激素替代治疗与绝经后骨质疏松症

绝经后骨质疏松症主要是由于卵巢功能的减退或衰竭、雌激素水平下降而导致破骨细胞的骨吸收大于成骨细胞的骨形成,以进行性骨丢失、骨小梁退行性病变、骨质疏松、骨脆性增加和骨折风险增加为临床特征的全身性疾病,具有发病率随绝经年限延长而增高的特点。临床中相当数量的绝经后女性并不重视骨质疏松的严重性,从而延误了预防和治疗的最佳时机,增加了骨质疏松症治疗的复杂性。激素替代治疗是预防和治疗绝经后女性骨质疏松的有效方法之一,尤其是对于预防过早绝经妇女的骨质丢失已成为一线的治疗手段,且具有成本低、安全性高的优点。激素替代治疗不仅可增加患者的骨密度、减缓骨丢失,而且还可使血清降钙素、碱性磷酸酶骨质破坏的标志物较基础水平明显下降,起到预防和治疗绝经后妇女骨质疏松和骨折的作用。本文就绝经后妇女骨质的改变进行综述。     

电针“命门”穴对绝经后骨质疏松症大鼠骨形成蛋白-2的影响

目的:观察电针"命门"穴对绝经后骨质疏松症大鼠股骨骨形成蛋白-2(bone morphogenetic protein-2,BMP-2)及骨生物力学的影响,探讨电针治疗绝经后骨质疏松症的机制。方法:将SD雌性大鼠随机分为假手术组、模型组、命门组、非经非穴组及雌激素组,每组10只。除假手术组外,各组大鼠均切除双侧卵巢制备绝经后骨质疏松症模型。造模成功后,命门组和非经非穴组每日电针"命门"及非经非穴1次,疏密波,频率为2Hz/15Hz,强度为1mA,每次持续20min,10d为1个疗程,治疗3个疗程;雌激素组用戊酸雌二醇片生理盐水混悬液(25μg/mL,2mL/500g)灌胃,连续灌服1个月。治疗后采用免疫组织化学方法检测大鼠左侧股骨BMP-2的表达变化,运用三点弯曲实验检测大鼠右侧股骨最大载荷及断裂载荷。结果:造模后大鼠阴道脱落细胞涂片可见细胞核大,核质比例大,提示去势成功。造模后大鼠股骨骨小梁较假手术组明显变少,结构松散,骨髓腔明显变大,存在大量脂肪和空泡,表现出典型的骨质疏松症组织形态。模型组最大载荷和断裂载荷较假手术组明显降低(P0.05),命门组及雌激素组最大载荷和断裂载荷较模型组及非经非穴组明显升高(P0.05)。模型组BMP-2表达较假手术组明显减弱(P0.05),命门组及雌激素组BMP-2表达较模型组明显增强(P0.05)。结论:电针"命门"穴能增加BMP-2的表达水平,提高骨生物力学性能,增强骨强度,从而治疗绝经后骨质疏松症。     

电针“关元”穴对去卵巢骨质疏松症大鼠血清胰岛素样生长因子-1和骨生物力学的影响

目的:探讨针刺治疗去卵巢骨质疏松症的作用机制。方法:4.5月龄SD雌性大鼠40只,随机分为假手术组、模型组、西药组和电针组。切除大鼠双侧卵巢建立绝经后骨质疏松症模型。电针组电针刺激"关元"穴20min,每日1次,10次为1个疗程,共3个疗程;西药组大鼠戊酸雌二醇片生理盐水混悬液(25μg/mL,2mL/500g体重)灌胃,疗程同电针组。采用ELISA法检测大鼠血清胰岛素样生长因子-1(IGF-1)水平,运用三点弯曲试验检测大鼠股骨骨生物力学的变化。结果:与假手术组相比,模型组大鼠血清IGF-1,股骨最大载荷、断裂载荷均显著性降低(P0.05,P0.01);与模型组相比,电针组、西药组大鼠血清IGF-1,股骨最大载荷、断裂载荷均显著性升高(P0.05,P0.01);电针组与西药组相比,差异无统计学意义(P0.05)。结论:电针通过提高大鼠血清IGF-1水平和骨强度,发挥对绝经后骨质疏松症的治疗作用。     

