达英-35、炔诺酮和黄体酮治疗围绝经期异常子宫出血疗效及安全性分析
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摘要
目的探讨达英-35、炔诺酮和黄体酮治疗围绝经期异常子宫出血(AUB)患者的疗效及安全性.方法将137例AUB患者随机分为达英-35组(A组,n=45)、炔诺酮组(B组,n=46)、黄体酮组(C组,n=46).3组患者均给予诊断性刮宫治疗,在此基础上,3组分别给予口服达英-35、炔诺酮、黄体酮进行治疗,连续治疗3个疗程.比较分析3组患者的临床疗效、子宫内膜和性激素水平变化、不良反应.结果治疗结束后,A组总有效率为95.6%,显著高于C组(82.6%,χ~2=3.90,P<0.05).B组与A组、C组总有效率比较差异均无统计学意义(χ~2=0.19,2.58,P>0.05).治疗后,A组、B组子宫内膜厚度均较C组明显降低(P<0.05).A组、B组治疗后子宫内膜厚度比较差异均无统计学意义(P>0.05).治疗后,各组FSH,LH及E2水平均明显下降,A组、B组下降幅度明显高于C组(P<0.05).A组、B组治疗后性激素水平比较差异均无统计学意义(P>0.05).A组、B组、C组不良反应的发生率分别为11.1%,15.2%,17.4%,差异无统计学意义(χ~2=0.74,P>0.05).A组1 a复发率为4.4%,显著低于C组复发率(17.4%,χ~2=3.98,P<0.05).结论达英-35、炔诺酮治疗AUB具有更好的疗效与安全性,尤其是达英-35在缩短阴道流血时间、改善子宫内膜增生及内分泌环境、调节内分泌激素、减少复发等方面具有明显的优势.
Objective To explore the efficacy and safety of diane-35,norethinne and progestin in the treatment of patients with abnormal uterine bleeding( AUB) during perimenopause.Method 137 AUB patients were randomly divided into diane-35 group( Group A,n = 45),norethindrone group( Group B,n = 46) and progesterone group( Group C,n=46).All the patients were all given diagnostic curettage treatment.On this basis,patients in the three groups were given orally diane-35,norethinne and progestin respectively for three consecutive treatment courses.The clinical efficacy,changes of endometrium and sex hormone levels and adverse reactions of three groups were compared and analyzed.Results After treatment,the total effective rate of Group A was 95.6%,significantly higher than that of Group C( 82.6%,χ~2= 3.90,P <0.05).There was no significant difference in the total effective rate among Group B,Group A,Group C( χ~2= 0.19,2.58,P>0.05).After treatment,endometrial thickness in Group A and Group B was significantly lower than that in Group C( P<0.05).There was no significant difference in endometrial thickness between Group A and Group B after treatment( P>0.05).After treatment,the levels of FSH,LH and E2 in each group decreased significantly,and the decreased levels in Group A and Group B were significantly higher than those in Group C( P<0.05).After treatment,there was no significant difference on sex hormone levels between Group A and Group B( P>0.05).There was no significant difference,the incidence of adverse reactions in Group A,Group B and Group C was 11.1%,15.2%,17.4%,respectively,with no statistical significance( χ~2= 0.74,P>0.05).1-year recurrence rate of Group A was 4.4%,significantly lower than that of Group C( 17.4%,χ~2= 3.98,P<0.05).Conclusions Diane-35 and norethinne have better efficacy and safety in the treatment of AUB,especially diane-35 has obvious advantages in shortening the time of vaginal bleeding,improving endometrial hyperplasia and endocrine environment,regulating endocrine hormones and reducing recurrence.
Objective To explore the efficacy and safety of diane-35,norethinne and progestin in the treatment of patients with abnormal uterine bleeding( AUB) during perimenopause.Method 137 AUB patients were randomly divided into diane-35 group( Group A,n = 45),norethindrone group( Group B,n = 46) and progesterone group( Group C,n=46).All the patients were all given diagnostic curettage treatment.On this basis,patients in the three groups were given orally diane-35,norethinne and progestin respectively for three consecutive treatment courses.The clinical efficacy,changes of endometrium and sex hormone levels and adverse reactions of three groups were compared and analyzed.Results After treatment,the total effective rate of Group A was 95.6%,significantly higher than that of Group C( 82.6%,χ~2= 3.90,P <0.05).There was no significant difference in the total effective rate among Group B,Group A,Group C( χ~2= 0.19,2.58,P>0.05).After treatment,endometrial thickness in Group A and Group B was significantly lower than that in Group C( P<0.05).There was no significant difference in endometrial thickness between Group A and Group B after treatment( P>0.05).After treatment,the levels of FSH,LH and E2 in each group decreased significantly,and the decreased levels in Group A and Group B were significantly higher than those in Group C( P<0.05).After treatment,there was no significant difference on sex hormone levels between Group A and Group B( P>0.05).There was no significant difference,the incidence of adverse reactions in Group A,Group B and Group C was 11.1%,15.2%,17.4%,respectively,with no statistical significance( χ~2= 0.74,P>0.05).1-year recurrence rate of Group A was 4.4%,significantly lower than that of Group C( 17.4%,χ~2= 3.98,P<0.05).Conclusions Diane-35 and norethinne have better efficacy and safety in the treatment of AUB,especially diane-35 has obvious advantages in shortening the time of vaginal bleeding,improving endometrial hyperplasia and endocrine environment,regulating endocrine hormones and reducing recurrence.
