左炔诺孕酮宫内缓释系统治疗子宫内膜息肉临床分析

目的：对子宫内膜息肉患者采用左炔诺孕酮宫内缓释系统治疗,探讨和分析其临床治疗效果。方法：选择12个月内宫腔镜确诊子宫内膜息肉发生2次或2次以上患者40例,随机分为两组,试验组20例,采用宫腔镜下子宫内膜息肉电切后同时放置曼月乐环1枚;对照组20例,采用宫腔镜下子宫内膜息肉电切术后口服优思明治疗。所有患者均选择术后每3个月复查阴道B超,术后1年常规宫腔镜检查,进而比较两组子宫内膜增生及子宫内膜息肉复发的情况。结果：试验组和对照组子宫内膜息肉复发率分别为5.0%（1/20）、25.0%（5/20）;此外,左炔诺孕酮宫内缓释系统放置前后月经量及内膜厚度的变化进行比较,差异具有统计学意义（P〈0.05）;两组患者不良反应发生率比较差异无统计学意义（P〉0.05）。结论：对子宫内膜息肉患者采用宫腔镜下子宫息肉电切术治疗,同时放置左炔诺孕酮宫内缓释系统治疗,可有效地防止患者复发,且不良反应少,值得在临床上应用。     

口服避孕药与宫腔内放置左炔诺孕酮宫内缓释系统治疗子宫内膜息肉术后复发的临床研究

目的 探讨子宫内膜息肉行宫腔镜手术后口服避孕药和宫腔内放置左炔诺孕酮宫内缓释系统（曼月乐）对预防术后复发的疗效.方法 选择行宫腔镜子宫内膜息肉切除术的患者174例,由患者知情并选择术后处理方式.51例在术后1个月开始服用避孕药12个月（避孕药组）,60例在术后1个月于宫腔内放置曼月乐（曼月乐组）,63例不进行任何预防复发处理（对照组）.术后随访3,6,12个月,并比较三组复发率、月经量、血红蛋白和不良反应的情况.结果 避孕药组复发率为3.9％（2/51）,曼月乐组为3.3％（2/60）,对照组为19.0％（12/63）,对照组的子宫内膜息肉复发率明显高于避孕药组和曼月乐组,差异有统计学意义（P＜0.05）.对照组术后3,6,12个月月经量少的构成比明显低于避孕药组和曼月乐组,差异有统计学意义（P＜0.05）.术后12个月对照组的血红蛋白明显低于避孕药组和曼月乐组[（124.55 ±9.33） g/L比（133.71±11.03）,（135.89±6.88） g/L],差异有统计学意义（P＜0.05）.曼月乐组不良反应发生率为18.3％（11/60）,明显少于避孕药组的35.3％（18/51）,差异有统计学意义（P＜0.05）.结论 宫腔镜术后可以用口服避孕药或于宫腔内放置曼月乐来降低子宫内膜息肉复发率,曼月乐不良反应发生率更低,是治疗和预防子宫内膜息肉安全而有效的方法.     

子宫内膜异位症保守性手术后药物治疗进展

子宫内膜异位症(EMs)是育龄妇女的常见病,保守性手术后复发率高,有必要予以术后药物治疗.目前的术后用药多样,但几乎都表现为用药依赖,往往需要数年甚至更久的维持用药.口服避孕药、孕激素因其经济、方便,不良反应少,可作为术后治疗的一线选择;而促性腺激素释放激素类似物长期用药的益处相比于其昂贵的医疗费用及不良反应优势并不明...     

