiroone ethoestradiol tablets has a significant effect in the treatment of perimenopausal dysfunctional uterine bleeding,which can improve the endocrine environment,inhibit endometrial hyperplasia,reduce the occurrence of adverse reactions of the patients,without affecting the coagulation function of the patients.