戊酸雌二醇片联合地屈孕酮在多次人工流产术后的应用效果

目的 观察多次人工流产术后采用戊酸雌二醇片联合地屈孕酮治疗的临床效果。方法 回顾性选取2016年2月—2019年12月厦门市思明区妇幼保健院收治的多次人工流产术患者共349例,根据患者入院后的治疗方案不同将其分为观察组196例和对照组153例。对照组术后按传统方法服用益母草颗粒,观察组术后采用戊酸雌二醇片联合地屈孕酮治疗。比较2组术后治疗3 d与7 d宫腔内膜厚度,手术当天与术后7 d炎性因子[白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、血管内皮生长因子(VEGF)]水平,术后各项临床指标变化情况。结果 术后治疗3 d,2组患者超声检查宫腔内膜厚度比较差异无统计学意义(P>0.05);术后治疗7 d,2组宫腔内膜厚度较之前有所改善,观察组内膜厚度大于对照组(P均<0.01)。术后7 d,2组IL-6、IL-8、TNF-α、VEGF水平均较手术当天有所降低,且观察组低于对照组(P均<0.01)。观察组患者阴道出血时间、月经复潮时间短于对照组,阴道出血量少于对照组,复潮月经量多于对照组(P均<0.01)。结论 多次人工流产术后患者...     

戊酸雌二醇联合醋酸甲羟孕酮治疗58例流产不全的临床观察

目的戊酸雌二醇联合醋酸甲羟孕酮治疗58例流产不全的临床疗效。方法本研究于2009年1月至2011年12月采用戊酸雌二醇联合醋酸甲羟孕酮对58例流产不全者进行治疗,并与采用催产素治疗的对照组进行临床疗效对比研究。结果两组患者经过积极的治疗后,其中研究组患者中痊愈55例,占87.93%(51/58),而对照组患者中治愈29例,占50.00%(29/58);研究组的临床治愈率明显高于对照组,且差异具有统计学意义(χ2=19.49,P<0.05)。另外,研究组患者阴道出血持续时间较对照组明显缩短,且差异具有统计学意义(t=6.12,P<0.05)。两组不良反应发生率无明显差异(χ2=0.49,P>0.05)。结论戊酸雌二醇联合醋酸甲羟孕酮治疗流产不全,提高了完全流产率,缩短了患者持续出血时间,值得临床推广使用。     

戊酸雌二醇与醋酸甲羟孕酮联用对围绝经期患者功能失调性子宫出血的临床疗效评价

目的:评价戊酸雌二醇与醋酸甲羟孕酮联用对围绝经期患者功能失调性子宫出血的疗效。方法:选取2015年1—12月间收治的围绝经期功能失调性子宫出血患者80例,按数字表抽取法将其随机分为对照组40例和观察组40例;对照组患者给予醋酸甲羟孕酮片治疗,观察组患者在对照组基础上加用戊酸雌二醇片治疗,比较两组患者治疗后的总有效率和止血的效果。结果:观察组患者治疗后控制出血时间和完全止血所需时间均短于对照组(P<0.05),总有效率为97.50%高于对照组为75.00%(P<0.05);两组患者用药期间不良反应的发生率低于对照组(P<0.05)。结论:针对临床收治的围绝经期功能失调性子宫出血患者,采用戊酸雌二醇片与醋酸甲羟孕酮片治疗,安全性高,出血时间短,复发率低。     

戊酸雌二醇配伍甲羟孕酮及益母草胶囊治疗药物流产不全临床观察

目的探讨戊酸雌二醇配伍甲羟孕酮及益母草胶囊治疗药物流产不全患者的效果。方法收集2013年该站收治的药物流产不全患者120例,按治疗方式的不同分为3组,A组采用常规清宫术,B组肌内注射缩宫素注射液,C组给予戊酸雌二醇配伍甲羟孕酮及益母草胶囊口服,比较三组患者疗效、阴道出血时间和不良反应发生情况。结果 A组和C组首次治疗痊愈率均明显高于B组,阴道出血时间均明显短于B组,不良反应发生率均明显低于B组,差异有统计学意义;与A组比较,C组首次治疗痊愈率略高,阴道出血时间略短,不良反应发生率略低,但差异无统计学意义。结论口服戊酸雌二醇配伍甲羟孕酮及益母草胶囊治疗药物流产不全效果良好,不良反应较少,且避免了清宫术对子宫产生的损伤。     

