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本研究旨在比较黄体期不同阶段应用米非司酮对黄体功能、卵泡发育、排卵和阴道出血类型的影响以探讨其生育调节的作用机理。15名采取屏障避孕的健康育龄妇女,随机分成三组(组Ⅰ~Ⅲ),分别在黄体早、中、晚期给予米非司酮口服25mgq12h×6。每例对象在对照周期、服药周期和随访周期均接受采血,测定其血清FSH、LH、PRL、E2和P的水平,记录其阴道出血量及时间。结果显示服药后阴道出血类型和激素水平的变化因服药时机而异。服药时间距LH峰愈近,则诱发阴道出血所需时间愈长,两者是显著负相关(r=-0.87,P<0.001)。黄体早期用药(组Ⅰ)对黄体功能及出血类型无明显影响。黄体中期用药(组Ⅱ)者中,3例孕酮水平提前下降,服药周期缩短,提示黄体过早溶解;另2例在月经预期来潮之前亦有一次阴道出血,但其孕酮水平并未随之下降,提示黄体未提前萎缩。黄体晚期用药(组Ⅲ)对服药周期无明显影响;但是在随访周期,2例对象卵泡发育缓慢,排卵明显延迟,并且其黄体期也缩短。
The aim of this study was to compare the effects of mifepristone on corpus luteum function, follicular development, ovulation and vaginal bleeding at different stages of luteal phase in order to investigate the mechanism of mifepristone’s effects on fertility regulation. Fifteen healthy women of childbearing age who took barrier contraception were randomly divided into three groups (group Ⅰ ~ Ⅲ). Mifepristone was given orally 25mgq12h × 6 in early, middle and late stages respectively. Each subject received blood sampling during the control, medication and follow-up cycles. Serum levels of FSH, LH, PRL, E2 and P were measured and the amount of vaginal bleeding and time were recorded. The results showed that vaginal bleeding after taking the type and hormone levels vary with the timing of taking medication. Medication time from LH peak closer, then the longer the time required to induce vaginal bleeding, the two were significantly negatively correlated (r = -0.87, P <0.001). Early administration of corpus luteum (group I) had no significant effect on corpus luteum function and type of bleeding. Progesterone levels decreased in advance in 3 of the mid-luteal phase (Group Ⅱ) patients, leading to a shortened period of medication, suggesting premature luteal lysis; the other 2 patients had vaginal bleeding before the expected menstrual flow, but their progesterone levels did not follow The drop, suggesting that corpus luteum did not shrink in advance. Late administration of luteal phase (group Ⅲ) had no significant effect on the medication cycle; however, in the follow-up cycle, follicles developed slowly and ovulation was delayed obviously, and their luteal phase shortened.