广东地区妇女乳腺癌预测模型的研究

目的建立广东地区妇女乳腺癌预测模型,筛选高危人群,为乳腺癌的早期干预提供线索。方法在门诊患者和正常体检的妇女中,采用简单随机的方法选取35～60岁乳腺癌病例284例,以1：2成组配对原则在相应年龄段内选取非乳腺癌妇女673例,进行回顾性病例对照研究。分析数据时,首先将数据按绝经前后分层;以是否为乳腺癌患者为结果变量,其余变量为自变量,分别通过logistic单因素、多因素回归分析筛选出绝经前、后乳腺癌的危险因素,并以此建立绝经前、后妇女乳腺癌预测模型;用判别分析法分别对绝经前、后预测模型的预测能力进行判别。结果绝经前妇女患乳腺癌的主要危险因素包括服用避孕药史、亲属中有乳腺癌患者、有不良情绪、有不良事件、劳动强度大、无乳腺组织活检史、很少参加运动等。绝经前妇女患乳腺癌的预测模型为：1／{1＋exp[-（-4．314＋1．333服用避孕药＋1．167亲属中有乳腺癌患者＋0．404有不良情绪＋0．613有不良事件＋0．754劳动强度大-0．716有乳腺组织活检史-0．839经常运动）]}。此模型有统计学意义（x^2=165．83,P=0．000）,并且其预测不发生乳腺癌的正确率为74．2％,预测发生乳腺癌的正确率为58．4％。绝经后妇女患乳腺癌的主要危险因素包括亲属中有乳腺癌患者、文化程度低、情绪调节能力差等。绝经后妇女患乳腺癌的预测模型为：1／{1＋exp[-（1.211＋2．269亲属中有乳腺癌患者-1．617文化程度高-0．635情绪调节能力强）]}。此模型有统计学意义（x^2=116．32,P=0．000）,并且其预测发生乳腺癌的正确率为78．9％,不发生乳腺癌的正确率为55．2％。结论绝经前、后妇女患乳腺癌的影响因素不完全相同。绝经后妇女乳腺癌预测模型对预测发生乳腺癌有一定的参考价值;绝经前妇女乳腺癌预测模型对预测不?     

绝经后女性退变性膝骨关节炎疼痛与性激素水平及关节液炎性因子的相关性研究

背景 绝经后女性退变性膝骨关节炎（KOA）疼痛患者较为多见。绝经后女性体内性激素水平降低，体内性激素水平及关节液中炎性因子是否会影响膝关节疼痛，目前缺乏临床实践证据。 目的 探讨绝经后退变性KOA疼痛与患者血液中性激素〔雌二醇（E2）、睾酮（T）、泌乳素（PRL）、促黄体生成素（LH）、卵泡刺激素（FSH）及孕酮（P）〕水平、膝关节液炎性因子〔白介素（IL）-1、IL-6、IL-10及肿瘤坏死因子α（TNF-α）〕之间的相关性，为临床中雌激素治疗退变性KOA疼痛提供新的诊疗依据。 方法 选取新疆医科大学第六附属医院2019年6月至2021年6月因退变性KOA疼痛住院的女性绝经患者90例，患者行视觉模拟量表（VAS）评分后分为轻度疼痛组30例（VAS评分≤3分）、中度疼痛组30例（VAS评分4~6分）及重度疼痛组30例（VAS评分7~10分）；对照组选取新疆医科大学第六附属医院同期体检的绝经后膝关节积液女性30例。所有受试者检测性激素和膝关节液中炎性因子。 结果 四组患者体质指数（BMI）比较，差异有统计学意义（P<0.05），其中对照组、轻度疼痛组BMI低于重度疼痛组（P<0.05）。四组患者的E2及T比较，差异有统计学意义（P<0.05），其中中、重度疼痛组E2、T均低于对照组，中、重度疼痛组E2与重度疼痛组T均低于轻度疼痛组（P<0.05）。对照组及轻、中、重度疼痛组退变性KOA患者的PRL、LH、FSH及P比较，差异均无统计学意义（P>0.05）。四组患者IL-1、IL-6、IL-10及TNF-α水平比较，差异均有统计学意义（P<0.05），其中轻度疼痛组IL-1，中、重度疼痛组IL-1、IL-6、IL-10、TNF-α均高于对照组，重度疼痛组IL-6、IL-10、TNF-α均高于轻度疼痛组（P<0.05）。E2和T与膝关节疼痛VAS评分呈负相关（rs=-0.686、-0.454，P<0.05），IL-1、IL-6及TNF-α与膝关节疼痛VAS评分呈正相关（rs=0.517、0.665、0.319，P<0.05），IL-10与膝关节疼痛VAS评分之间无相关关系（rs=0.162，P>0.05）。 结论 绝经后退变性KOA疼痛患者体内E2及T水平与VAS评分呈负相关，不同疼痛程度退变性KOA患者的PRL、LH、FSH及P水平之间无明显差异。绝经后退变性KOA患者膝关节液中IL-1、IL-6及TNF-α水平与VAS评分呈正相关，降低关节内IL-1、IL-6及TNF-α水平可提高机体对膝关节疼痛的耐受，为临床上治疗退变性膝关节疼痛提供了一定的参考依据。     

