护骨素基因多态性对绝经后妇女骨量的影响

目的　探讨绝经后妇女护骨素 (osteoprotegerin ,OPG)基因启动子 95 0T C单核苷酸多态性与骨密度和骨代谢生化指标的相关性。方法　应用聚合酶链反应 限制性片断长度多态性 (PCR RFLP)方法测定 2 5 9名上海市绝经后女性OPG基因启动子 (95 0T C)基因型 ;应用双能X线骨密度仪(DEXA)测定股骨颈、腰椎等部位的骨密度 ,同时检测骨代谢生化指标。结果　在绝经后妇女中发现TT、TC、CC 3种基因型 ,各基因型的分布频率分别为 :TT 5 9%、TC 2 8%、CC 13%。将绝经后妇女分为 <6 5岁组 (Ⅰ组 )和≥ 6 5岁组 (Ⅱ组 ) 2组 ,发现在Ⅰ组不同基因型妇女股骨颈部位骨密度 (BMD)间差异有显著意义 (P <0 .0 5 ) ,分别为 :TT (0 .6 4± 0 .11)g/cm2 ,TC(0 .6 7± 0 .11)g/cm2 ,CC (0 .6 8± 0 .14 )g/cm2 。经体重指数、年龄等因素校正后 ,差异仍有显著意义 (P <0 .0 5 )。而Ⅰ组的其他指标和Ⅱ组的各项指标在不同基因型间的差异无显著意义 (均P >0 .0 5 )。结论　OPG基因多态性对年龄小于 6 5岁的绝经后妇女的股骨颈部位骨密度有明显影响 ,OPG基因多态性可能对女性峰值骨量的获得有影响。     

Discriminative Capacity of Calcaneal Quantitative Ultrasound and of Osteoporosis and Fracture Risk Factors in Postmenopausal Women with Osteoporotic Fractures

Bone fragility fractures constitute the principal complication of osteoporosis. The identification of individuals at high risk of sustaining osteoporotic fractures is important for implementing preventive measures. The purpose of this study is to analyze the discriminative capacity of a series of osteoporosis and fracture risk factors, and of calcaneal quantitative ultrasound (QUS), in a population of postmenopausal women with a history of osteoporotic fracture. A cross-sectional analysis was made of a cohort of 5195 women aged 65 or older (mean±SD: 72.3±5.4 years) seen in 58 primary care centers in Spain. A total of 1042 women (20.1%) presented with a history of osteoporotic fracture. Most fractures (93%) were non-vertebral. Age-adjusted odds ratios corresponding to each decrease in one standard deviation of the different QUS parameters ranged from 1.47 to 1.55 (P < 0.001) for fractures. The age-adjusted multivariate analysis yielded the following risk factors independently associated with a history of osteoporotic fracture: number of fertile years, a family history of fracture, falls in the previous year, a history of chronic obstructive airway disease, the use of antiarrhythmic drugs, and a low value for any of the QUS parameters. The area under the receiver operating characteristic curve of the best model was 0.656. In summary, a series of easily assessable osteoporotic fracture risk factors has been identified. QUS was shown to discriminate between women with and without a history of fracture, and constitutes a useful tool for assessing fracture risk. Various of the vertebral and hip fracture risk factors frequently cited in North American and British populations showed no discriminative capacity in our series—thus suggesting that such factors may not be fully applicable to our population and/or to the predominant type of fractures included in the present study. For a complete list of ECOSAP investigators, see Appendix ECOSAP, Ecografia Ósea in Atención Primaria     

绝经后阴道出血548例临床分析

目的 探讨绝经后阴道出血的病因和诊断。方法 对2000年1月至2003年12月经我院妇科活检或手术后病理证实的绝经后阴道出血548例患者的临床资料进行回顾性分析。结果 按病理分类：良性疾病引起的绝经后出血占70．3％，非器质性疾病占18．2％，恶性疾病占11．5％。良性疾病中以慢性宫颈炎最常见，恶性疾病以官颈癌和子宫内膜癌为主。结论 绝经后阴道出血的首位病因为良性疾病，其次是非器质性疾病，恶性疾病为第三位。绝经时间长的阴道出血，恶性肿瘤的发生率明显增高。对绝经后阴道出血应引起重视，常规行妇科检查结合必要的辅助检查可明确诊断。     

Impact of hormone replacement therapy on postprandial lipoproteins and lipoprotein(a) in normolipidemic postmenopausal women

