米非司酮聯(lián)合宮瘤消膠囊對子宮肌瘤患者細(xì)胞因子和性激素水平影響研究

朱曉蘭 李潔明

【摘要】目的：研究米非司酮聯(lián)合宮瘤消膠囊對子宮肌瘤患者細(xì)胞因子和性激素水平影響。方法：選取2013年10月至2014年10月收入我院婦科并存在手術(shù)指征的子宮肌瘤患者100例，隨機(jī)數(shù)表分為治療組和對照組，每組各50例。治療組使用米非司酮聯(lián)合宮瘤消膠囊治療；對照組僅使用米非司酮口服治療。并對兩組療效、子宮體積、最大肌瘤體積及細(xì)胞因子和性激素水平進(jìn)行比較。結(jié)果： 治療組總有效率為94.0%，顯著高于對照組的76.0%，組間比較差異有統(tǒng)計學(xué)意義（χ2=6.256，P<0.05）。 治療前，兩組子宮體積及最大肌瘤體積差異無統(tǒng)計學(xué)意義（P>0.05），治療后，兩組子宮體積及最大肌瘤體積較顯著減小，組內(nèi)比較差異具有統(tǒng)計學(xué)意義（P<0.05），且治療組子宮體積及最大肌瘤體積顯著小于對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。治療前，兩組血清IL-22，TNF2α水平差異無統(tǒng)計學(xué)意義（P>0.05），治療后，與對照組相比治療組血清IL-22水平顯著升高，TNF2α水平顯著降低，差異具有統(tǒng)計學(xué)意義（P<0.05）。治療前兩組FSH、LH、E2、P 水平比較差異均無統(tǒng)計學(xué)意義（P>0.05），治療后兩組E2、P 水平均顯著降低，組內(nèi)比較差異具有統(tǒng)計學(xué)意義（P<0.05），治療后治療組E2、P 水平顯著低于對照組，組間比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療期間，治療組4例患者出現(xiàn)潮熱，3例患者出現(xiàn)惡心嘔吐，無其他不良反應(yīng)；對照組6例患者出現(xiàn)潮熱，5例患者出現(xiàn)惡心嘔吐，無其他不良反應(yīng)，兩組不良反應(yīng)較輕，未影響治療，治療結(jié)束后恢復(fù)，治療前后兩組均檢查血常規(guī)及肝腎功能，無異常，兩組不良反應(yīng)發(fā)生率無無統(tǒng)計學(xué)差異（χ2=1.118，P>0.05）。結(jié)論： 米非司酮聯(lián)合宮瘤消膠囊治療子宮肌瘤效果較好，并可調(diào)節(jié)患者內(nèi)分泌功能，不良反應(yīng)發(fā)生率低，值得臨床推廣應(yīng)用。

【關(guān)鍵詞】米非司酮；宮瘤消；子宮肌瘤；細(xì)胞因子；性激素

Effect of mifepristone combined Gongliuxiao on cell factor and sex hormone levels in patients with uterine fibroidsZHU Xiaolan1， LI Jieming2. 1. Department of Obstetrics and Gynecology， Guangyuan Third Peoples Hospital， Guangyuan 628001， Sichuan， China； 2. Department of Obstetrics and Gynecology， Guangyuan First Peoples Hospital， Guangyuan 628001， Sichuan， China

【Abstract】Objectives： To investigate the effect of mifepristone combined Gongliuxiao on cell factor and sex hormone levels in patients with uterine fibroids. Methods： 100 patients with uterine fibroids were randomly divided into treatment group and control group， 50 cases in each group. Treatment group was treated with mifepristone combined with Gongliuxiao capsule； the control group was given mifepristone. The effect， uterine volume， maximum fibroid volume and cell factor and sex hormone levels were evaluated. Results： The total effective rate of treatment group was 94%， significantly higher than 76% in the control group， with significant differences between the groups （χ2=6.256， P<0.05）. Before treatment， the two groups had no statistically significant difference in uterine volume and maximum fibroid volume （P>0.05）， but after treatment， the uterine volume and maximum fibroid volume was significantly decreased in both groups， with statistically significant difference within the group （P<0.05） and in the treatment group， the uterine volume and maximum fibroid volume was significantly less than the control group， with statistically significant difference （P<0.05）. Before treatment， the Serum IL-22 and TNF2α levels in the two groups was not significantly different （P>0.05）； after treatment， compared with the control group， the serum IL-22 level of the treatment group was significantly increased， and TNF2α levels decreased significantly， with statistically significant difference （P<0.05）. Before treatment， the FSH， LH， E2， P levels in the two groups were not significantly different （P>0.05）； E2 and P levels in the two groups after treatment significantly decreased， with statistically significant difference within the group （P<0.05）， and those in the treatment group was significantly lower than the control group， with statistically significant difference （P<0.05）. During the treatment， there were 4 patients with fever， 3 patients with nausea and vomiting in the treatment group； there were 6 patients with fever and 5 patients with nausea and vomiting in the control group. All the adverse reactions were mild， which did not affect recovery. The blood and liver function were checked both before and after treatment， with no abnormal situation found. No statistical difference was found in adverse reactions between the two groups （χ2=1.118， P>0.05）. Conclusion：The treatment of mifepristone， combined Gongliuxiao in patients with uterine fibroids is effective， which can be applied in clinical practice.

【Key words】Mifepristone； Gongliuxiao； Mifepristone； Uterine fibroids； Cytokine； Sex hormone

【中圖分類號】R737.33【文獻(xiàn)標(biāo)志碼】A

子宮肌瘤為女性常見良性腫瘤，發(fā)病率占女性生殖腫瘤之首[1]。臨床癥狀主要為陰道不規(guī)則流血、下腹墜脹、疼痛、壓迫、貧血、不孕等，對患者健康和生殖有極大影響[2]。生育期女性子宮肌瘤發(fā)病率高達(dá)30%，部分伴有貧血癥狀[3]。目前發(fā)病機(jī)制尚未明確，多認(rèn)為與遺傳、雌孕激素、受體等相關(guān)，子宮肌瘤生長速度與雌激素、孕酮及生長激素有關(guān)，其在生殖階段出現(xiàn)，懷孕期間增加，更年期后消退[4]。……