目的 研究米非司酮联合孕三烯酮治疗子宫内膜异位症的临床效果。方法 选择2012年3月—2013年3月浚县人民医院收治的子宫内膜异位症患者150例,随机分为对照组和治疗组,每组75例。对照组患者在月经来潮后第2天开始口服孕三烯酮胶囊,2.5 mg /次,2次/周。治疗组患者口服米非司酮片,12.5 mg/次,1次/d,孕三烯酮胶囊的用法用量同对照组。两组均连续治疗24周。观察两组的临床疗效,同时对两组盆腔症状评分、总体征评分、血清性激素水平、妊娠结局进行比较。结果 对照组和治疗组总有效率分别为81.3%、96.0%,两组比较差异有统计学意义(P < 0.05)。治疗后,两组患者盆腔症状(痛经、性交痛、盆腔痛)、总体征(盆腔触痛、硬结)评分均显著降低,同组治疗前后差异有统计学意义(P < 0.05);且治疗组各评分的下降程度优于对照组,两组比较差异有统计学意义(P < 0.05)。两组患者血清促卵泡生成素(FSH)、黄体生成素(LH)、雌激素(E₂)、孕酮(P)水平明显低于治疗前,同组治疗前后差异有统计学意义(P < 0.05);且治疗组激素水平下降程度优于对照组,两组比较差异有统计学意义(P < 0.05)。对照组随访6、12个月时,妊娠率为25.3%、12.0%;治疗组为41.3%、26.7%,两组各随访时间点的妊娠率比较差异有统计学意义(P < 0.05)。结论 米非司酮联合孕三烯酮治疗子宫内膜异位症具有较好的临床疗效,可降低患者性激素水平,改善妊娠结局,值得临床推广和应用。

Objective To explore the efficacy of mifepristone combined with gestrinone in treatment of endometriosis. Methods The patients with endometriosis (150 cases) of Junxian People's Hospital from March 2012 to March 2013 were randomly divided into control and treatment groups, and each group had 75 cases. The patients in control group were po administered with Gestrinone Capsules on the second day of menstruation, 2.5 mg/time, twice every week. The patients in treatment group were po administered with Mifepristone Tablets, 12.5 mg/time, once daily, and the usage and dosage of Gestrinone Capsules were the same as the control group. The patients in two groups were treated for 24 weeks. After treatment, the efficacy was evaluated, and pelvic symptom scores, overall score, serum sex hormone levels and pregnancy outcomes in two groups were compared. Results The efficacies in control and treatment groups were 81.3% and 96.0%, respectively, and there were differences between two groups (P < 0.05). After treatment, pelvic symptoms (including dysmenorrhea, algopareunia, and pelvic pain) and overall character (including pelvic tenderness and induration) scores were significantly reduced, and the difference was statistically significant in the same group (P < 0.05). And these scores in treatment group improved better than those in control group, with significant difference between two groups (P < 0.05). FSH, LH, E₂, and P in two groups were significantly lower than before treatment, and the difference was statistically significant in the same group (P < 0.05). Drop degree of hormone levels in the treatment group were better than those of control group, with significant difference between two groups (P < 0.05). The control group were followed up for 6 and 12 months, the pregnancy rate were 25.3% and 12.0%, respectively; while the treatment group were 41.3% and 26.7%, respectively, and the differences of pregnancy rates in the follow-up times between two groups were statistically significant (P < 0.05). Conclusion Mifepristone combined with gestrinone has the good clinical effect in treatment of endometriosis, and can reduce sex hormone levels, while can improve the pregnancy outcome, which is worth clinical promotion.

国家自然科学基金资助项目(81000240)