Pleş Liana, Sima Romina Marina, Carp Delia, Florescu Cosmin, Dimitriu Mihai Cornel Traian, Ionescu Crîngu Antoniu
Department of Obstetrics-Gynecology and Neonatology, "Carol Davila" University of Medicine and Pharmacy, Department of Obstetrics and Gynecology, "Bucur" Maternity, "St. John" Clinical Hospital, Bucharest, Romania;
Rom J Morphol Embryol. 2018;59(4):1127-1132.
Selective progesterone receptor modulators (SPRMs), such as Mifepristone, Asoprisnil, Ulipristal acetate (UPA) and Vilaprisan, were tested for their antiproliferative effects on uterine fibroids. In Romania, despite the UPA availability, physicians remained reserved on the lack of experience and concerns about the safety of the drug on endometrium.
PATIENTS, MATERIALS AND METHODS: We performed an observational study on premenopausal women with symptomatic uterine fibroids. The patients received UPA in doses of 5 mg for 12-13 weeks. The fibroids dimensions and endometrium thickness were recorded at before and after the treatment. The pathological samples were assessed by two pathologists, and they recorded progesterone receptor modulator associated endometrial changes (PAEC) as extensive PAEC (EPAEC), minimally PAEC (MPAEC), absent PAEC (APAEC) and Ki67 immunoexpression in endometrium.
A number of 57 women were introduced in our study and we had a dropout of one patient. The fibroid dimensions and endometrial thickness decreased after UPA. The pathological exam of the endometrium revealed: APAEC in 26.8% of cases, MPAEC in 60.7% of cases and EPAEC in 12.5% of cases. EPAEC were more frequent in patients with larger fibroids. PAEC had a strong correlation with Ki67 index (p≤0.01). PAEC were more frequent in older women (p≤0.01). Ki67 had a higher expression in EPAEC - mean: 69% (range: 63-75%), standard deviation (SD): 3.95.
UPA treatment decreased fibroids dimension and improved patients' symptoms in our study. EPAEC was associated with abundant Ki67 antigen. UPA administration for three months is a safe method without endometrial atypia but longer protocols require extended studies about the proliferative potential of the endometrium.
已对米非司酮、阿索普瑞尼、醋酸乌利司他（UPA）和维拉普瑞森等选择性孕激素受体调节剂（SPRMs）对子宫肌瘤的抗增殖作用进行了测试。在罗马尼亚，尽管有UPA可供使用，但由于缺乏经验且担心该药物对子宫内膜的安全性，医生们仍持保留态度。
患者、材料与方法：我们对有症状的绝经前子宫肌瘤女性进行了一项观察性研究。患者接受5毫克剂量的UPA治疗12 - 13周。记录治疗前后肌瘤大小和子宫内膜厚度。病理样本由两名病理学家评估，他们记录孕激素受体调节剂相关的子宫内膜变化（PAEC），分为广泛PAEC（EPAEC）、轻度PAEC（MPAEC）、无PAEC（APAEC）以及子宫内膜中的Ki67免疫表达情况。
我们的研究纳入了57名女性，有1名患者退出。UPA治疗后肌瘤大小和子宫内膜厚度减小。子宫内膜的病理检查显示：26.8%的病例为APAEC，60.7%的病例为MPAEC，12.5%的病例为EPAEC。EPAEC在肌瘤较大的患者中更常见。PAEC与Ki67指数密切相关（p≤0.01）。PAEC在老年女性中更常见（p≤0.01）。Ki67在EPAEC中的表达较高——平均值：69%（范围：63 - 75%），标准差（SD）：3.95。
在我们的研究中，UPA治疗减小了肌瘤大小并改善了患者症状。EPAEC与丰富的Ki67抗原相关。三个月的UPA给药是一种安全的方法，不会导致子宫内膜异型增生，但更长疗程的方案需要对子宫内膜的增殖潜能进行进一步研究。