左炔诺孕酮宫内节育系统的临床使用对子宫内膜厚度及血清性激素结合球蛋白水平的影响

目的探讨左炔诺孕酮宫内节育系统的临床使用对子宫内膜厚度和血清性激素结合球蛋白水平的影响,为左炔诺孕酮宫内节育系统的临床使用提供更多可靠的依据。方法选取2017年1月-2019年1月在医院进行放置左炔诺孕酮宫内节育系统(曼月乐)女性50例为研究组,选取30例健康女性为对照组,测量放置前、后子宫内膜厚度和血清性激素结合球蛋白水平。结果研究组女性放置前与对照组女性子宫内膜厚度和血清性激素结合球蛋白水平差异无统计学意义(P>0.05)。研究组女性放置1、3、6个月后子宫内膜厚度逐渐变薄,血清性激素结合球蛋白水平逐渐下降,差异均有统计学意义(均P<0.05)。研究组女性子宫内膜厚度和血清性激素结合球蛋白水平与置入节育系统时间呈负相关性(r=-0.784,-0.762,P<0.05),其子宫内膜厚度与血清性激素结合球蛋白水平呈正相关(r=0.856,P<0.05)。结论左炔诺孕酮宫内节育系统可能通过降低子宫内膜厚度和血清性激素结合球蛋白水平达到其治疗目的。     

聚三亚甲基碳酸酯-丙交酯共聚物微球长效避孕体系的研究

目的:用可生物降解共聚物聚三亚甲基碳酸酯-丙交酯(PTMC-co-DL-LA)为载体,制备含左旋18甲基炔诺酮(LNG)的载药微球,初步考察不同共聚组成聚合物制得的微球性能及体外释放行为,探讨该共聚物微球作为LNG的长效避孕释放载体的可行性。方法:采用溶剂挥发法(O/W),用不同共聚组成比的PTMC-co-DL-LA及其相应均聚物聚三亚甲基碳酸酯(PTMC)和聚丙交酯(PDLLA)制备含LNG的可生物降解微球,表征制得微球的粒径大小及分布、表面形态等性能,考察不同共聚组成聚合物微球对LNG的体外释放行为。结果:粒径均匀分布较窄,平均粒径<5μm:含LNG的微球表面平整光滑,其包封率均>90%。共聚物微球的LNG释放速率均较PTMC和PDLLA均聚物低,体现出良好的长效释放行为。结论:不同共聚组成聚合物制得的微球LNG的释放速率不同,均具有对LNG的长效释放作用,有望通过体内研究,使载有LNG的PTMC-co-DL-LA共聚物微球用于长效避孕。     

18-甲基炔诺酮抗家兔排卵作用机理的初步分析

本实验使用家兔诱导排卵动物模型,分别观察了消旋18-甲基炔诺酮和左旋18-甲基炔诺酮对于用铜盐、由PMSG和hCG以及由LH-RH诱导的家兔排卵的影响。实验分三组:一组于实验第1～3天皮下注射雌二醇(每只100μg/天),第4天经耳缘静脉注射1%醋酸酮(0.4ml/kg),24小时后处死并检查排卵点。二组于实验第1～2天皮下注射雌二醇,第4天皮下注射一次LH-RH(12.5μg/只),48小时后处死并观察和记数排卵点。三组于实验第2天皮下注射PMSG(12.5u),第4天经耳缘静脉注射50iuhCG,48小时后处死并检查排卵点。各组中的实验组于第1～4天肌肉注射消旋18-甲基炔诺酮或左旋18-甲基炔诺酮(每只8mg/天)对照组给予等量溶媒。结果表明,两种18-甲基炔诺酮皆明显抑制由铜盐诱导的家兔排卵,抗排卵率分别为83.3%和66.7%。然而,两者对于由LH-RH和由PMSG与hCG诱导的家兔排卵皆无明显影响。以上结果提示,消旋18-甲基炔诺酮和左旋18-甲基炔诺酮的抗排卵作用可能是通过干扰下丘脑LH-RH的释放而实现的,并非由于在垂体水平拮抗LH-RH的作用或在性腺水平上拮抗促性腺激素作用的结果。     

18甲基炔诺酮阴道环的临床观察

本文介绍108例妇女使用释放左旋18甲基炔诺酮20微克/天阴道环一年的临床效果和副反应。每100例妇女使用一年的净累积率为:妊娠率3.7,脱落率4.6,与阴道环有关的停用率26.9,持续使用率71.2。副反应主要为月经紊乱,但随使用时间的延长而逐步改善。本文有20例首进行月经血量,血红蛋白和铁蛋白测定。使用阴道环后第一月,经血量略有增加,此后有下降趋势,血红蛋白浓度在放环后第6和第12月有明显增加(P<0.05)。     

