炔雌醇环丙孕酮对原发免疫性血小板减少症致异常子宫出血患者的临床疗效  

Clinical effect of ethinylestradiol and cyproterone acetate on abnormal uterine bleeding caused by primary immune thrombocytopenia

作　　者：董丽丽[1] 李银凤[1] 刘改文[1] 陈玉莹 白月 DONG Li-li;LI Yin-feng;LIU Gai-wen;CHEN Yu-ying;BAI Yue(Department of Obstetrics and Gynecology,Hohhot First Hospital,Hohhot 010000,Inner Mongolia,China;Department of Pharmacy,Hohhot First Hospital,Hohhot 010000,Inner Mongolia,China)

机构地区：[1]呼和浩特市第一医院妇产科,呼和浩特010000 [2]呼和浩特市第一医院药剂科,呼和浩特010000

出　　处：《东南国防医药》2020年第3期234-238,共5页Military Medical Journal of Southeast China

基　　金：内蒙古自治区卫生和计划生育委员会科研计划项目(201703148)。

摘　　要：目的观察炔雌醇环丙孕酮对原发免疫性血小板减少症(ITP)致异常子宫出血患者的临床疗效。方法选择2017年1月至2018年5月期间呼和浩特市第一医院治疗的ITP致异常子宫出血患者70例,按照随机数字表法分为2组,每组35例,其中对照组采取对症治疗,孕酮组在对照组基础上加用炔雌醇环丙孕酮治疗,比较2组患者治疗前、治疗1个月、3个月和6个月后的血小板、血红蛋白含量变化,凝血四项指标[凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)]的变化,以及平均输血小板量、止血时间和子宫内膜厚度等。结果孕酮组在治疗1个月、3个月和6个月后的血小板含量[(5.46±0.56、6.89±0.69、7.45±0.75)×10^9/L]、血红蛋白含量[(53.45±3.45、59.75±3.05、61.58±2.69)g/L]均高于对照组[(3.95±0.58、4.18±0.48、5.01±0.58)×10^9/L,(48.54±3.58、50.65±2.54、52.41±2.75)g/L,P<0.05],平均输血小板量[(5.45±0.74、4.25±0.45、4.25±0.26)单位/月]均低于对照组[(7.42±0.86、6.68±0.65、5.86±0.51)单位/月,P<0.05]。治疗后孕酮组出血控制时间[(66.81±11.31)h]和完全止血时间[(66.81±11.31)h]均短于对照组[(86.19±12.02)h,(86.19±12.02)h,P<0.05]。2组患者治疗后子宫内膜厚度均较治疗前下降(P<0.05),孕酮组治疗后子宫内膜厚度[(6.77±1.15)mm]低于对照组[(8.28±1.21)mm],差异有统计学意义(P<0.01)。结论对于ITP致异常子宫出血患者可采用加炔雌醇环丙孕酮进行治疗,在缩短出血时间,减少输血小板量方面有效更优,维持且相对增加血红蛋白和血小板量,且对患者其他凝血指标无明显影响。该治疗方法值得临床推广应用。Objective To study the clinical effect of ethinylestradiol and cycloproterone acetate on abnormal uterine bleeding caused by primary immune thrombocytopenia(ITP).Methods Seventy patients with abnormal uterine bleeding caused by ITP in our hospital from January 2017 to May 2018 were average divided into two groups,according to the random number table method.The control group received symptomatic treatment,and the research group was treated with ethinylestradiol and cycloproterone acetate on the basis of the symptomatic treatment.The changes of platelet and hemoglobin contents,four coagulation indexes(PT,APTT,TT,FIB),average platelet transfusion,hemostasis time and endometrial thickness were compared before treatment,1,3 and 6 months after treatment.Results After 1,3 and 6 months of treatment,the platelet content[(5.46±0.56,6.89±0.69,7.45±0.75)×10^9/L],hemoglobin content[(53.45±3.45,59.75±3.05,61.58±2.69)g/L]in the study group were higher than those in the control group[(3.95±0.58,4.18±0.48,5.01±0.58)×10^9/L,(48.54±3.58,50.65±2.54,52.41±2.75)g/L,P<0.05].The mean platelet transfusion volume[(5.45±0.74,4.25±0.45,4.25±0.26)unit/month]in the study group was lower than that in the control group[(7.42±0.86,6.68±0.65,5.86±0.51)unit/month,P<0.05].The bleeding control time[(19.77±8.18)h]and complete hemostasis time[(66.81±11.31)h]in the study group were shorter than those in the control group[(26.42±9.57)h,(86.19±12.02)h,P<0.05].The endometrial thickness of two groups after treatment were lower than that before treatment(P<0.05).The endometrial thickness of the study group after treatment[(6.77±1.15)mm]was lower than that of the control group[(8.28±1.21)mm](P<0.01).Conclusion Patients with abnormal uterine bleeding due to primary immune thrombocytopenia can be treated with ethinyl estradiol and progesterone.Treatment with ethinyl estradiol and progesterone tablets can significantly reduce bleeding time,reduce platelet transfusion,and maintain and relatively increase the amount of hemoglobin and pla

关 键 词：炔雌醇环丙孕酮 原发免疫性血小板减少症 异常子宫出血 血小板 血红蛋白 凝血四项 子宫内膜厚度 

分 类 号：R714.21[医药卫生—妇产科学]