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目的观察长疗程小剂量服用糖皮质激素受体(GR)拮抗剂米非司酮对糖皮质激素的影响。方法40例子宫肌瘤患者,从月经第1～5天开始每日口服米非司酮10mg,连续6个月。用免疫化学发光法测定血清皮质醇、雌二醇、孕酮、促黄体生成素(LH)、促卵泡素(FSH),并记录患者的不良反应。结果治疗3个月35%患者出现抗糖皮质激素症状,治疗6个月症状无明显加重。有抗糖皮质激素症状患者血清皮质醇水平于治疗3个月时明显升高,而治疗6个月时明显降低(P<0.05),与无抗糖皮质激素症状患者相比较差异均有统计学意义(均P<0.05)。结论长疗程小剂量服用米非司酮无严重抗糖皮质激素效应发生;测定循环中皮质醇、孕酮水平可能不适合用来判断米非司酮有无抗糖皮质激素效应及抗孕激素效应发生。
Objective To observe the effects of long-term treatment with low dose of mifepristone, a glucocorticoid receptor (GR) antagonist, on glucocorticoids. Methods Forty cases of uterine fibroids were treated with mifepristone 10 mg daily for 6 months from the first day to the fifth day of menstruation. Serum cortisol, estradiol, progesterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH) were measured by immunochemiluminescence method. The adverse reactions of the patients were recorded. Results Anti-glucocorticoid symptoms were found in 35% of patients at 3 months of treatment, with no obvious symptoms after 6 months of treatment. The level of serum cortisol in patients with anti-glucocorticoid symptoms increased significantly at 3 months and decreased significantly at 6 months (P <0.05), and there was statistical difference between those with anti-glucocorticoid symptoms Significance (all P <0.05). Conclusion The long-term treatment with low dose of mifepristone has no serious anti-glucocorticoid effect; determination of circulating cortisol and progesterone levels may not be suitable for determining whether mifepristone has anti-glucocorticoid effect and anti-progesterone effect occur.