不同药物对围绝经期排卵障碍性异常子宫出血患者血清性激素水平及预后的影响分析

Effects of dydrogesterone and medroxyprogesterone on serum sex hormone levels and prognosis in patients with abnormal uterine bleeding associated with ovulatory dysfunction during perimenopause

摘要

目的 比较地屈孕酮、醋酸甲羟孕酮两种药物对围绝经期排卵障碍性异常子宫出血(AUB-O)患者血清性激素水平及预后的影响。方法 选取南京市高淳人民医院2024年1月至2025年5月收治的180例围绝经期AUB-O患者,按随机数表法分为A组(口服地屈孕酮)和B组(口服醋酸甲羟孕酮),各90例,比较两组性激素水平、临床指标、贫血情况以及预后。结果 治疗后,A组雌二醇(E₂)、促卵泡激素(FSH)、促黄体生成激素(LH)水平[分别为(195.65±30.27)pmol/L、(25.68±6.80)IU/L、(12.48±4.12)IU/L],显著低于B组[(232.65±35.44)pmol/L、(29.63±7.38)IU/L、(16.80±4.55)IU/L](t=7.531、3.734、6.677,P<0.05);A组月经失血图(PBAC)评分显著低于B组,月经天数、子宫内膜厚度显著少于B组(t=4.891、4.176、5.483,P<0.05);A组血红蛋白(Hb)、红细胞比容(Hct)水平显著高于B组(t=6.087、5.362,P<0.05);A组不良反应总发生率显著低于B组(χ²=4.038,P<0.05),两组复发率比较差异不显著(P>0.05)。结论 地屈孕酮在调节围绝经期AUB-O患者性激素水平、改善出血情况及症状方面均表现出较好的效果,且具有较高安全性。

Abstract

Objective To compare effects of dydrogesterone and medroxyprogesterone acetate on serum sex hormone levels and prognosis in perimenopausal women with abnormal uterine bleeding associated with ovulatory dysfunction (AUB-O). Methods A total of 180 perimenopausal women with AUB-O who admitted to Nanjing Gaochun People's Hospital from January 2024 to May 2025 were selected.They were divided into group A (oral dydrogesterone) and group B (oral medroxyprogesterone acetate) in random number table method,with 90 cases in each group.Sex hormone level,clinical indicator,anemia status,and prognosis were compared between the two groups. Results After treatment,the serum levels of estradiol (E₂),follicle-stimulating hormone (FSH),and luteinizing hormone (LH) of the perimenopausal women with AUB-O in the group A were (195.65±30.27)pmol/L,(25.68±6.80)IU/L and (12.48±4.12)IU/L respectively,which were lower than (232.65±35.44)pmol/L,(29.63±7.38)IU/L and (16.80±4.55)IU/L respectively in the group B (t=7.531,3.734 and 6.677 respectively,all P<0.05).Pictorial blood loss assessment chart (PBAC) score,duration of menstruation and endometrial thickness of the permenopausal women with AUB-O in the group A were significantly lower,shorter and thinner compared to group B (t=4.891,4.176 and 5.483 respectively all P<0.05).The hemoglobin (Hb) and hematocrit (Hct) levels of the permenopausal women with AUB-O in the group A were significantly higher than those in the group B (t=6.087 and 5.362 respectively,both P<0.05),and the incidence of adverse reactions was lower than that in the group B (χ ²=4.038,P<0.05).There was no difference in recurrence rate between the two groups (P>0.05). Conclusion Dydrogesterone exerts better effects and higher safety than medroxyprogesterone acetate in regulating sex hormone levels and alleviating bleeding and symptoms of the perimenopausal women with AUB-O.

关键词

排卵障碍性异常子宫出血 / 围绝经期 / 地屈孕酮 / 醋酸甲羟孕酮 / 性激素 / 预后

Key words

abnormal uterine bleeding associated with ovulatory dysfunction / perimenopause / dydrogesterone / medroxyprogesterone acetate / sex hormone / prognosis

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基金资助

江苏大学医学临床科技发展基金项目(JLY2021177)