黄体酮联合戊酸雌二醇治疗人工流产术后阴道出血患者的疗效及其对子宫内膜功能的影响

目的 探讨黄体酮联合戊酸雌二醇治疗人工流产术后阴道出血患者的疗效及其对子宫内膜功能的影响。方法 选取2019年2月—2021年10月于庐山市妇幼保健院收治的66例人工流产术后阴道出血患者作为研究对象,随机分为A组和B组,各33例。术后A组服用黄体酮胶囊治疗,B组采用黄体酮联合戊酸雌二醇治疗,2组患者均持续治疗3个月。比较2组临床疗效、阴道出血量、术后阴道出血时间、术后首次月经来潮时间、子宫内膜厚度,术前及术后7 d子宫血流动力学指标[子宫动脉峰值血流速度(PSV)、阻力指数(RI)],术前及术后3个月性激素指标[雌二醇(E₂)、促卵泡成熟激素(FSH)、黄体生成素(LH)]水平,不良反应发生率。结果 B组总有效率为94.00%,高于A组的75.76%(χ²=4.243,P=0.039)。B组阴道出血量、术后阴道出血时间、首次月经来潮时间较A组短,子宫内膜厚度较A组大(P<0.05)。术后7 d, B组子宫动脉PSV、RI较同组术前降低,且B组较A组更低(P<0.05)。术后3个月,2组血清E₂水平高于术前,F...     

雌二醇与甲羟孕酮对人流术后子宫内膜修复的临床效果比较

目的观察口服戊酸雌二醇（补佳乐）与醋酸甲羟孕酮（安宫黄体酮）对人流术后子宫内膜修复的临床疗效。方法收集2011年1月—2012年1月到湖北潜江市计划生育服务站进行两次及以上的人工流产患者106例,随机分成两组,每组53例。一组口服补佳乐,另一组口服安宫黄体酮。连续服用3周后,观察子宫内膜厚度,观察两组月经量和不良反应发生情况。结果治疗后两组患者的子宫内膜均显示增厚,且服用补佳乐组（6.7±0.58）mm的患者显示了更佳的效果,与服用安宫黄体酮相比,差异有统计学意义（P〈0.05）。两组患者治疗后,月经量也比治疗前明显增多。两组患者在给药后偶可出现恶心、呕吐,头昏以及乳腺小叶增生等不良反应。但两组不良反应比较差异无统计学意义（P〉0.05）。结论人工流产后口服补佳乐比安宫黄体酮能更好地修复子宫内膜,可作为人工流产术后子宫内膜修复的的常规用药。     

戊酸雌二醇片联合醋酸甲羟孕酮治疗围绝经期综合征的临床疗效及其对患者血管内皮功能的影响

目的 观察戊酸雌二醇片联合醋酸甲羟孕酮治疗围绝经期综合征的临床疗效及其对患者血管内皮功能的影响。方法 选取2020年1月—2021年5月南华大学附属长沙中心医院收治的80例围绝经期综合征患者作为研究对象,采用随机数字表法分为对照组与观察组,各40例。对照组采用醋酸甲羟孕酮治疗,观察组采用醋酸甲羟孕酮联合戊酸雌二醇治疗。2组均持续治疗3个月。比较2组治疗前及治疗3个月后性激素[黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E₂)]水平、骨密度、子宫内膜厚度及血管内皮功能指标(全血高切黏度、内皮素1),不良反应发生情况。结果 观察组总有效率为95.00%,高于对照组的80.00%(χ²=4.114,P=0.043)。治疗前及治疗3个月后,2组LH、FSH、E2水平比较,差异无统计学意义(P> 0.05);治疗3个月后,2组LH、FSH水平低于治疗前(P <0.01)。治疗3个月后,观察组脊柱骨密度、子宫内膜厚度高于治疗前,且高于对照组(P <0.01)。治疗3个月后,观察组全血高切黏度及2组内皮素1低于治疗前,且观察组全血高...     

戊酸雌二醇/雌二醇环丙孕酮片用于围绝经期的临床观察

目的观察戊酸雌二醇/雌二醇环丙孕酮片用于围绝经期的临床效果。方法对有围绝经期症状患者59例采用戊酸雌二醇/雌二醇环丙孕酮片治疗。观察治疗前后雌二醇(E2)、卵泡刺激素(FSH)、子宫内膜厚度变化情况。结果治疗后E2、FSH、子宫内膜厚度等均有所改善,与治疗前比较差异均有统计学意义(P<0.05)。结论戊酸雌二醇/雌二醇环丙孕酮片用于围绝经期效果显著,无不良反应,值得临床推广应用。     

Differential effects of medroxyprogesterone acetate on thrombosis and atherosclerosis in mice

Background and purpose:

The risk for cardiovascular events including venous and arterial disease and stroke is elevated after treatment with estrogen and medroxyprogesterone acetate (MPA) in postmenopausal women. Here, we have investigated the effect of MPA on arterial thrombosis and atherosclerosis in a murine model of atherosclerosis.

