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亮丙瑞林与米非司酮用于子宫内膜异位症术后疗效对比
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| 篇名： | 亮丙瑞林与米非司酮用于子宫内膜异位症术后疗效对比 |
| TITLE： | Comparison of postoperative efficacy between leuprorelin and mifepristone in the treatment of endometriosis |
| 摘要： | 目的 比较亮丙瑞林与米非司酮对子宫内膜异位症（EMs）术后患者性激素水平、卵巢功能、不良反应及复发情况等方面的效果差异。方法采用随机数字表法将178例于2021年9月－2023年9月在吉安市中心人民医院行手术治疗的EMs患者分为亮丙瑞林组和米非司酮组，各92例。于患者术后首次月经来潮的第1～5天开始用药——亮丙瑞林组患者给予注射用醋酸亮丙瑞林微球脐周皮下注射，每次3.75mg，每4周1次，一共注射6次；米非司酮组患者给予米非司酮胶囊口服，每次12.5mg，每天1次，连服6个月。比较两组患者术前和治疗后视觉模拟评分法（VAS）评分、血清性激素[促卵泡激素（FSH）、黄体生成激素（LH）和雌二醇（E2）]水平、卵巢功能指标[血清抗米勒管激素（AMH）、窦卵泡计数（AFC）]、Th1/Th2漂移指标[γ干扰素（IFN-γ）、白细胞介素2（IL-2）、IL-4和IL-10]水平；同时比较两组患者不良反应发生、转归情况和随访1年内的复发情况。结果两组患者术前各项指标比较，差异均无统计学意义（P＞0.05）。两组患者治疗后的慢性盆腔痛、痛经、性交痛的VAS评分以及血清FSH、LH、E2、IL-4、IL-10水平均显著低于术前（P＜0.05），血清IFN-γ、IL-2水平均显著高于术前（P＜0.05），且亮丙瑞林组患者治疗后上述各项指标均显著优于米非司酮组（P＜0.05）。两组患者治疗后的血清AMH水平均显著低于术前，AFC显著多于术前（P＜0.05），而亮丙瑞林组患者治疗后血清AMH水平显著高于米非司酮组，AFC显著多于米非司酮组（P＜0.05）。两组患者各项不良反应发生率及转归率的差异均无统计学意义（P＞0.05）。停药后随访1年，亮丙瑞林组患者的复发率显著低于米非司酮组（1.15%vs.10.99%，P＜0.05）。结论亮丙瑞林与米非司酮均是EMs的有效治疗药物，但前者在缓解患者疼痛程度、调节血清性激素水平、保护卵巢功能、调节免疫功能及降低复发率方面更具优势。 |
| ABSTRACT： | OBJECTIVE To compare the effects of leuprorelin and mifepristone on sex hormone levels， ovarian function， adverse reactions， and recurrence in patients with endometriosis （EMs） after surgery. METHODS A total of 178 patients who underwent surgical treatment for EMs in Ji’an Central People’s Hospital from September 2021 to September 2023 were randomly divided into the leuprorelin group and the mifepristone group， with 92 cases in each group. Medication was initiated on days 1 to 5 of the first menstrual cycle following surgery. Patients in the leuprorelin group received subcutaneous injections of Leuprorelin acetate microspheres， 3.75 mg per time， once every four weeks， for a total of 6 injections. Patients in the mifepristone group took 12.5 mg of Mifepristone capsules orally once daily for six consecutive months. Visual analog scale （VAS）， serum sex hormone levels [follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， and estradiol （E2）]， ovarian function indicators [anti- Müllerian hormone （AMH）， antral follicle count （AFC）]， and T helper 1 cell （Th1）/Th2 shift markers [interferon-γ （IFN-γ）， interleukin 2 （IL-2）， IL-4， and IL-10] were compared between the two groups before surgery and after treatment. Incidence and outcome of adverse reactions and recurrence within one year were also compared between the two groups. RESULTS There were no statistically significant differences in baseline indicators between the two groups before surgery （P＞0.05）. After treatment， both groups showed significantly lower VAS scores for chronic pelvic pain， dysmenorrhea and dyspareunia， and significantly reduced serum FSH， LH， E2， IL-4 and IL-10 levels compared to before surgery （P＜0.05）， while serum IFN-γ and IL-2 levels were significantly increased （P＜0.05）； the leuprorelin group showed significantly greater improvements than the mifepristone group in all these indicators （P＜0.05）. After treatment， serum AMH levels in both groups were significantly lower than before surgery levels， while AFC was significantly increased （P＜0.05）； the leuprorelin group had significantly higher serum AMH levels and more AFC compared to the mifepristone group （P＜0.05）. There were no significant differences in the incidence of adverse reactions and outcome rates between the two groups （P＞0.05）. During one year of follow-up after discontinuation， the recurrence rate in the leuprorelin group was significantly lower than in the mifepristone group （1.15% vs. 10.99%， P＜0.05）. CONCLUSIONS Both leuprorelin and mifepristone are effective therapeutic drugs for EMs， but the former has advantages in alleviating pain， regulating serum sex hormone levels， protecting ovarian function， regulating immune function and reducing recurrence rates. |
| 期刊： | 2025年第36卷第11期 |
| 作者： | 刘丽珍；郭丽芬；罗春艳；彭瑞红 |
| AUTHORS： | LIU Lizhen，GUO Lifen，LUO Chunyan，PENG Ruihong |
| 关键字： | 子宫内膜异位症；亮丙瑞林；米非司酮；性激素；卵巢功能；Th1/Th2漂移；复发 |
| KEYWORDS： | endometriosis； leuprorelin； mifepristone； sex hormones； ovarian function； Th1/Th2 shift； recurrence |
| 阅读数： | 11 次 |
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