目的 研究米非司酮聯(lián)合孕三烯酮治療子宮內(nèi)膜異位癥的臨床效果。方法 選擇2012年3月—2013年3月浚縣人民醫(yī)院收治的子宮內(nèi)膜異位癥患者150例,隨機分為對照組和治療組,每組75例。對照組患者在月經(jīng)來潮后第2天開始口服孕三烯酮膠囊,2.5 mg /次,2次/周。治療組患者口服米非司酮片,12.5 mg/次,1次/d,孕三烯酮膠囊的用法用量同對照組。兩組均連續(xù)治療24周。觀察兩組的臨床療效,同時對兩組盆腔癥狀評分、總體征評分、血清性激素水平、妊娠結(jié)局進行比較。結(jié)果 對照組和治療組總有效率分別為81.3%、96.0%,兩組比較差異有統(tǒng)計學意義(P < 0.05)。治療后,兩組患者盆腔癥狀(痛經(jīng)、性交痛、盆腔痛)、總體征(盆腔觸痛、硬結(jié))評分均顯著降低,同組治療前后差異有統(tǒng)計學意義(P < 0.05);且治療組各評分的下降程度優(yōu)于對照組,兩組比較差異有統(tǒng)計學意義(P < 0.05)。兩組患者血清促卵泡生成素(FSH)、黃體生成素(LH)、雌激素(E₂)、孕酮(P)水平明顯低于治療前,同組治療前后差異有統(tǒng)計學意義(P < 0.05);且治療組激素水平下降程度優(yōu)于對照組,兩組比較差異有統(tǒng)計學意義(P < 0.05)。對照組隨訪6、12個月時,妊娠率為25.3%、12.0%;治療組為41.3%、26.7%,兩組各隨訪時間點的妊娠率比較差異有統(tǒng)計學意義(P < 0.05)。結(jié)論 米非司酮聯(lián)合孕三烯酮治療子宮內(nèi)膜異位癥具有較好的臨床療效,可降低患者性激素水平,改善妊娠結(jié)局,值得臨床推廣和應(yīng)用。

Objective To explore the efficacy of mifepristone combined with gestrinone in treatment of endometriosis. Methods The patients with endometriosis (150 cases) of Junxian People's Hospital from March 2012 to March 2013 were randomly divided into control and treatment groups, and each group had 75 cases. The patients in control group were po administered with Gestrinone Capsules on the second day of menstruation, 2.5 mg/time, twice every week. The patients in treatment group were po administered with Mifepristone Tablets, 12.5 mg/time, once daily, and the usage and dosage of Gestrinone Capsules were the same as the control group. The patients in two groups were treated for 24 weeks. After treatment, the efficacy was evaluated, and pelvic symptom scores, overall score, serum sex hormone levels and pregnancy outcomes in two groups were compared. Results The efficacies in control and treatment groups were 81.3% and 96.0%, respectively, and there were differences between two groups (P < 0.05). After treatment, pelvic symptoms (including dysmenorrhea, algopareunia, and pelvic pain) and overall character (including pelvic tenderness and induration) scores were significantly reduced, and the difference was statistically significant in the same group (P < 0.05). And these scores in treatment group improved better than those in control group, with significant difference between two groups (P < 0.05). FSH, LH, E₂, and P in two groups were significantly lower than before treatment, and the difference was statistically significant in the same group (P < 0.05). Drop degree of hormone levels in the treatment group were better than those of control group, with significant difference between two groups (P < 0.05). The control group were followed up for 6 and 12 months, the pregnancy rate were 25.3% and 12.0%, respectively; while the treatment group were 41.3% and 26.7%, respectively, and the differences of pregnancy rates in the follow-up times between two groups were statistically significant (P < 0.05). Conclusion Mifepristone combined with gestrinone has the good clinical effect in treatment of endometriosis, and can reduce sex hormone levels, while can improve the pregnancy outcome, which is worth clinical promotion.

國家自然科學基金資助項目(81000240)