| Objective: In this study ,the levels of serum adiponectin were detected on uterine leiomyom patient,the purpose was to study the effects of adiponectin on uterine leiomyom and the levels of serum adiponectin, C, E2, LH, FSH, P were detected before and after taking Mifepristone on uterine leiomyom patients. Volume changes of leiomyoma and uterus were mea- sured with ultrasonography before treatment (as baseline) and 3 months, 6 months of therapy. The purpose was to study the response to leiomyom and the effect on anti-glucocorticoid and adiponectin with long term mifepristone on uterine leiomyoma patients.Methods: 60 uterine leiomyom patients who were 26-52 aged were enrolled in this study. They were separated into two groups at random. The studied groups in- cluded 40 patients and the first control group included 20 patients. The second control group included 20 healthy women who were 27-50 aged. The studied group was treated with 10mg of mifepristone daily for 6 moths, beginning on day 1 to5 of the menstrual cycle. The first control group was injected 3.75 mg Enantone for 3 moths, injecting on day 2 of the menstrual cycle. The second control group has no treatment.Volume changes of leiomyoma and uterus w ere measured with ultrasonography before treatment (as baseline) and 3 moths, 6 moths of therapy in the studied group. Blood samples for hemoglobin, liver and renal function, adiponectin, C, E2, LH, FSH, P were obtained. Serum adiponectin level was determined by enzyme marked monoclonal antibody assay, estradiol (E2) testosterone (T) and progesterone (P) LH, FSH levels were measured by immunofluorescence. Endometrial samples, effect and side effect were also assessed.Volume changes of leiomyoma and uterus were measured with ultrasonography before treatment (as baseline) and 3 months therapy in the first control group. Blood samples for hemoglobin, adiponectin, Hb were obtained. The uterine volume reducing by over 20% is the effective group and less than 20% is the null group.Blood samples for hemoglobin, adiponectin, Hb were ob- tained in the second control groups.serum adiponectin level was determined by enzyme marked monoclonal antibody assay, E2, P, FSH, LH, C were measured by immunofluorescence.Acquired data were analyzed by SAS software. Adi- ponectin, E2, P, FSH, LH, C were described by X±s. The significant difference of data among the three groups, between before and after treatment of the studied group and the first control group was tested with t test. Results: the levels of serum adiponectin were significantly higher in uterine leiomyom patients (the studied groups+, the first control group) than those in the second control (p<0.05). There were no significant differences in the levels of E2, P and T. Negative correlation was found between adiponectin and E2. in uterine leiomyom patients(r=0.32, p<0.05) and no significant difference with P, T(r=0.15,0.14 p>0.05).The uterus volume of uterine leiomyom patients is decided by three diameters of the uterus, and the results is classified into 4groups, that is <200,200~<400,400~<800,800cm3 . As to the patients with average uterine volume over 400 cm3, the adiponectin level drops gradually as the uterus grows in volume; as to the patients with average uterine volume less than 400 cm3 , no significant difference of adiponectin displays com- pared with the second controlled group(p>0.05). The adi- ponectin level of the patients with uterine volume over 400 cm3 is significantly lower than the ones with uterine volume less than 400 cm3 (p<0.05). This means the adiponectin level is closely connected with the volume of the uterine, and 400 cm3 is the point beyond which a drop-down appears. The adiponectin level also shows similar connection with the uterine diameters of uterine leiomyom patients. The biggest uterine leiomyom are diametrically classified into three groups 2-4, 4-6, 6-8 cm. To those whose average uterine leiomyom diameter is over 4-6cm, the adiponectin level drops as the uterine leiomyom grows; To those whose average uterine leiomyom diameter is less than 4-6cm, there is no significant difference compared with the controlled group (p>0.05). Significant difference (p<0.05) is shown in that the patients with average uterine leiomyom dia- meters between 6 and 8cm show lower adiponectin level than those with average diameters between 4 and 6cm, which means that the adiponectin level is closely connected with the volume of the uterine, and 6-8cm is the point beyond which a drop- down appears.After three months treatment, among the patients of the studied groups, the