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目的研究奥美昔芬对围绝经期功能失调性子宫出血(DUB)患者雌激素受体(ER)、孕激素受体(PR)和血管内皮生长因子(VEGF)阳性率的影响。方法选取2012年1月至2013年1月于本院治疗的围绝经期DUB患者60例,随机分为对照组和观察组,每组30例。对照组给予左炔诺孕酮,观察组给予奥美昔芬。采用免疫化学方法检测治疗前后子宫内膜ER、PR和VEGF的阳性率。记录治疗前后子宫内膜厚度、血红蛋白水平、月经失血图(PBAC)评分及不良反应情况。跟踪随访6个月后患者DUB的复发情况。结果治疗后两组患者ER和PR阳性率均降低,而VEGF阳性率升高,其中观察组较对照组变化更为显著,分别为(34.48%对55.37%),(25.12%对42.84%),(78.31%对63.85%),差异均具有统计学意义(P<0.05)。患者子宫内膜厚度和PBAC评分均低于治疗前,血红蛋白水平高于治疗前,观察组较对照组变化更为显著,分别为[(5.76±0.89)对(7.14±1.10)]mm,(74对97)分,(121.17对91.22)g/L,差异均具有统计学意义(P<0.05)。随访结果表明,对照组复发率高于观察组(20.0%对6.7%),且对照组复发患者ER和PR阳性率高于观察组复发患者(67.18%对35.59%)和(69.33%对37.24%),VEGF阳性率低于观察组(35.26%对62.32%),差异均具有统计学意义(P<0.05)。此外,对照组不良反应发生率高于观察组(13.33%对6.67%),差异具有统计学意义(P<0.05)。结论奥美昔芬治疗围绝经期DUB的效果优于左炔诺孕酮,可降低ER和PR阳性率,升高VEGF阳性率。
Objective To investigate the effects of omeprosyne on the positive rates of estrogen receptor (ER), progesterone receptor (PR) and vascular endothelial growth factor (VEGF) in patients with dysfunctional uterine bleeding in the peri-menopausal period. Methods Sixty patients with perimenopausal DUB treated in our hospital from January 2012 to January 2013 were randomly divided into control group and observation group, 30 cases in each group. The control group was given levonorgestrel, and the observation group was given omeprosyne. Immunochemistry method was used to detect the positive rate of endometrial ER, PR and VEGF before and after treatment. The thickness of endometrium, hemoglobin level, menstrual blood loss (PBAC) score and adverse reactions were recorded before and after treatment. The follow-up of patients with DUB recurrence after 6 months. Results After treatment, the positive rate of ER and PR decreased and the positive rate of VEGF increased in both groups. The changes in the observation group were more significant than those in the control group (34.48% vs. 55.37%, 25.12% vs. 42.84%, respectively) (78.31% vs 63.85%), the differences were statistically significant (P <0.05). The patients’ endometrial thickness and PBAC score were lower than those before treatment, and the hemoglobin levels were higher than those before treatment in the observation group ([5.76 ± 0.89 vs 7.14 ± 1.10] mm, (74 97) points, (121.17 vs 91.22) g / L, the differences were statistically significant (P <0.05). The follow-up results showed that the recurrence rate of the control group was higher than that of the observation group (20.0% vs. 6.7%), and the positive rates of ER and PR in the control group were higher than those in the observation group (67.18% vs 35.59%) and (69.33% vs 37.24% ), The positive rate of VEGF was lower than the observation group (35.26% vs 62.32%), the differences were statistically significant (P <0.05). In addition, the incidence of adverse reactions in the control group was higher than that in the observation group (13.33% versus 6.67%), with significant difference (P <0.05). Conclusion Omexitifene is superior to levonorgestrel in the treatment of peri-menopausal DUB, which can reduce the positive rate of ER and PR and increase the positive rate of VEGF.