醋酸甲孕酮致异常子宫出血——性激素与子宫内膜超微结构的改变  

DMPA induced abnormal uterine bleeding: changes of sex hormone levels and endometrial ultrastructure

作　　者：余俊[1] 冯淑芝[2] 李明[2] 

机构地区：[1]湖北中医院妇产科,武汉430061 [2]武汉大学人民医院妇产科,武汉430060

出　　处：《生殖医学杂志》2008年第5期371-375,共5页Journal of Reproductive Medicine

摘　　要：目的探讨长效醋酸甲孕酮(DMPA)致异常子宫出血的机理。方法自愿使用注射DMPA 150 mg避孕者52人,用药前及用药满一年时测定血雌孕激素水平,受试者记录一年中阴道出血情况,长期异常子宫出血者选取6人刮取子宫内膜,电镜观察子宫内膜超微结构。结果DMPA使用者用药前后血雌二醇、孕酮值差异无显著性(P>0.05)。其中闭经组、正常子宫出血组、异常子宫出血组血雌孕激素结果相似。异常子宫出血者子宫内膜超微结构显示子宫内膜上皮细胞与腺上皮细胞形态轻度异常,腺腔无糖原颗粒分泌;间质细胞变化与用药时间长短相关,早期间质细胞形态轻度异常,晚期大量间质细胞凋亡,毛细血管少见。结论DMPA致异常子宫出血与低雌激素相关,但雌激素不是单一决定因素。Objectives： To explore the possible mechanism of DMPA induced abnormal uterine bleeding. Methods： Fifty-two volunteers were recruited to use 150 mg DMPA for contraception for one year. At the 5th day of menstrual cycle before using DMPA, and at the end of 12 months of using the drug, serum levels of estradiol and progestogen were measured. Menstrual changes were observed in one year. Curettage was performed in six volunteers who had long-term abnormal uterine bleeding. Ultrastructure of endometrium was observed by electronic microscope. Results： There was no significant difference in serum levels of estradiol and progestogen before and after using DMPA（P〉0.05）. The levels of estradiol and progestogen were similar in three groups-normal uterine bleeding group, abnormal uterine bleeding group and amenorrhea group. Electronic microscopic observation showed that the morphology of endometrial epithelioid cell and glandular cell was slightly abnormal in the patients with abnormal uterine bleeding. There were no glucogen particles in the lumen of gland. The change of stromal cells was relevant to the duration of the drug use. In early stage the morphology of stromal cells was slightly abnormal, while in late stage, a great number of stromal cells showed apoptosis. Capillary vessels were seldom seen. Conclusion： Abnormal uterine bleeding in DMPA users was relevant to low estradiol level, but low estradiol level was not the single decisive factor.

关 键 词：醋酸甲孕酮 异常子宫出血 子宫内膜超微结构 

分 类 号：R994.1[医药卫生—毒理学]