利塞膦酸钠联合阿法骨化醇治疗绝经后骨质疏松32例

目的观察利塞膦酸钠联合阿法骨化醇和钙剂治疗绝经后骨质疏松的疗效。方法收集医院2010年1月至12月绝经后骨量减少和骨质疏松门诊和住院患者64例,随机均分成两组,A组予利塞膦酸钠联合阿法骨化醇、钙尔奇D治疗,B组予钙尔奇D治疗,治疗前后检测腰椎骨密度(BMD)、股骨颈BMD、全髋部BMD、血清Ⅰ型前胶原氨基端前肽(P1NP)、血Ⅰ型胶原交联羧基末端肽β降解产物(β-CTX)、血常规及尿常规等,并记录两组的不良反应。结果治疗12个月后,A组和B组的总有效率分别为90.62%和56.25%;两组患者的腰椎BMD、股骨颈BMD、全髋部BMD等均明显好转,与治疗前相比具有显著性差异(P<0.05),且A组改善程度优于B组(P<0.05);A组的P1NP和β-CTX明显降低(P<0.05)。结论利塞膦酸钠联合阿法骨化醇、钙尔奇D治疗绝经后骨质疏松具有良好的效果,且毒副作用较小。     

阿伦膦酸钠治疗绝经后骨质疏松症的疗效观察

目的观察阿伦膦酸钠对绝经后妇女原发性骨质疏松症的有效性和安全性。方法绝经后骨质疏松患者130例,将患者完全随机分成观察组及对照组,各65例。观察组每周口服阿伦膦酸钠70mg和元素钙(碳酸钙)及骨化醇;对照组口服元素钙(碳酸钙)及骨化醇。疗程均为12个月;通过骨密度仪观察治疗前及治疗后的骨密度的变化。结果治疗12个月后,观察组L2～4和股骨颈平均骨密度明显高于治疗前和对照组治疗后[L2～4：（844±116）mg/cm3比（788±76）mg/cm3、（785±64）mg/cm3;股骨颈：（681±71）mg/cm3比（644±72）mg/cm3、（662±90）mg/cm3],差异均有统计学意义（P<0.05或P<0.01)。治疗过程中未发现与药物有关的不良反应。结论阿伦膦酸钠治疗绝经后骨质疏松症有效且安全。     

橄榄油对大鼠去势后骨代谢指标及骨密度的影响

目的:观察橄榄油对去势后大鼠骨代谢和骨密度的影响,探讨并分析橄榄油防治绝经后骨质疏松症(PMOP)的有效性及机理。方法:将30只5～6个月龄清洁型SD雌性大鼠进行随机分成四组:①假手术组(Sham组)、②去卵巢组(OVX组)、③去卵巢+橄榄油组(OVX+Olive)、④去卵巢+雌激素组(OVX+E)。治疗组用药:(OVX+Olive)组及(OVX+E)组均采用经口灌胃方式进行用药,按1 ml/100 g体重,1次/天灌胃,连续12周。12周后分别左心室取血,检测血中雌二醇(E2)、血钙、血碱性磷酸酶(ALP)、白介素-6(IL-6)水平,放血处死后取出腰椎及左侧股骨行双能X线骨密度(DEXA)测定。结果:OVX组中血E2明显低于Sham组和治疗组,差异有统计学意义(P<0.01、P<0.05),ALP、IL-6值显著高于其余三组,差异有统计学意义(P<0.05);治疗组中E2、ALP、IL-6与Sham组差异无统计学意义(P>0.05);四组中血钙值差异均无统计学意义(P>0.05)。去势橄榄油组与雌激素组骨密度平均值均较OVX组高,差异有统计学意义(P<0.05),但该两组间差异无统计学意义(P>0.05)。结论:橄榄油能有效地减轻大鼠卵巢切除术引起的骨质丢失,可能通过补充植物雌激素发挥拟雌激素样作用。     