In 43 normolipidemic postmenopausal women we studied fasting and postprandial (oral fat load with 50 g fat per square meter; blood sampling for 5 h) lipoprotein components and lipoprotein(a) levels before and with the administration of conjugated equine estrogens opposed by medrogestone (on days 11–21). Data was compared intraindividually; the second testing was performed during the last 5 days of the combined estrogen/progestogen phase of the third cycle. Fasting low-density lipoprotein (LDL) and total cholesterol concentrations decreased significantly; high-density lipoprotein (HDL) cholesterol, including subfractions HDL₂ and HDL₃, was not changed. Fasting triglyceride concentrations increased. All lipoprotein fractions measured showed a postprandial elevation with the exception of chylomicron cholesterol concentrations. There was a significant effect of hormone replacement therapy on the postprandial course of total cholesterol (decrease; P < 0.001), VLDL cholesterol (increase; P = 0.025), and the triglyceride proportion in the LDL plus HDL fraction (increase; P < 0.001). With hormone replacement therapy the postprandial curve of total triglycerides was increased only 1 h after the fat load while chylomicron triglyceride concentrations were lowered after 5 h. VLDL triglycerides were not influenced. In all patients with lipoprotein(a) levels above 10 mg/dl, this parameter decreased (about 25%). Although increasing fasting triglyceride concentrations, hormone replacement therapy does not bring about an exaggerated postprandial increase in triglycerides. Postprandial chylomicron clearance is evidently promoted. Hormone replacement therapy leads to a small increase in triglycerides in the LDL plus HDL fraction by inhibiting hepatic lipase activity. Moreover, the decrease in lipoprotein(a) levels may contribute to the antiatherosclerotic effect.Abbreviations: CEE conjugated equine estrogens - HDL high-density lipoproteins - HRT hormone replacement therapy - LDL low-density lipoproteins - TG triglycerides - VLDL very low density lipoproteins Correspondence to: U. Julius     

The relationship of bacterial vaginosis, candida and trichomonas infection to symptomatic vaginitis in postmenopausal women attending a vaginitis clinic

Objective: To estimate the prevalence of bacterial vaginosis, Candida albicans, and Trichomonas vaginalis infections in a population of postmenopausal women with symptoms of vaginitis seen at a vaginitis clinic either as self-referred or clinician referred patients. Methods: A cross-sectional study of 148 postmenopausal women (cases) and 1564 controls of reproductive age attending a vaginitis clinic. C. albicans and T. vaginalis infections were diagnosed by culture techniques. Bacterial vaginosis was diagnosed on the basis of clinical findings. Results: Fifty-six (37.8%) postmenopausal women and 834 (53.3%) controls were diagnosed with T. vaginalis or C. albicans infection, or bacterial vaginosis, or mixed infection (odds ratio (OR) 0.53, 95% confidence interval (CI) 0.37–0.75). C. albicans and T. vaginalis infection were diagnosed in 34.1% (534/1564) and 1.92% (30/1564) of women of childbearing age and in 3.5% (20/148) and 10.8% of postmenopausal women, respectively. (P < 0.05 for both comparisons). The prevalence of bacterial vaginosis was similar between the two groups (14/148 in postmenopausal patients and 210/1564 in controls of reproductive age; P = 0.22). Conclusions: Among postmenopausal women attending a vaginitis clinic, a defined diagnosis of bacterial vaginosis, C. albicans or T. vaginalis infection can be made in about one third of such patients. Concerning the two thirds of symptomatic women lacking such a microbiologic diagnosis, alternative causes (e.g., estrogen deficiency, nonanaerobic bacterial infections, local irritants or allergenes, and dermatologic conditions) need to be considered.     

绝经后应用小剂量利维爱妇女血浆蛋白、血糖和血脂的变化

目的：观察绝经后应用小剂量利缩爱妇女血浆蛋白、血糖和血脂的变化。方法：检测６０例妇女用药３,６,１２和２４个月时的血浆白蛋白（Ａ）、球蛋白（Ｇ）、血糖（ＧＬ）、总胆固醇（ＴＣ）、甘油三脂（ＴＧ）、高密度脂蛋白（ＨＤＬ）和低密度脂蛋白（ＬＤＬ）,结果：用药６个月时Ａ升高,以１２个月时升高最明显（Ｐ〈０．０１）。用药３个月后ＴＧ显著降低（Ｐ〈０．０５～０．０１）,ＨＤＬ用药３个月时有所降低（Ｐ〉０．０１）,以后渐恢复至用药前水平。用药后Ｇ、ＧＬ、ＴＣ、ＬＤＬ无明显变化,但ＧＬ、ＴＣ降低的妇女多于升高者。结论：小剂量利维爱可使绝经后妇女Ａ升高,明显降低ＴＧ,对Ｇ、ＧＬ、ＴＣ、ＨＤＬ、ＬＤＬ无明显影响。     