Experimental approach:

Apolipoprotein E (ApoE)^−/− mice were bilaterally ovariectomized and treated with placebo, MPA (27.7 µg·day⁻¹) and MPA + 17-β-oestradiol (E₂; 1.1 µg·day⁻¹) for 90 days, on a Western-type diet. Thrombotic response was measured in a photothrombosis model, platelet activation by fluorescence activated cell sorting (FACS) analysis (CD62P) and thrombin generation by the endogenous thrombin potential (ETP). Furthermore, aortic plaque burden and aortic root plaque composition were determined.

Key results:

MPA and MPA + E₂-treated animals showed an aggravated thrombotic response shown by significantly reduced time to stable occlusion. The pro-thrombotic effect of MPA was paralleled by increased ETP whereas platelet activation was not affected. Furthermore, MPA + E₂ reduced the number of cells positive for α-smooth muscle actin and increased hyaluronan in the plaque matrix. Interestingly, total plaque burden was reduced by MPA but unchanged by MPA + E₂.

Conclusion and implications:

Long-term treatment with MPA and MPA + E₂ increased arterial thrombosis despite inhibitory effects of MPA on atherosclerosis in ApoE-deficient mice. Increased thrombin formation, reduced smooth muscle content and remodelling of non-collagenous plaque matrix may be involved in the pro-thrombotic effects. Thus, MPA exhibits differential effects on arterial thrombosis and on atherosclerosis.     

复方戊酸雌二醇和炔诺酮对动物雌激素和孕激素活性影响的研究

目的 研究戊酸雌二醇与炔诺酮的复方(E-N)对动物性激素影响。方法 小鼠子宫测重试验、观察大鼠阴道上皮细胞角化试验、观察兔子宫内膜变化试验。结果 E-N使小鼠子宫增重,促进大鼠阴道上皮细胞角质化,使兔子宫内膜腺体增生。结论 动物实验表明：E-N具有显著的雌激素活性及一定的孕激素活性。     

A comparative pharmacokinetic study of micronized estradiol valerate administered alone and in combination with medroxyprogesterone acetate in postmenopausal women

The objective of this study was to evaluate a possible pharmacokinetic interaction between 17beta-estradiol (E2) and medroxyprogesterone (MP) when administered together in a combined tablet because both hormones have common metabolic routes of biotransformation. The study assessed the mean pharmacokinetics parameters of E2 found after 1-dose administration of 2 different tablets containing E2, 1 containing 2 mg of micronized 17beta-estradiol valerate (E2V) and the other, administered after 2 weeks, 2 mg of E2V in combination with 5 mg of medroxyprogesterone acetate (MPA). The subjects were 15 healthy postmenopausal women with normal laboratory and clinic tests. The study was randomized, double blind, crossover, with 2 periods and 2 sequences. The blood samples were obtained at 0, 1, 2, 3, 4, 6, 8, 10, 12, and 24 hours after each administration. The E2 serum concentrations were determined by electrochemoluminiscence assay. From these data, the following pharmacokinetic parameters were calculated for E2 alone and E2 in combination with MPA (E2V/MPA): Cmax = 104.89 +/- 26.96, 103.27 +/- 44.40; AUC0-24 =1900.30 +/- 392.23, 1783.70 +/- 756.39; AUC0-infinity = 5576.06 +/- 4065.87, 5317.89 +/- 3702.54; ka = 1.06 +/- 0.31, 1.09 +/- 0.13; t1/2 = 35.65 +/- 20.62, 36.12 +/- 18.04; MRT = 16.29 +/- 8.77, 16.27 +/- 4.88; V/F = 16.29 +/- 8.76, 16.27 +/- 4.88. No significant differences between the pharmacokinetic parameters of E2 and E2/MPA were found, which led us to conclude that there is no pharmacokinetic interaction.     

