不同剂量米非司酮联合炔雌醇环丙孕酮治疗围绝经期异常子宫出血的疗效对比

Clinical observation on different doses mifepristone combined with ethinylestradiol cyproterone for treatment of perimenopausal dysfunctional uterine bleeding

目的探究不同剂量米非司酮联合炔雌醇环丙孕酮对于围绝经期异常子宫出血的临床效果。方法选取2013年6月—2016年6月至梧州市红十字会医院治疗的异常子宫出血患者69例,按随机数字表法分为A、B、C组,3组均使用炔雌醇环丙孕酮作为基础治疗,A组在基础治疗上予以米非司酮6.25 mg/d,B组予以米非司酮12.5 mg/d,C组予以米非司酮18.75mg/d。疗程为6个月。测定3组患者治疗前后的卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E)、孕酮(P)以及子宫体积与内膜厚度的变化。观察并比较3组患者的治疗有效率和不良反应发生率。结果与治疗前相比,治疗后A、B、C组的血清内FSH、LH、P和E水平均降低,差异有统计学意义(P<0.05);B组和C组治疗后体内E水平低于A组,差异均有统计学意义(P<0.05);治疗后3组FSH、LH、P水平差异无统计学意义。治疗前后3组患者子宫体积差异均无统计学意义。治疗前3组子宫内膜厚度差异无统计学意义,治疗后3组子宫内膜厚度均较治疗前降低,差异有统计学意义(P<0.05),而治疗后3组之间子宫内膜厚度差异无统计学意义。B组和C组治疗有效率均大于A组,差异有统计学意义(P<0.05),而B、C两组之间治疗有效率差异无统计学意义。B、C组控制出血时间少于A组,差异有统计学意义(P<0.05);不良反应主要表现为恶心、头晕和腹痛,A、B两组不良反应发生率差异无统计学意义;C组高于A、B两组,差异有统计学意义(P<0.05)。结论米非司酮12.5 mg/d的剂量联合炔雌醇环丙孕酮治疗围绝经期异常子宫出血的治疗有效率较高,且不良反应发生率较低,可作为最佳治疗剂量推荐临床使用。

Objective To explore the clinical efficacy of different doses mifepristone combined with ethinylestradiol for the treatment of perimenopausal dysfunctional uterine bleeding.Methods 69 cases with functional uterine bleeding in June 2013-June 2016 were divided into three groups A,B,C by random number table method.The cases in group A were treated with mifepristone of 6.25 mg/d,in group B were 12.5 mg/d,and in group C were 18.75 mg/d.At same time,all cases were treated with ethinylestradiol.FSH,LH,E,and P levels as well as the volume of uterus and the change of the endometrium thickness were reduced.The treatment effectiveness and the incidence of three groups were compared.Results After treated the FSH,LH,P and E were lower than before treated,the difference was statistically significant(P<0.05).After treatment the level of E in group B and group C were lower than group(P<0.05).The uterine size had no significant difference between before and after treated.After treated three groups of endometrial thickness had a significance different between before treated(P<0.05).The total effective of group B and group C were higher than group A,the difference was statistically significant(P<0.05).The control bleeding time of group C was less than A and B(P<0.05).The incidence of adverse reactions of group C was higher than group A and B(P<0.05).Conclusion For patients with perimenopausal dysfunctional uterine bleeding,the 12.5 mg/d does of mifepristone combined with ethinylestradiol is superior,and the adverse reactions after treatment is less;the method is safe and reliable,which is worthy to be popularized in clinic.