南方医科大学学报2024，Vol.44Issue(11)：2055-2062,8.DOI:10.12122/j.issn.1673-4254.2024.11.01
醋酸甲地孕酮联合盐酸二甲双胍作为早期子宫内膜样腺癌和子宫内膜非典型增生患者保留生育功能治疗:一项前瞻性研究
Megestrol acetate plus metformin for fertility-sparing treatment of atypical endometrial hyperplasia and early-stage endometrial adenocarcinoma:a prospective study
摘要
Abstract
Objective To evaluate the efficacy of medroxyprogesterone acetate(MA)plus metformin as the primary fertility-sparing treatment for atypical endometrial hyperplasia(AEH)and early-stage grade 1 endometrial adenocarcinoma(G1 EAC)and the recurrence rate after treatment.Methods Sixty patients(aged 20-42 years)with AEH and/or grade 1 EAC limited to the endometrium were enrolled prospectively and randomized into two groups(n=30)to receive oral MA treatment at the daily dose of 160 mg(control)or MA plus oral metformin(850 mg,twice a day)for at least 6 months.The treatment could extend to 12 months until a complete response(CR)was achieved,and follow-up hysteroscopy and curettage were performed every 3 months.For all the patients who achieved CR,endometrial expressions of IGFBP-rP1,p-Akt and p-AMPK were detected immunohistochemically.Results A total of 58 patients completed the treatment.After 9 months of treatment,23(76.7%)patients in the combined treatment group and 20(71.4%)in the control group achieved CR;two patients in the control group achieved CR after converting to the combined treatment.The recurrence rate did not differ significantly between the control group and combined treatment group(30.0%vs 22.7%,P>0.05).Ten(35.7%)patients in the control group experienced significant weight gain of 5.7±6.1 kg,while none of the patients receiving the combined treatment exhibited significant body weight changes.Compared with the control group,the patients receiving the combined treatment showed enhanced endometrial expressions of IGFBP-rP1 and p-AMPK with lowered p-Akt expression.Conclusion Metformin combined with MA may provide an effective option for fertility-sparing treatment of AEH and grade 1 stage IA EAC,and the clinical benefits of metformin for controlling MA-induced weight gain and promoting endometrial expressions of IGFBP-rP1 and p-AMPK while inhibiting p-Akt expression warrants further study.关键词
子宫内膜样腺癌/盐酸二甲双胍/子宫内膜非典型增生/保留生育功能治疗/醋酸甲地孕酮/胰岛素样生长因子结合蛋白相关蛋白1Key words
endormetrial adenocarcinoma/metformin/atypical endometrial hyperplasia/fertility-sparing treatment/megestrol acetate/insulin-like growth factor binding protein-related protein 1引用本文复制引用
王圆圆,来天娇,褚丹霞,白晶,严淑萍,秦海霞,郭瑞霞..醋酸甲地孕酮联合盐酸二甲双胍作为早期子宫内膜样腺癌和子宫内膜非典型增生患者保留生育功能治疗:一项前瞻性研究[J].南方医科大学学报,2024,44(11):2055-2062,8.基金项目
Supported by Supported by National Natural Science Program of China(31670844) （31670844）
Central Plains Thousand Talents Program(ZYQR200810107),and Outstanding Talents of Science and Technology Innovation Program of Henan Province(2018JR0004).Corresponding authors:GUO Ruixia,E-mail:grxcdxzzu@163.com. 国家自然科学基金(31670844) （ZYQR200810107）
中原英才千人计划项目(ZYQR200810107) （ZYQR200810107）
河南省科技创新计划杰出人才项目(2018JR0004) （2018JR0004）