Development and validation of a reversed-phase liquid chromatographic method for analysis of estradiol valerate and medroxyprogesterone acetate in a tablet formulation

A simple and accurate liquid chromatographic method was developed for estimation of estradiol valerate and medroxyprogesterone acetate in pharmaceuticals. Drugs were chromatographed on a reverse phase C18 column, using a mixture (30:70) of ammonium nitrate buffer and acetonitrile and eluants monitored at a wavelength of 280 nm. Solution concentrations were measured on a weight basis to avoid the use of an internal standard. The method was statistically validated for its linearity, accuracy, precision and selectivity. Due to its simplicity and accuracy, the authors believe that the method may be used for routine quality control analysis. It does not require any specific sample preparation except the use of a column guard before the analytical column and suitable prefilter attached to the syringe prior to injection.     

甲孕酮联合MVP方案与单纯MVP方案治疗晚期非小细胞肺癌的对比研究

目的　观察患者服用甲孕酮合并 MVP方案与单纯使用 MVP方案化疗治疗初治非小细胞肺癌(non- small cell cancer,NSCL C)的疗效 ,生活质量改善 ,毒性等情况并加以比较。方法　 A组 (2 9例 )接受甲孕酮 MVP方案治疗 ,B组 (2 7例 )接受 MVP方案治疗 ,采用单盲随机分组 ,毒性反应按 WHO标准进行评价。结果　 A、B两组疗效 (CR PR)分别为 2 7.6 %及 2 2 .2 % ,P>0 .0 5。中位生存期 A组 30周 ,B组 2 4周 ,(P<0 .0 1)。白细胞、血红蛋白减少及恶心、呕吐反应 ,B组较 A组明显 ,差异有显著性。两组均未发现其他严重的毒性反应。结论　甲孕酮联合 MVP方案组与单纯 MVP方案治疗组疗效差异无显著性 ,但前者中位生存期长 ,患者生活质量改善 ,毒副反应小     

结合雌激素-醋酸甲羟孕酮替代防治绝经后妇女的血脂紊乱

目的 :探讨结合雌激素 醋酸甲羟孕酮(Pre)替代防治绝经后妇女的血脂紊乱及心血管疾病。方法 :64例绝经后妇女 ,随机分为服药组 32例 ,年龄 (60±s 4 )a ;对照组 32例 ,年龄 (5 9± 6)a ,采用Pre作为绝经后激素替代治疗药物 ,服药组口服Pre 1片 ,qd× 2 8d为一个周期 ,连用 6个周期 ,对照组在观察期间仅给安慰剂服用。服药前后 ,用放射免疫法测定血雌二醇 (E2 )、促卵泡刺激素(FSH) ;采用酶法及酶联免疫双抗体夹心法测定血浆脂蛋白的浓度。结果 :服用Pre 6个周期后 ,E2 上升至卵泡中期水平 ,FSH显著降低 [E2 为 (75± 5 0 )ng·L- 1;FSH为 (38± 2 0 )IU·L- 1],低密度脂蛋白胆固醇 (LDL C)和脂蛋白 (a) [LP (a) ]显著降低[(2 .7± 0 .5 )mmol·L- 1;(98± 169)mg·L- 1],而高密度脂蛋白胆固醇 (HDL C)显著升高 [(1.82±0 .10mmol·L- 1]。结论 :绝经后妇女使用激素替代治疗 ,能改变其体内激素水平 ,改善血浆脂蛋白代谢     

宫血宁胶囊联合醋酸甲羟孕酮和戊酸雌二醇治疗青春期功能失调性子宫出血的疗效观察

目的探讨宫血宁胶囊联合醋酸甲羟孕酮和戊酸雌二醇治疗青春期功能失调性子宫出血的临床疗效。方法选取2014年1月—2015年1月在海南省第三人民医院接受治疗的青春期功能失调性子宫出血患者76例,随机分为对照组和治疗组,每组各38例。所有患者均给予必要的心理干预。对照组口服醋酸甲羟孕酮片,8 mg/d,止血3 d后开始减量,每3天减量1/3,维持量为1 mg/d;同时口服戊酸雌二醇片,4~6 mg/次,3次/d。治疗组在对照组基础上口服宫血宁胶囊,2粒/次,3次/d。两组患者均连续治疗21 d。观察两组患者的临床疗效,同时比较治疗前后两组患者止血时间、性激素水平和WHOQOL-BREF评分的变化情况。结果治疗后,对照组和治疗组总有效率分别为84.21%、97.37%,两组比较差异有统计学意义(P0.05)。治疗后,治疗组的有效控制出血时间和完全止血时间明显短于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者促卵泡激素(FSH)、黄体生成素(LH)、雌二醇(E2)水平均明显降低(P0.05);且治疗组上述性激素指标水平降低更显著(P0.05)。治疗后,两组患者生理健康评分、心理状态评分、社会关系评分、周围环境评分和总分均较同组治疗前升高(P0.05);治疗组上述各项WHOQOL-BREF评分升高的更明显(P0.05)。结论宫血宁胶囊联合醋酸甲羟孕酮和戊酸雌二醇治疗青春期功能失调性子宫出血疗效确切,可有效提高患者生活质量,具有一定的临床应用推广价值。     

