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目的探讨小剂量米非司酮对女性生殖/内分泌系统的影响。方法选取子宫腺肌病患者31例,服用米非司酮4个月。检测用药前后血雌二醇(estradiol,E2)、促卵泡素(Follicle-stimulating hormone,FSH)、谷丙转氨酶(glutamic-pyruvic transaminase,GPT)、肌酐(creatinine,Cr)及用药前后卵巢体积、子宫体积及子宫内膜增殖细胞核抗原(proliferation cell nuclear antigen,PCNA)指数。结果治疗后E2水平[(131.68±40.31)pmol/L]较治疗前E2水平[(255.90±152.61)pmol/L]明显下降,差异有统计学意义(P<0.05);治疗前后FSH水平差异无统计学意义(P>0.05)。②卵巢体积[(10.68±0.24)cm3]及子宫体积[(64.20±1.04)cm3]均小于治疗前[(14.25±0.51)cm3、(81.42±1.01)cm3],差异有统计学意义(P<0.05)。③治疗后内膜转化率为33.3%,部分内膜发生增生过长;治疗前后内膜PCNA指数差异无统计学意义(P>0.05)。④治疗前后血GPT、Cr差异无统计学意义(P>0.05)。结论小剂量米非司酮对垂体具有雌激素样的负反馈作用;同时通过抗雌激素样作用直接作用于卵巢,使卵巢激素缺乏周期性变化而出现闭经,并伴随卵巢、子宫缩小及更年期症状;还对子宫内膜具有微弱的雌激素样作用。
Objective To investigate the effect of low dose mifepristone on female reproductive / endocrine system. Methods 31 patients with adenomyosis were selected and treated with mifepristone for 4 months. The levels of estradiol (E2), Follicle-stimulating hormone (FSH), glutamic-pyruvic transaminase (GPT), creatinine (Cr) and ovarian volume before and after treatment, Endometrial proliferating cell nuclear antigen (PCNA) index. Results After treatment, the level of E2 was significantly lower than that before treatment [(131.68 ± 40.31) pmol / L] (255.90 ± 152.61 pmol / L, P <0.05) Statistical significance (P> 0.05). ② The ovarian volume [(10.68 ± 0.24) cm3] and the uterus volume (64.20 ± 1.04 cm3) were significantly lower than those before treatment (14.25 ± 0.51 cm3, 81.42 ± 1.01 cm3, P < 0.05). ③ After treatment, the rate of endometrial conversion was 33.3%, some of the endometrial hyperplasia was too long. There was no significant difference in endometrial PCNA index before and after treatment (P> 0.05). ④ There was no significant difference in GPT and Cr between before and after treatment (P> 0.05). Conclusion Low dose mifepristone has an estrogen-like negative feedback effect on the pituitary gland. At the same time, it directly acts on the ovary through anti-estrogen-like effect, causing amenorrhea with periodic changes of ovarian hormones deficiency accompanied by symptoms of ovary, uterine contractions and menopause ; Also has a weak endometrial estrogen-like effect.