黄体酮联合结合雌激素治疗围绝经期综合征的临床研究

目的 探究黄体酮与地屈孕酮分别联合低剂量结合雌激素治疗围绝经期综合征的疗效。方法 选取2015年10月—2017年10月在昆山市第四人民医院接受治疗的80例围绝期综合征患者作为研究对象，根据治疗方法将患者分为对照组和观察组，每组各40例。对照组患者给予低剂量结合雌激素片0.3 mg/d；用药12 d后口服地屈孕酮片，10 mg/d，持续用药18 d。观察组患者给予低剂量结合雌激素片0.3 mg/d；用药12 d后，口服黄体酮软胶囊100 mg/d，连续用药18 d。30 d为一个用药周期，周期之间无停药间隔，两组均治疗3个周期。观察两组患者的临床疗效，同时比较两组治疗前后的Kupperman评分和血清激素水平。结果 治疗后，观察组临床总有效率为85.00%，与对照组的77.50%差异无统计学意义。治疗后，对照组和观察组的Kupperman评分均显著降低，同组治疗前后比较差异具有统计学意义（P<0.01）；但两组间的Kupperman评分比较无显著差异。两组治疗后血清卵泡刺激素（FSH）、促黄体生成激素（LH）水平明显下降；血清雌二醇（E₂）和抗苗勒管激素（AMH）水平显著上升（P<0.05），且观察组血清E₂和AMH水平显著高于对照组（P<0.05）。结论 黄体酮与地屈孕酮联合低剂量结合雌激素均可显著地缓解围绝经期综合征患者的症状，但黄体酮相比于地屈孕酮更能有效延缓患者卵巢功能衰退，改善患者体内激素及卵巢功能相关因子水平。

Comparison on efficacy of progesterone and dydrogesterone combined with low dose conjugated estrogens in treatment of perimenopausal syndrome

Objective To explore the efficacy of progesterone and dydrogesterone combined with low dose conjugated estrogens in treatment of perimenopausal syndrome. Methods A total of 80 patients with perimenopausal syndrome who were treated in the Kunshan Fourth People''s Hospital from October 2015 to October 2017 were selected as the research objects. According to the treatment methods, the patients were divided into control group and observation group, with 40 patients in each group. Patients in the control group were given low-dose Conjugated Estrogens Tablets at 0.3 mg/d. After 12 days of medication, patients were po administered with Dydrogesterone Tablets at 10 mg/d and continued for 18 days. Patients in the observation group were given a lowdose Conjugated Estrogens Tablets of 0.3 mg/d. After 12 days of administration, Patients were po administered with Progesterone Soft Capsules, 100 mg/d continuously for 18 days. 30 d was a medication cycle, with no stopping interval between cycles, and both groups were treated for 3 cycles. After treatment, the clinical effect in two groups were observed, and the Kupperman score, and serum hormone levels before and after treatment were compared. Results After treatment, the total clinical effective rate of the observation group was 85.00%, and the difference was not statistically significant compared with 77.50% of the control group. After treatment, Kupperman scores of the control group and the observation group were significantly decreased, and the difference in Kupperman scores in the same group was statistically significant (P<0.01). However, there was no significant difference in Kupperman score between two groups. After treatment, the serum levels of FSH and LH in two groups were decreased significantly, serum E 2 and AMH levels were significantly increased (P<0.05), and serum E₂ and AMH levels in the observation group were significantly higher than those in the control group (P<0.05). Conclusion Both progesterone and dydrogesterone combined with low dose conjugated estrogens can significantly alleviate the symptoms of patients with perimenopausal syndrome, but compared with dydrogesterone, progesterone can effectively delay the ovarian function decline, and improve the levels of hormones and factors related to ovarian function in patients.