长疗程服用米非司酮对子宫肌瘤患者糖皮质激素影响及缩小肌瘤效果临床分析.docVIP

长疗程服用米非司酮对子宫肌瘤患者糖皮质激素影响及缩小肌瘤效果临床分析 　　【摘要】 目的 分析研究?L疗程服用米非司酮对子宫肌瘤患者糖皮质激素的影响及缩瘤效果。方法 90例子宫肌瘤患者从月经1～2 d开始服用米非司酮， 连续服用6个月， 分别在治疗前、治疗3个月、 　　治疗6个月时测量患者子宫和肌瘤的三维径线， 同时用免疫化学发光法测定患者的血清皮质醇、雌二醇、孕酮、促黄体生成素、促卵泡素， 在治疗过程中观察患者是否出现不良发应。结果 患者服药3个月后， 促黄体生成素有显著升高， 服药6个月后升高幅度有所减低， 治疗前与治疗3、6个月后对比差异具有统计学意义（P0.05）。治疗3个月后， 子宫和肌瘤的最大体积均较治疗前显著缩小（P0.05）， 肌瘤体积缩小43.8%， 子宫体积缩小27.6%；治疗6个月后， 子宫和肌瘤的最大体积继续缩小， 肌瘤体积缩小57.7%， 子宫体积缩小42.7%， 与治疗3个月比较差异具有统计学意义（P0.05）。治疗3个月后， 40例患者出现糖皮质激素症状， 当患者使用米非司酮6个月后上述症状依然存在， 但无明显加重迹象。40例出现糖皮质激素症状患者的血清皮质醇治疗3个月后较治疗前明显升高， 治疗6个月较治疗前明显降低（P0.05）。患者经过治疗后临床症状均显著的改善， 患者在用药期间均出现闭经情况， 在停药4周后月经恢复。结论 长疗程服用米非司酮可以有效缩小子宫肌瘤；部分患者出现抗糖皮质激素效应， 这种效应还会随着血清皮质醇而波动， 判断是否有米非司酮抗糖皮质激素效应的发生不适合用测定血清皮质醇水平的方法。 　　【关键词】 米非司酮；子宫肌瘤；糖皮质激素；缩小肌瘤 　　DOI：10.14163/j.cnki.11-5547/r.2017.18.059 　　【Abstract】 Objective To analyze and research influence by long-term administration of mifepristone on glucocorticoid in uterine fibroid patients and its fibroid shrinking effect. Methods A total of 90 uterine fibroid patients received mifepristone from 1～2 d of menstruation for 6 months. Three-dimensional radial lines of uterus and fibroid were measured before treatment and in 3 and 6 months of treatment. Immunochemistry luminescence method was applied to detect serum cortisol， estradiol， progesterone， luteinizing hormone， and follicle-stimulating hormone. Observation was made on occurrence of adverse reactions during treatment. Results After 3 months of medication， luteinizing hormone showed obvious increase， and its increasing range was gradually reduced after 　　6 months of medication. The difference between its level before treatment and in 3 and 6 months of treatment had statistical significance （P0.05）. After 3 months of treatment， maximum volumes of uterus and fibroid were all obviously smaller than those before treatment （P 　　3 months of treatment （P0.05）. After 3 months of treatment， there were 40 cases with symptoms of glucocorticoid， and 6-month administration of mifepristone in those patients showed no obvi