Intranasal 17beta-estradiol treatment and Vitamin B12, folate and homocysteine in menopause

Objective: This study assessed the effect of intranasal administration of 17β-estradiol (Aerodiol^®) on plasma levels of homocysteine, Vitamin B12 and folate in postmenopausal women.

Methods: In all, 26 symptomatic postmenopausal women who had undergone hysterectomy and oophorectomy at least 12 months previously participated in this 6-month randomized prospective clinical study. Menopause was determined by serum FSH level >30 μIU/ml and serum estradiol concentration <30 pg/ml. Intranasal 17β-estradiol treatment was given once daily at a standard daily dose of 300 μg to 16 women, and 10 did not receive any treatment.

Results: In the group receiving intranasal 17β-estradiol, mean (±S.D.) plasma homocysteine level decreased significantly from pre-treatment values (from 16.68 ± 4.33 to 14.15 ± 1.18 nmol/ml, p = 0.029) and the mean folate level increased (from 4.11 ± 0.80 to 5.64 ± 1.87 ng/ml, p = 0.012). Vitamin B12 levels showed a tendency towards increasing. In the treated group, significant negative correlations were observed between homocysteine and folate values (r = −0.586, p = 0.017) and between homocysteine and Vitamin B12 values (r = −0.672, p = 0.004). No significant changes were observed in the untreated group.

Conclusion: The reduction in plasma homocysteine levels observed after 6 months’ treatment with intranasal 17β-estradiol may reflect an alteration in folate and Vitamin B12 homeostasis.     

Möglichkeiten einer hormonellen Therapie bei urogynäkologischen Problemen in der Postmenopause

Urogynecological disorders play a large role in the treatment of older patients. In addition to various forms of stress incontinence in consequence of an adynamic pelvic floor, other causes for concern include atrophic processes in the female urogenital tract that can affect micturition, the higher incidence of ascending infections, and the clinical course of stress incontinence. The distress caused by these ailments is considerable for those women afflicted. Indubitably there are therapy options available for alleviation of these symptoms with hormone treatment, even though the efficacy of hormone substitution for these urogynecological complaints can be considered limited.     

Brachial artery responses in menopausal women using tibolone.

OBJECTIVE: To determine the effect of tibolone treatment on brachial artery pulsatility index (PI), resistance index (RI), and flux-mediated dilation (FMD) in postmenopausal Mexican women. METHOD: The FMD, PI, and RI of the right brachial artery were measured in 19 postmenopausal women before and after they received a hyperemic stimulus, first at baseline and then following a 6-month treatment with 2.5 mg of tibolone per day. Statistical analysis was performed using the t test. RESULTS: The mean+/-SD age was 52.2+/-3.9 years; time since menopause was 24.6+/-16.7 months; and treatment duration was 5.7+/-2.0 months. Compared with prestimulus measurements, a significant poststimulus increase in arterial diameter and a significant decrease in PI were observed at baseline. Compared with prestimulus measurements, a significant poststimulus increase in arterial diameter and a significant decrease in both PI and RI were observed post-treatment. CONCLUSION: Tibolone treatment had a favorable effect on brachial artery responses to hyperemic stimuli.     

Sex hormone status of the postmenopausal woman

Plasma levels of testosterone, androstenedione, dehydroepiandrosterone and its sulphate, and of androstenediol, as well as estrone and estradiol, were determined in several groups of postmenopausal women.The ovaries contribute to plasma estrogen levels only early in the postmenopause, but continue to secrete testosterone and minimal amounts of androstenedione throughout the postmenopause.With age there is a decreased secretion by the adrenal of dehydroepiandrosterone (sulphate) and of androstenediol.The levels of androstenedione and estrone and the androstenedione/estrone ratio remain unchanged with increasing age. The levels of estrone and estradiol, and the ratios, estrone/androstenedione and estradiol/testosterone, are correlated with fat mass. There is also an inverse curvilinear relationship with precursor concentration. This suggests either a progressive saturation of the tissular aromatase with increasing precursor level, or the existence of an unknown estrogen precursor.