米非司酮与戊酸雌二醇治疗放置曼月乐后阴道不规则出血的疗效研究

Efficacy of Mifepristone and Estradiol Valerate in Treatment of Irregular Vaginal Bleeding After Placing Mirena

目的比较米非司酮与戊酸雌二醇治疗放置曼月乐后阴道不规则出血的临床效果。方法选取作者医院收治的81例因放置曼月乐后不规则出血超过3个月的患者,采用随机数字表法将患者分为治疗组(n=40)和对照组(n=41),治疗组患者口服米非司酮100 mg,4周一次,共3次;对照组患者口服戊酸雌二醇片1 mg/d,连续3周,停药7天,重复3次。比较两组患者出血模式、出血/点滴出血天数、月经失血图(pictorial blood loss assessment chart,PBAC)评分以及满意度。结果治疗后第4周,治疗组的出血总天数与对照组比较差异无统计学意义(P>0.05);随着时间推移,治疗组长时间出血、频繁出血以及不规则出血的比例均低于对照组,组间比较差异均具有统计学意义(P均<0.05)。从第8周开始,治疗组的PBAC评分低于对照组,满意度较高。两组患者治疗前后的内膜厚度、不良反应发生率比较差异无统计学意义(P>0.05)。结论与口服戊酸雌二醇相比,米非司酮治疗放置曼月乐后的阴道不规则出血效果更佳,能缩短出血/点滴出血天数,减少不规则出血以及频繁出血的发生率,且服用方便,安全性良好。

Objective To compare the clinical effects of mifepristone and estradiol valerate in the treatment of irregular vaginal bleeding after placing Mirena.Methods A total of 81 patients with irregular bleeding more than 3 months after placing Mirena in author′s hospital were selected and divided into treatment group(n=40)and control group(n=41)by random number table method.The patients in the treatment group were given oral mifepristone 100 mg every 4 weeks for 3 times;while the patients in the control group were given oral estradiol valerate tablets 1 mg once a day for 3 weeks,and the drug was stopped for 7 days,repeated 3 times.The bleeding pattern,days of vaginal bleeding/spotting,pictorial blood loss assessment chart(PBAC)score and satisfaction were compared between the two groups.Results In the 4th weeks after treatment,there was no significant difference in the total bleeding days between the treatment group and the control group(P>0.05);as time went on,and the rates of long-term bleeding,frequent bleeding and irregular bleeding in the treatment group were lower than those in the control group,and the differences between the two groups were statistically significant(all P<0.05).From the 8th week,the PBAC score of the treatment group was lower than that of the control group with high degree of satisfaction.There was no significant difference in the endometrial thickness and the incidence of adverse effects between the two groups before and after treatment(P>0.05).Conclusion Compared with oral estradiol valerate,mifepristone is more effective in the treatment of irregular vaginal bleeding after placing mirenela,which can shorten the days of vaginal bleeding/spotting,reduce the incidence of irregular bleeding and frequent bleeding,which is convenient to take and with good safety.