Bioavailability of estradiol from a new matrix and a conventional reservoir-type transdermal therapeutic system

Objective: Bioavailability of estradiol delivered from a newly developed matrix-type transdermal therapeutic system (MTTS) was compared with that of the conventional reservoir-type system (RTTS). Both formulations have a nominal delivery rate of 50 μg per day of 17β-estradiol (E2). Plasma concentrations of E2 and estrone (E1) were determined at steady state during a 96-h application of each formulation to 34 postmenopausal volunteers, using a two-stage randomized two-period crossover design. Results: The MTTS proved to be equivalent to the RTTS with respect to the extent of E2 absorption. Due to differences in patch design and composition, the rate of absorption was different between the two systems, with less fluctuating E2 plasma levels during application of the matrix system. Local tolerability and adhesion of MTTS appeared to be better than those of the reservoir system. Received: 29 February 1996/Accepted in revised form: 22 May 1996     

Evaluation of a new estradiol oral contraceptive: estradiol valerate and dienogest

Importance of the field: Since ethinyl estradiol is a potent activator of hepatic enzymes, the use of natural estradiol (E2) has been studied; but, until recently, bleeding control has hampered development of an E2 pill.

Areas covered in this review: A historical review of oral contraceptive development leading to the successful design of an estradiol pill. Pharmacology, mechanism of action and clinical trials of contraceptive efficacy and bleeding profile of the estradiol valerate/dienogest (E2V/DNG) pill are reviewed. Details of two placebo-controlled treatment trials of the E2V/DNG pill in women with heavy menstrual bleeding are discussed. All available literature was searched using pubMed and additional data were obtained from published abstracts.

What the reader will gain: Information on the novel features and indications for the E2V/DNG pill.

Take home message: The dynamic-dosing E2V/DNG oral contraceptive pill provides a highly effective contraceptive option with an adjusted Pearl Index (method failure) of 0.51 (upper limit of 95% CI 0.97) and unadjusted Pearl Index (user failure) of 1.01 (1.59) for women aged 18 – 35 years. In addition, two large randomized controlled trials have demonstrated that E2V/DNG provides effective treatment for women with heavy menstrual bleeding.     

The influence of transdermal oestradiol replacement therapy and medroxyprogesterone acetate on serum lipids and lipoproteins

Aims The objective of this study was to examine the effects of continuous transdermal oestradiol with or without sequential oral medroxyprogesterone acetate on serum lipids and lipoproteins in menopausal women.
Methods Sixty-two healthy menopausal women, attending at two menopause clinics in Western India, were recruited for this study over a period of 1 year. Group 1 included 38 hysterectomised women being treated with continuous transdermal oestradiol only (50  μg daily). Group 2 included 24 menopausal women with an intact uterus being treated with transdermal oestradiol (50  μg daily) and medroxyprogesterone acetate (10  mg daily for the first 12 days of each calendar month). Women maintained on 50  μg oestradiol throughout 6 months (group 1: n =22; group 2: n =16) were reviewed for changes in serum lipids and lipoproteins at the end of 6 months (group 1), and between days 8 and 12 of the seventh month (combined phase of treatment) (group 2).
Results In group 1, there was a small reduction in the concentrations of total cholesterol (−5.5%, P =0.04) and a small but not significant reduction in LDL-cholesterol (−5.7%, P =0.16). In group 2, there were no significant changes in total cholesterol (−4.2%, P =0.43) and LDL-cholesterol (−3.9%, P =0.57). HDL-cholesterol levels did not change significantly with unopposed transdermal oestradiol (+3.0%, P =0.53), or with additional sequential medroxyprogesterone acetate (−3.8%, P =0.32). Serum triglyceride concentrations decreased significantly in both the groups (−13.9%, P =0.01, and −13.4%, P =0.008, respectively). Serum lipid changes did not differ between the groups.
Conclusions Transdermal oestrogen therapy appears to be of particular benefit for women with hypertriglyceridaemia. There were no significant adverse effects of medroxyprogesterone acetate on serum lipids and lipoproteins.