雌孕激素治疗对围绝经期子宫肌瘤的影响

The effect of estrogen and progesterone therapy on perimenopausal uterine fibroids

目的分析雌孕激素治疗对围绝经期子宫肌瘤的影响。方法选取2022年1~12月在浙江省杭州市桐庐县第一人民医院就诊的围绝经期子宫肌瘤患者132例。按照随机数字表法分为常规治疗组和雌孕激素组,每组66例。常规治疗组给予谷维素口服,20mg/次,2次/d;维生素B1口服,20mg/次,2次/d;治疗3个月。雌孕激素组在常规治疗组基础上给予雌孕激素治疗,给予戊酸雌二醇口服,0.5mg/次,1次/d,连用3周,第12~14天给予地屈孕酮,5mg/次,1次/d,治疗3个月。之后根据患者围绝经期症状、雌二醇(E_(2))水平并结合中华医学会绝经学组推荐的最低有效剂量以及患者个体情况调整E2使用剂量,最高剂量不超过1.5mg/d。观察两组治疗前后子宫肌瘤大小和子宫内膜厚度、血清性腺轴相关激素指标[雌二醇(E_(2))、卵泡刺激素(FSH)、黄体生成素(LH)]、围绝经期症状(潮热、盗汗、心悸、失眠积分)、Kupperman评分及生活质量评分。结果(1)治疗后,两组子宫肌瘤大小和子宫内膜厚度较治疗前差异均无统计学意义(P>0.05),且组间比较差异也无统计学意义(P>0.05)。(2)治疗后,两组血清E_(2)水平均升高(P<0.05),血清FSH、LH水平均降低(P<0.05),且雌孕激素组血清E_(2)水平高于常规治疗组(P<0.05),血清FSH、LH水平均低于常规治疗组(P<0.05)。(3)治疗后,两组潮热、盗汗、心悸、失眠积分均下降(P<0.05),且雌孕激素组潮热、盗汗、心悸、失眠积分均低于常规治疗组(P<0.05)。(4)治疗后,两组Kupperman评分均明显下降(P<0.05),生活质量评分均显著升高(P<0.05),且雌孕激素组Kupperman评分低于常规治疗组(P<0.05),生活质量评分高于常规治疗组(P<0.05)。结论小剂量雌孕激素治疗围绝经期子宫肌瘤可以调节患者性腺轴分泌功能,改善围绝经期症状,且未对子宫肌瘤产生明显影响。

Objective To analyze the effect of estrogen and progesterone therapy on perimenopausal uterine fibroids.Method 132 patients with perimenopausal uterine fibroids who visited the First People's Hospital of Tonglu County,Hangzhou City,Zhejiang Province from January 2022 to December 2022 were selected.According to the random number table method,they were divided into a conventional treatment group and an estrogen and progesterone group,with 66 cases in each group.The conventional treatment group was given oral administration of sitagliptin at a dose of 20mg,twice a day;Vitamin B1 orally,20mg,twice a day,treatment for 3 months;The estrogen and progesterone group was treated with estrogen and progesterone in addition to the conventional treatment group.Estradiol valerate was orally administered at a dose of 0.5mg,once a day,for 3 consecutive weeks.From day 12 to 14,dexamethasone was administered at a dose of 5mg,once a day,until the end of the 3-month treatment period.Afterwards,the dosage of E_(2) should be adjusted based on the patient's perimenopausal symptoms,estradiol(E_(2))levels,and combined with the minimum effective dose recommended by the menopausal study group of the Chinese Medical Association,as well as the individual condition of the patient.The maximum dose should not exceed 1.5mg/d.Observe the size of uterine fibroids and endometrial thickness,serum gonadal axis related hormone indicators[estradiol(E_(2)),follicle stimulating hormone(FSH),luteinizing hormone(LH)],perimenopausal symptoms(hot flashes,night sweats,palpitations,insomnia score),Kupperman score,and quality of life score before and after treatment in two groups.Results(1)After treatment,there was no significant change in the size of uterine fibroids and endometrial thickness between the two groups compared to before treatment,and there was no statistically significant difference between the groups(P>0.05).(2)After treatment,the serum E levels in both groups increased(P<0.05),while the serum FSH and LH levels decreased(P<0.05).The serum E_(2) levels in the estrogen and progesterone group were higher than those in the conventional treatment group(P<0.05),and the serum FSH and LH levels were lower than those in the conventional treatment group(P<0.05).(3)After treatment,the scores of hot flashes,night sweats,palpitations,and insomnia in both groups decreased(P<0.05),and the scores of hot flashes,night sweats,palpitations,and insomnia in the estrogen and progesterone group were lower than those in the conventional treatment group(P<0.05).(4)After treatment,both groups showed a significant decrease in Kupperman scores(P<0.05)and a significant increase in quality of life scores(P<0.05).In addition,the Kupperman scores of the estrogen and progesterone group were lower than those of the conventional treatment group(P<0.05),and the quality of life scores were higher than those of the conventional treatment group(P<0.05).Conclusion Low dose estrogen and progesterone treatment for perimenopausal uterine fibroids can regulate the secretion function of the patient's gonadal axis,improve perimenopausal symptoms,and have no significant effect on uterine fibroids.