average LH level rises 2 times (p<0.01)than before, P and C have a slight rise, with P rising 6.4% and C 5.4%; E2 and FSH shows no significant grow compared with before(p>0.05). For Enantone group, after 3 months treatment, FSH,LH,E2 and P values drop down, all of which display significant difference (p<0.01), with the E2 item showing strong effect in particular, whilst the C value shows no shift (p>0.05).33 subjects of the studied group show positive results. Compared with the conditions before the treatment, the uterine volume averagely reduce by 34.7%, with the maximum drop in size of 45.5% to the average top uterine leiomyom, and the serum adiponectin level significantly increases by 26.53% (p<0.05). The null group consists of 7 subjects. Compared with the conditions of treatment before, the uterine volumes increases by 18.74%, the average volume of the top uterine leiomyom increases by 6.6%, while the adiponectin level drops by 10.31% (p>0.05).Before treatment, there is no difference shown in adi- ponectin level between the effective group and the null group. After the treatment, significant differences appear between the two groups. Compared with the conditions before the treatment, all the subjects of first controlled group shows positive result in that the average uterine volume reduces by 36.6%; the average volume of top uterine leiomyom reduces by 47.5%, and the adiponectin level shows no significant change (p>0.05). The adiponectin level between the effective group and the first controlled group shows no difference (p>0.05) before treatment, and vice versa after treatment. There is no change in size re- duction between the two groups mentioned above (p<0.05).3 months treatment shows that with the studied group, LH value averagely doubles, and it drops significantly after 6 months treatment and it is the same with the P and C values, which shows significant statistic meaning(p<0.05). Other hormones are stable. There are 35% of patients with anti- glucocorticoid at 3 months treatment, among whom shows6 tiredness, 3 constipation, 3 dizziness and 2 pigmentation. The above symptoms continue to be after 6 months treatment, relatively stable. The cortisol level of the patients suffering anti- glucocorticoid symptoms varies accordingly, before the trea- tment 400 nmol/l, 3 months'treatment 492 nmol/l and 6 months 360.5 nmol/l, resulting in 23% rise with 3 months'treatment and 26.8% drop with 6 months treatment. There is no difference shown in cortisol level in the null group before and after trea- tment.After 6 months'treatment, among the patients there app- eared 5 GPT rise, and the aminopherase drops to normal level after 1 month's taking glucuronolactone. There are no damage shown to liver and renal function, with 7 showing hectic fever and 4 showing decreased libido. In the following 6 months after the discontinuation, among subjects of the studied group there are 4 amenorrhea, 6 oligomenorrhea, and 4 out of communi- cation. It shows that the treatment brings significantly positive effect while there are some side effects that can disappear with the discontinuation of the treatment.Conclusion: 1.This study makes an exploration into the possible relation between adiponectin level and the uterine leiomyom growth. The paper discovers that when the uterine leiomyom grows to a certain size, adiponectin level is dropping as the uterine leiomyom continues to grow, which might imply that adiponectin has function on leiomyoma cell, and even might facilitate the division growth of the uterine muscle cells. The study finds that the adiponectin level has a negative function on the E2 value, which is in agreement with the same literature. Since leiomyom growth is closely connected with E2, implying that adiponectin might function on leiomyom growth by activating the E2. 2.This study makes a comparison of fun- ctions on suppressing the leiomyom growth between mife- pristone and the Enantone, showing that mifepristone might per- form its functions on subduing the leiomyom cell growth by suppressing the E2 and IGF-1.3. With analysis of the 6 months data of mifepristone treating uterine leiomyom patients, this study propose that mifepristone might be suitable for treatment of those who suffer serious hypohemia before operation, or as the expectant treatment for those who are approaching critique age with light anti-glucocorticoid symptoms and changing of Cortisol; Serum concentrations of cortisol is indicated to be unfit for confirming anti-glucocorticoid activities of mifepris- tone. |
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