米非司酮周期疗法与孕激素治疗围绝经期功血的比较

目的 观察小剂量米非司酮周期疗法治疗围绝经期功能失调性子宫出血（功血）的临床疗效.方法 观察组（43例）于诊刮后第3日开始空腹服用米非司酮10 mg/d,5 d,并在以后3个月经的第1天起同法服5 d.对照组（38例）诊刮后第3天开始口服炔诺酮5 mg/d,血止后20 d停药.在以后2、3个月经周期的第15天开始服用甲羟孕酮10 mg/d,连服10 d后停药.停药后均随访18个月.结果 两组均建立规律月经周期,周期差异无统计学意义（P ＞ 0.05）,观察组经期短于对照组（P ＜ 0.01）.两组3次用药月经前平均子宫内膜厚度均得到有效控制,3次用药月经前及月经后平均子宫内膜厚度组间分别比较,差异均无统计学意义（P ＞ 0.05）.观察组用药后黄体素（P）、雌激素（E2）较对照组显著降低（P ＜ 0.01）.观察组停药后月经恢复正常率高于对照组,复发率低于对照组.结论 米非司酮周期疗法在帮助患者建立正常月经周期、控制子宫内膜厚度、血红蛋白恢复方面效果同孕激素,但月经期短,复发率低.

A comparison between the curative effect of short-term Mifepristone therapy and that of progestin therapy on perimenopausal dysfunctional uterine bleeding

Objective To observe effects of perimenopausal dysfunctional uterine bleeding treated periodically by little dose Mifepristone.Methods Three days after curettage practice,patients in the experimental group(43 patients) began to take five consecutive days of Mifepristone(10 mg daily).In the following three menstrual cycles,patients were treated with five more consecutive days of Mifepristone at the first day of each menopausal cycle.Three days after curettage practice,38 patients in the control group were treated with Norethisterone(5 mg daily) until 20 days after the endometrium hemorrhage had been ceased.From the fifteenth day to the twenty-fifth day of the second and the third menstrual cycle,the patients started Medroxy Progesterone Acetate(10 mg daily).The two groups were followed up for another 18 months after stopping taking medicine.Results There was no difference in menstrual cycles between the two groups(P > 0.05),whereas the duration of the experimental group was shorter than that of the control group(P < 0.01).The differences of up-regulation in hemoglobin of both groups after treatment were not statistically significant.The endometrial thickness of the two groups after treatment of drugs was not increased dramatically and there was no difference of the endometrial thickness between the two groups(P > 0.05).The level of progesterone and estrogen in peripheral blood after taking drugs in the experimental group was lower than in control group(P < 0.01).After withdrawing drugs,there were more patients recovering to regular menstrual cycles in the experimental group.Moreover,the experimental group had a lower recurrent rate.Conclusion Five-day three-cycle Mifepristone therapy and progestin therapy have similar effects on rebuilding regular menstrual cycles,controlling endometrial thickness,restoring hemoglobin and improving fading of endometrial cells.But the duration of menstrual cycles rebuilt by Mifepristone therapy is shorter than that by progestin therapy.Due to its effect on central nervous system,Mifepristone therapy helps patients to restore menstrual cycles after stopping drug-taking.