| 摘要: | 當子宮內膜組織出現在子宮肌肉層內時，就稱為「子宮腺肌症」(adenomyosis)。根除性的治療方法是切除子宮，但是因應現代人晚婚，生育能力的保存更是一件重要的課題，以及手術可能會有併發症，例如骨盆器官下垂、或是廔管等，所以藉由口服藥物來治療或是緩解子宮腺肌症的症狀，是目前的新趨勢。但是要如何選擇適當的口服藥物，以往並沒有大規模的藥物試驗，以及欠缺適合台灣女性的臨床資料可以用來佐證。
我國目前全民健保納保率達到99%以上，所以健保資料成為醫藥衛生相關領域研究中具有代表性的實證資料。本研究我們運用台灣的健保資料庫百萬人抽樣檔，針對Gestrinone、Medroxyprogesterone和Danazol保留子宮的成功率，和治療趨勢做進一步分析。
Gestrinone是一種合成之類固醇荷爾蒙，具有抗黃體脂酮性質，主要機轉為抑制下視丘合成或釋放促性腺素。Medroxyprogesterone能夠導致子宮內膜產生蛻膜變化，並使子宮內膜萎縮。Danazol具有抑制雌激素產生的作用。但是如果要全體分析，容易造成錯誤偏差，本研究利用國衛院所設計的歸人抽樣檔來作分析。
抽樣檔中共有8331位罹患子宮腺肌症民眾的資料，其中有1464位接受子宮切除手術，切除比率為17.57%。使用Gestrinone有40位，有1位接受子宮切除手術，切除比率為2.5%。使用Danazol有23位，有1位接受子宮切除手術，切除比率為4.3%。使用Medroxyprogesterone有89位，有16位接受子宮切除手術，切除比率為17.98%。Gestrinone可以有效降低切除子宮的比率，治療效果也比Medroxyprogesterone好。(p=0.022)
Introduction:
The aim of this study is to evaluate the clinical efficacies of Gestrinone, Danazol, and Medroxyprogesterone acetate in patients with adenomyosis from National Health Insurance Research Database (NHIRD) in Taiwan.
Endometriosis accounts for the most common reason of female pelvic pain and infertility as the result of chronic by inflammation status induced endometriosis. If endometriosis found in the uterus, adenomyosis is called. Hysterectomy can offer the definite treatment for endometriosis, so an alternative treatment is needed for fertility preservation. Besides, there are many kinds of possible surgical complication such as urinary incontinence, fistula, or hemorrhage during hysterectomy.
But there is no any large scale trial can tell us which medication is better. Therefore, we analyzed the clinical data from NHIRD and compare the efficacies of Gestrinone, Danazol, and Medroxyprogesterone acetate. Gestrinone is a synthetic steroid hormone that acts as an anti-progestin and also has some androgenic activity. Its mechanism of action consists of suppression of the release of pituitary gonadotropins. Gestrinone also interacts with the endometrium, which inhibited its growth. The inhibition is the result of Gestrinone's interaction with androgen receptors which is the reason for androgenic side effects. The mechanism of Danazol is similar with that of Gestrinone. Medroxyprogesterone acetate contains a hormone which is similar to the hormoneprogesterone that is naturally produced by the body. It is used for the treatment of endometriosis and menstrual problems such as irregular bleeding or amenorrhoea.
Method:
The ICD9-code 617.0 was used to obtain the data of the patients with adenomyosis from NHIRD. Then the data of the patients who used Gestrinone , Danazol, and Medroxyprogesterone was selected in this research. The rate of hysterectomy among these three groups were compared to understand the efficacy of Gestrinone, Danazol, and Medroxyprogeterone.
Results:
There were 8,331patients found in the NHIRD via the ICD-9 code 617.0. Among them,1,464 pts underwent hysterectomy(17.57%). Among the patient who use Gestrinone(n=40), there was only one patient receive hysterectomy(2.5%). Among the patient who use Danazol (n=23), 1 patients underwent hysterectomy(4.3%). Among the patient who use medroxyprogesterone (n=89), 16 patients underwent hysterectomy(18.0%).
Conclusion:
There were 79.6% of adenomyosis diagnosed via sonography. If patients needed to receive hysterectomy, laparoscopic method is most popular. Gestrinone could reduce the incidence of hysterectomy than medroxyprogesterone.(p=0.012) |
