小剂量米非司酮对子宫内膜的影响

目的通过研究小剂量米非司酮对子宫内膜的影响,探讨长期应用小剂量米非司酮的安全性。方法随机抽取门诊就诊的子宫肌瘤或子宫腺肌病患者40例,年龄为(39.11±7.98)岁。均于月经的第5天开始服用米非司酮12.5mg/d,连续服用1个月,自第2个月开始,每天服用6.25mg/d,连续服用3个月,共计4个月经周期(120d)。分别于服药前月经周期的卵泡期(月经的第1～9天)及服药第120天至停药一周内进行随访。每次随访均做阴道超声测量子宫内膜厚度,取子宫内膜行HE染色、免疫组化二步法测PCNA指数,测量血E2、FSH、谷丙转氨酶(GPT)、肌酐(Cr),记录阴道流血情况及不适症状等。应用SPSS11.5统计软件进行数据处理。结果①米非司酮治疗前血雌二醇为(69.73±41.58)pg/mL,为卵泡期水平,治疗后为(35.88±10.98)pg/mL,为绝经期水平,两者比较,差异有显著性(P<0.01)。②米非司酮治疗前后FSH分别为(5.02±2.91)IU/L及(5.88±1.73)IU/L,两者比较,差异无显著性(P>0.05)。③病理报告示治疗后内膜转化率为33.3%,部分内膜发生增生过长,未发现不典型增生;米非司酮治疗前后子宫内膜的PCNA指数分别为(795.80±59.70)及(820.60±48.05),两者比较,差异无显著性(P>0.05)。④米非司酮治疗后谷丙转氨酶为(19.50±7.91)U/L,肌酐为(68.61±25.56)μmol/L,与治疗前比较,差异无显著性(P>0.05)。结论小剂量米非司酮具有微弱的雌激素样作用,对子宫内膜无抑制,服用小剂量米非司酮4个月,可导致内膜出现增生过长,但未发现不典型增生情况,说明此种用药方法是相对安全的,但其长期应用的安全性有待进一步探讨。

Study on the Influence of Low-dose Mifepristone in Uterine Endometrium

Objective To study on the influence of low-dose mifepristone in uterine endometrium.Methods Forty women with uterine leiomyomata or adenomyosis,were chosen at random as the control group in this study.All took mifepristone 12.5 mg daily for one month from the fifth day of menstruation cycle,and then took it 6.25mg daily for 3 months.Two menstruation cycles were monitored.First,follicular phase before treating（from the first day to the ninth day of menstruation cycle）.Second,from the 120th day of taking medicine to a week after treating.Every time,uterine endometrial thickness were measured by transvaginal ultrasonography.And the serum glutamic-pyruvic transaminase level,creatinine level were measured in the situation of forbiding food.The Proliferating Cell Nuclear Antigen Index were measured by immunohistochemistry.So did the pathological examination of endometrial specimens,the serum E2 levels and FSH levels.Everyday the patients kept diary,recording the vagina bleeds,discomfort symptom and etc.Appling SPSS11.5 statistics software to carry on datas.Results ①E2 level before treating is placed in the follicular phase of the cycle（69.73±41.58pg/mL）.However,E2 level treated with mifepristone descends obviously（P 0.01）,being placed in the postmenopausal phase（35.88±10.98 pg/mL）.②FSH level has no obvious differenc e（P 0.05）between treated with mifepristone（5.88±1.73IU/L）and untreated with it（5.02±2.91IU/L）.③The pathological examination shows endometrial conversion rate is 33.3%,and detect endometrial hyperplasia,but no atypical hyperplasia was noted.PCNA index has no obvious difference between treated with mifepristone（820.60±48.05）and untreated with mifepristone（795.80± 59.70）（P 0.05）.④GPT and Cr levels were unaffected after mifepristone administration（P 0.05）.Conclusions Low-dose mifepristone can not inhibit endometrium because of its slender estrogen effection.After taking it for 4 month,there is a endometrial hyperplasia phenomenon but no atypical hyperplasia,so this way of taking it is safe,but Further investigation of the endometrial effects of mifepristone must be conducted if mifepristone is to be used for longer than 4 months.