地屈孕酮联合小剂量米非司酮对围绝经期排卵障碍性异常子宫出血的疗效及性激素影响OA
Efficacy of Dydrogesterone Combined with Low-Dose Mifepristone in Perimenopausal Ovulatory Dysfunction Abnormal Uterine Bleeding and Its Effects on Sex Hormones
目的 分析在地屈孕酮治疗基础上加用小剂量米非司酮,对围绝经期排卵障碍性异常子宫出血(AUB-O)患者止血结局、子宫内膜相关超声指标及性激素水平的影响.方法 回顾性纳入 2022 年 5 月至 2025 年 2 月商丘市第一人民医院围绝经期 AUB-O 患者 114 例,按实际用药方案分为对照组 58 例(地屈孕酮)与研究组 56 例(地屈孕酮+小剂量米非司酮),两组均治疗 3 个周期.比较两组疗效分级、控制出血与完全止血所需时间、经阴道超声测得的子宫内膜厚度与子宫体积,以及性激素水平和血红蛋白(Hb)变化;记录不良反应,并随访停药后 6 个月复发情况.结果 研究组治疗有效率高于对照组,控制出血时间、完全止血时间均明显短于对照组,差异均有统计学意义(P＜0.05).治疗后,研究组子宫内膜厚度低于对照组,差异有统计学意义(P＜0.05).治疗后,研究组 FSH、Hb 水平均高于对照组,而 E2 和 P 水平均低于对照组,差异均有统计学意义(P＜0.05).研究组患者随访期间疾病复发率低于对照组,差异有统计学意义(P＜0.05).结论 在地屈孕酮基础上联用小剂量米非司酮能提升对围绝经期AUB-O的疗效,缩短止血时间,改善子宫内膜状态,并降低停药后复发风险,应用安全性良好.
Objective To analyze the effects of adding low-dose mifepristone to dydrogesterone therapy on hemostatic outcomes,endometrium-related ultrasonographic indicators,and sex hormone levels in patients with perimenopausal ovulatory dysfunction abnormal uterine bleeding(AUB-O).Methods A total of 114 patients with perimenopausal AUB-O treated at Shangqiu First People's Hospital from May 2022 to February 2025 were retrospectively enrolled.According to the actual medication regimen,they were divided into a control group(58 cases,treated with dydrogesterone)and a study group(56 cases,treated with dydrogesterone plus low-dose mifepristone).Both groups were treated for three cycles.The graded therapeutic efficacy,time required to control bleeding and to achieve complete hemostasis,endometrial thickness and uterine volume measured by transvaginal ultrasonography,as well as changes in sex hormone levels and hemoglobin(Hb),were compared between the two groups.Adverse reactions were recorded,and recurrence within 6 months after drug withdrawal was followed up.Results The overall treatment response rate in the study group was higher than that in the control group,and the time to bleeding control and the time to complete hemostasis were both significantly shorter than those in the control group;the differences were statistically significant(P＜0.05).After treatment,the endometrial thickness in the study group was lower than that in the control group,with a statistically significant difference(P＜0.05).After treatment,follicle-stimulating hormone(FSH)and Hb levels in the study group were higher than those in the control group,whereas estradiol(E2)and progesterone(P)levels were lower than those in the control group;all differences were statistically significant(P＜0.05).During follow-up,the recurrence rate in the study group was lower than that in the control group,and the difference was statistically significant(P＜0.05).Conclusion On the basis of dydrogesterone therapy,the addition of low-dose mifepristone can improve the efficacy in treating perimenopausal AUB-O,shorten the time to hemostasis,improve endometrial status,and reduce the risk of recurrence after drug withdrawal,with good safety.
李泽华;时文丽;何亚静;段晓艳
商丘市第一人民医院 妇科,河南 商丘 476000商丘市第一人民医院 妇科,河南 商丘 476000商丘市第一人民医院 妇科,河南 商丘 476000商丘市第一人民医院 妇科,河南 商丘 476000
异常子宫出血围绝经期地屈孕酮米非司酮性激素
abnormal uterine bleedingperimenopausedydrogesteronemifepristonesex hormones
《临床研究》 2026 (4)
31-34,4
评论