New onset alopecia and hirsutism in a postmenopausal women

Recent onset of hirsutism in postmenopausal women is mostly caused by androgen secretion from adrenal or ovarian tumours. Ovarian hyperthecosis (OH) is a cause of hyperandrogenism in premenopausal women, few cases of postmenopausal presentation have been described. We report on a 73-year old women with androgenic alopecia and hirsutism of recent onset because of elevated testosterone levels. Radiologic imaging showed no tumours of the adrenal glands and ovaries. Careful re-evaluation revealed increased ovarian size in relation to age. Bilateral ovarectomy confirmed the diagnosis of ovarian hyerthecosis and led to improvement of clinical findings. It is important to review imaging findings as OH may elude imaging studies. OH should be included in the differential diagnosis of postmenopausal hyperadnrogenism particularly if androgen excess is of recent-onset.     

Medical methods for cervical ripening before the removal of intrauterine devices in postmenopausal women: a systematic review

In China, most women with intrauterine devices (IUDs) ask to have them removed following the menopause. As the cervix is stenotic after the menopause and most IUDs do not have a thread attached, various medical methods are used for cervical ripening prior to IUD removal. A systematic review of the relevant literature was conducted to compare different medical methods for cervical priming with no treatment, or with other methods, prior to IUD removal in postmenopausal women. Multiple electronic databases including the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, the WHO Reproductive Health Library (2011) and the Chinese Biomedical Literature Database were searched systematically. Reference lists of articles published in English or Chinese between 1980 and 2011 were searched. All randomized controlled trials (RCTs) on IUD removal following the menopause using medical agents compared with no treatment, or with other treatments, were included. Outcomes were the ease of IUD removal, need for forced cervical dilatation, cervical width, procedure time, severe pain and any side-effects. Data were processed using RevMan 5 software. Thirty original RCTs were eligible for inclusion. Most medical agents such as oestrogens, mifepristone, misoprostol and methyl carboprost were highly effective for facilitating IUD removal, and reduced the need for further dilatation during the procedure. In particular, treatment with mifepristone or misoprostol prior to IUD removal was found to increase the width of the cervical canal and reduce the procedure time. Mifepristone was more effective than vaginal misoprostol for cervical dilatation, but it showed similar effectiveness to misoprostol and nilestriol in terms of the ease of IUD removal. Sublingual misoprostol was superior to oral misoprostol for facilitating IUD removal. A dose of misoprostol as low as 200 μg was effective for cervical priming. For vaginal and oral misoprostol, the optimum times of application were 2–3 h and 1 day prior to the procedure, respectively. All the prophylactic medical methods were able to alleviate pain during IUD removal, and vaginal misoprostol was more effective than nilestriol. Uterine injury was more common with no treatment and with nilestriol. Gastrointestinal side-effects such as nausea and diarrhoea were common with oral misoprostol and vaginal misoprostol, respectively. Therefore, mifepristone or sublingual misoprostol should be the medical treatments of choice. Oestrogen regimens might be alternatives when mifepristone or misoprostol are contraindicated, and there is a need for further study on combined regimens for cervical priming.     

己烯雌酚联合萘普生栓用于绝经后取器的临床分析

目的观察己烯雌酚联合萘普生栓用于绝经后取器的临床效果。方法选取绝经后取器的妇女104例,随机分成两组,观察组(59例)取器前予己烯雌酚联合萘普生栓,对照组(45例)不给药,对所得两组数据进行统计学分析。结果观察组宫颈松弛程度及镇痛效果均优于对照组,取器成功率高,两组间差异有统计学意义(P<0.05)。结论己烯雌酚联合萘普生栓用于绝经后取器可取得满意效果。