引文
[1]中华医学会妇产科学分会妇科内分泌学组.异常子宫出血诊断与治疗指南[J].中华妇产科杂志,2014,49(11):801-806.
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[4]宋建平.围绝经期功能失调性子宫出血的药物治疗进展[J].实用妇科内分泌杂志,2017,4(25):17,19.
[5]中华医学会妇产科学分会绝经学组.围绝经期异常子宫出血诊断和治疗专家共识[J].协和医学杂志,2018,9(4):313-319.
[6]徐亚萍.119例围绝经期功能性子宫出血的临床分析[J].吉林医学,2014,35(35):7878.
[7] Goldstein S R,Lumsden M A.Abnormal uterine bleeding in perimenopause[J].Climacteric,2017,5(5):1-7.
[8]沈文秀.炔雌醇环丙孕酮片治疗青春期功能性子宫出血的临床疗效及其安全性[J].临床合理用药,2018,11(11):23-24.
[9]孙青.炔雌醇环丙孕酮治疗围绝经期异常子宫出血的效果观察[J].广西医科大学学报,2017,34(4):594-596.
[10]付俊明.不同药物治疗围绝经期功能性子宫出血的临床有效性分析[J].吉林医学,2017,38(10):1879-1881.
[11]姜秀闪.探讨去氧孕烯炔雌醇片和炔诺酮治疗围绝经期功能性子宫出血的疗效[J].中国继续医学教育,2018,10(20):132-134.
[12] S haw A B,Marlin E S,Ikeda D S,et al. Ventriculoperitoneal shunt infection following uterine instrumentation for dysfunctional uterine bleeding[J]. J Clin Neurosci,2014,28(10):745-748.
[13]陈蓉,郁琦.围绝经期功能失调性子宫出血的性激素疗法[J].中国实用妇科与产科杂志,2012,28(10):745-748.
[2] T alukdar B,Mahela S. Abnormal uterine bleeding in perimenopausal women:Correlation with sonographic findings and histopathological examination of hysterectomy specimens[J].J Midlife Health,2016,7(2):73-77.
[3] Singh S,Best C,Dunn S,et al.No.292-Abnormal uterine bleeding in pre-menopausal women[J]. Journal of Obstetrics&Gynaecology Canada,2018,40(5):e391-e413.
[4]宋建平.围绝经期功能失调性子宫出血的药物治疗进展[J].实用妇科内分泌杂志,2017,4(25):17,19.
[5]中华医学会妇产科学分会绝经学组.围绝经期异常子宫出血诊断和治疗专家共识[J].协和医学杂志,2018,9(4):313-319.
[6]徐亚萍.119例围绝经期功能性子宫出血的临床分析[J].吉林医学,2014,35(35):7878.
[7] Goldstein S R,Lumsden M A.Abnormal uterine bleeding in perimenopause[J].Climacteric,2017,5(5):1-7.
[8]沈文秀.炔雌醇环丙孕酮片治疗青春期功能性子宫出血的临床疗效及其安全性[J].临床合理用药,2018,11(11):23-24.
[9]孙青.炔雌醇环丙孕酮治疗围绝经期异常子宫出血的效果观察[J].广西医科大学学报,2017,34(4):594-596.
[10]付俊明.不同药物治疗围绝经期功能性子宫出血的临床有效性分析[J].吉林医学,2017,38(10):1879-1881.
[11]姜秀闪.探讨去氧孕烯炔雌醇片和炔诺酮治疗围绝经期功能性子宫出血的疗效[J].中国继续医学教育,2018,10(20):132-134.
[12] S haw A B,Marlin E S,Ikeda D S,et al. Ventriculoperitoneal shunt infection following uterine instrumentation for dysfunctional uterine bleeding[J]. J Clin Neurosci,2014,28(10):745-748.
[13]陈蓉,郁琦.围绝经期功能失调性子宫出血的性激素疗法[J].中国实用妇科与产科杂志,2012,28(10):745-748.