An open label, comparative study of the effects of a dose-reduced oral contraceptive containing 20 microg ethinyl estradiol and 100 microg levonorgestrel on hemostatic, lipids, and carbohydrate metabolism variables

In this open label, randomized study we compared the influence of a dose-reduced oral contraceptive containing 20 microg ethinyl estradiol (EE) and 100 microg levonorgestrel (20 EE) with a reference preparation containing 30 microg EE and 150 microg levonorgestrel (30 EE) on hemostatic, lipids, and carbohydrate metabolism variables. Data from 48 volunteers were obtained. The direction of the change (increase or decrease) in most of the hemostatic variables were similar in both treatment groups. In particular, prothrombin fragment 1 + 2 increased during treatment, reaching a median percent change of 40% in the 20 EE group and of 17% in the 30 EE group after one year. D-Dimer fibrin split products remained virtually unchanged, with no change at Cycle 13. The median HDL2 cholesterol levels decreased by 26% in the 20 EE group and by 39.8% in 30 EE group (p = 0.0045 for group difference) after one year. The median one year change for LDL cholesterol was 3.23% in the 20 EE group, compared to 25% in the 30 EE group, for VLDL 11.1% compared to 38.8%, respectively, and for total triglycerides 10.0% compared to 37.5%, respectively. The median absolute change for the area under the curve (AUC)(0-3h) for glucose at treatment Cycle 13 was 41.25 mmol/L x min in the 20 EE group and 73.50 mmol/L x min in the 30 EE group. The AUC(0-3h) insulin at treatment Cycle 13 decreased in the 20 EE group by 1635.0 pmolL x min and increased in the 30 EE group by 11797.5 pmolL x min (p = 0.0491 for group difference). Both study treatments were safe and well tolerated by the volunteers.In conclusion, the balanced one-third dose reduction in this new oral contraceptive evoked similar effects on the hemostatic variables, but favorable results for the lipid and carbohydrate profiles.     

Contraception and treatment in the perimenopause with a novel "frameless" intrauterine levonorgestrel-releasing drug delivery system: an extended pilot study

The objective of the study was to evaluate the contraceptive performance, acceptability, side effects, and adverse events of a novel "frameless" intrauterine drug delivery system (IUS), FibroPlant-levonorgestrel (LNG) releasing 14 microg of LNG/day, in perimenopausal women. An ancillary objective was to evaluate the effect of the new IUS on menstrual blood loss in women with or without fibroids.The study, consisting of 109 women, suggests that FibroPlant-LNG IUS is an effective contraceptive. No pregnancies occurred with the FibroPlant-LNG IUS. The total use-related discontinuation rate at 1 year is low (1.9) and results in a high rate of continuation of use (98.1). In addition, the FibroPlant-LNG IUS demonstrated a high level of effectiveness in reducing bleeding in women with excessive menstrual flow even when medium or large fibroids were present. However, an effect on the size of the fibroids could not be demonstrated.Patient satisfaction with the method is high, which is a prerequisite for continuance of the method, and may be linked with the advantageous design characteristics of the FibroPlant-LNG IUS, the virtual absence of hormonal side effects, and the low incidence of irregular bleeding and spotting even during the first 3 months after insertion of the FibroPlant IUS. Counseling remains important though to explain to women about the possible occurrence of changes in their menstrual pattern that may sometimes be annoying but harmless.It is concluded that many women over age 40 years could substantially benefit from the advantages of this intrauterine drug delivery technology which provides contraception and treatment of a possible associated condition such as menorrhagia. The treatment also creates the opportunity to pass through the transitional perimenopausal period smoothly and to benefit fully from the advantages hormone replacement therapy offers in terms of treatment of short-term symptoms and long-term prevention by gradually replacing the waning estrogens.