不同剂量孕三烯酮治疗子宫腺肌病的临床疗效分析

发布时间：2018-07-26 18:57

【摘要】：目的：子宫腺肌病是一种激素依赖性疾病，其患病率明显升高，发病年轻化趋势也日益明显，成为第三位妇科住院指征和子宫切除的主要原因。对于年轻且有生育要求、症状较轻、近绝经期者、保守性手术治疗后复发者或伴有严重的合并症不能耐受手术者一般选择药物治疗缓解症状。孕三烯酮是治疗子宫腺肌病的常用药物，副作用相对较轻。因此，本研究的目的就在于通过对子宫腺肌病患者服用不同剂量的孕三烯酮，评价其对月经及出血情况、痛经缓解率、子宫大小、CA125的临床疗效，以及对肝功能的影响，为子宫腺肌病的药物治疗提供临床依据，以提出具有确切疗效并适于推广到临床的治疗方案。方法：选取2013年3月至2013年10月就诊于山西医科大学第二临床医学院的符合入选及排除标准的子宫腺肌病患者42例，将其随机分为两组，对照组24例，自月经周期第1-5天起口服孕三烯酮2.5mg，每周2次，连用3个月；观察组18例，自月经周期第1-5日起口服孕三烯酮2.5mg，，每周3次，连用1个月，后改为每周2次，连用2个月。三个月后复查，观察两组患者月经及阴道异常出血情况、痛经缓解程度、子宫体积的改变、CA125以及肝功能。子宫体积的测量通过妇科彩超测其各轴径数值大小，计算方式按照椭圆体积=4/3πabc（abc为各轴长度数值一半，π=3.1415）。采用SPSS17.0对所有数据进行统计分析处理，其中计量资料采用均数±标准差描述，计数资料组间比较采用卡方检验，服药前后的比较采用重复测量的方差分析，检验水准α=0.05，以P＜0.05为差异具有统计学意义。结果：口服孕三烯酮治疗子宫腺肌病，观察组阴道不规则流血率明显小于对照组，闭经率高于对照组（P＜0.05）；服药1月后两组痛经均缓解，观察组更明显,差异具有统计学意义（P＜0.05），服药3月后两组间痛经缓解率差异无统计学意义（P＞0.05）；服用孕三烯酮三个月后，不同给药方式均能缩小子宫体积，差异有统计学意义（P＜0.05）,组间两两比较，子宫体积缩小，差异无统计学意义（P＞0.05）；服药1月、3月后与服药前相比两组CA125水平差异均具有统计学意义（P＜0.05），组间差异无统计学意义（P＞0.05）；服药1月、3月后与服药前相比，两组ALT、AST差异均具有统计学意义（P＜0.05），组间比较也具有统计学意义；服药后虽观察组较对照组肝功能损害较大，但ALT在100IU以内对患者肝正常功能的影响无损害。结论：给予子宫腺肌病患者孕三烯酮3次/周*1个月、2次/周*2个月的给药方式，即首月加量，可明显降低阴道不规则流血的发生率、更快的缓解痛经、缩小子宫体积，且对肝正常功能无损害。
[Abstract]:Objective: adenomyosis is a hormone dependent disease. The prevalence rate of adenomyosis is obviously increased, and the tendency of onset is becoming more and more obvious, which is the main reason of the third gynecological inpatient indication and hysterectomy. For those who are young and have fertility requirements, mild symptoms, near menopausal period, patients with recurrence after conservative surgery or with severe complications, patients who are unable to tolerate surgery generally choose medication to relieve their symptoms. Pregnenone is a commonly used drug for the treatment of adenomyosis, with relatively mild side effects. Therefore, the purpose of this study was to evaluate the effects of different doses of pregnenone on menstruation and bleeding, dysmenorrhea relief rate, clinical efficacy of uterine size CA125, and liver function in patients with adenomyosis. To provide the clinical basis for the drug treatment of adenomyosis and to put forward the treatment plan which has definite curative effect and is suitable for clinical application. Methods: from March 2013 to October 2013, 42 patients with adenomyosis who met the criteria of inclusion and exclusion were selected and randomly divided into two groups, the control group (n = 24) and the control group (n = 24). From the 1st to 5th day of menstrual cycle, pregnancy trienone 2.5 mg was given orally twice a week for 3 months, while in the observation group, 2.5 mg of pregnancy trienone was given orally 3 times a week for 1 month from the 1st to 5th day of menstrual cycle, and then changed to 2 times a week for 2 months. After 3 months, the abnormal bleeding of menstruation and vagina, the degree of dysmenorrhea, the change of uterine volume and liver function were observed. The size of each axis diameter was measured by gynecological color Doppler ultrasound. The calculation method was based on the ellipsoidal volume of 4 / 3 蟺 abc (abc for the length of each axis half, 蟺 ~ (3.1415). All the data were statistically analyzed by SPSS17.0, in which the mean 卤standard deviation was used to describe the measurement data, the chi-square test was used to compare the counting data groups, and the variance analysis of repeated measurements was used to compare the data before and after taking the medicine. The test level was 0.05, and the difference was statistically significant (P < 0.05). Results: the rate of irregular vaginal bleeding in the observation group was significantly lower than that in the control group, and the rate of amenorrhea was higher than that in the control group (P < 0.05). The difference was statistically significant (P < 0.05). There was no significant difference in the relief rate of dysmenorrhea between the two groups after 3 months (P > 0.05). The difference was statistically significant (P < 0.05). There was no significant difference in uterine volume between the two groups (P > 0.05). There were significant differences in CA125 levels between the two groups after one month and three months after treatment (P < 0. 05), but there was no significant difference between the two groups (P > 0. 05). The difference of alt and AST between the two groups was statistically significant (P < 0. 05) and the difference between the two groups was also statistically significant. Although the liver function damage of the observation group was greater than that of the control group, the effect of ALT within 100IU on the normal liver function of the patients was not impaired. Conclusion: the administration of trienone 3 times / week * 1 month / week * 2 months in patients with adenomyosis can significantly reduce the incidence of irregular vaginal bleeding, relieve dysmenorrhea and reduce the volume of uterus. There was no damage to normal liver function.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.71

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