Clinical Outcomes Following Letrozole Treatment according to Estrogen Receptor Expression in Postmenopausal Women: LETTER Study (KBCSG-006)

PurposeIn this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels.MethodsIn this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3–4, 5–6, and 7–8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate.ResultsBetween April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8–96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity.ConclusionTreatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression.Trial RegistrationClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT01069211","term_id":"NCT01069211"}}NCT01069211     

Hyaluronic Acid in Postmenopause Vaginal Atrophy: A Systematic Review

BackgroundThe decline in postmenopausal serum estrogen concentration results in several changes in the vulvovaginal and vesicourethral areas, resulting in the genitourinary syndrome of menopause, including symptoms such as vaginal atrophy.AimTo evaluate the effects of hyaluronic acid in vaginal atrophy.MethodsA search strategy was developed using the following terms: “Hyaluronic Acid vaginal gel,” “vaginal estrogens,” “Vaginitis, Atrophic,” and “Postmenopause.” This strategy was used in major databases such as MEDLINE, EMBASE, Scopus, Cochrane library, Web of Science, Virtual Health Library (BVS), Congress Abstracts, and Gray Literature (Google Scholar and British Library) for studies published until June 2020.OutcomesA systematic review was carried out to assess the results of atrophic vaginitis/vaginal dryness, dyspareunia, vaginal pH, and cell maturation of the studies found by the search strategy.ResultsA total of 833 studies were identified, 528 studies were directed for reading titles and abstracts, and 515 were excluded for not meeting the selection criteria. A total of 13 studies were selected for reading the full text. 5 primary studies involving 335 women met the criteria and were included. The studies were published between the years 2011 and 2017. It was not possible to perform meta-analysis owing to the substantial heterogeneity present in the studies. The results presented suggest that treatment with hyaluronic acid, when compared with the use of estrogens, does not present a significant difference in the results obtained for the outcomes: epithelial atrophy, vaginal pH, dyspareunia, and cell maturation.Clinical TranslationHyaluronic acid appears to be an alternative to non-hormonal treatments for the signs of vaginal atrophy and dyspareunia.Strengths & LimitationsThe analysis of the studies in this systemic review suggests that hyaluronic acid has efficacy similar to vaginal estrogens for the treatment of the signs of vaginal atrophy and dyspareunia. However, the included studies measured the data in different ways, causing the performance of meta-analysis to be impaired.ConclusionThe comparisons presented suggest that hyaluronic acid has a profile of efficacy, safety, and tolerability comparable with vaginal estrogens for the treatment of symptoms of vaginal atrophy. It is a possible alternative for women who cannot use hormonal treatment.dos Santos CCM, Uggioni MLR, Colonetti T, et al. Hyaluronic Acid in Postmenopause Vaginal Atrophy: A Systematic Review. J Sex Med 2021;18:156–166.     

绝经后细菌性阴道病27例的临床分析

目的：探讨绝经后妇女细菌性阴道病（ＢＶ）的临床特点。方法；将２７例绝经后ＢＶ患者的ｐＨ值，阴道乳酸杆菌数量与５８６例生育年龄ＢＶ患者及１１７例老年性阴道炎患者的ｐＨ值。阴道乳酸杆菌数量进行比较分析。结果：绝经后ＢＶ患者的阴道ｐＨ值与生育年龄ＢＶ患者相同，均超过４．５。绝经期ＢＶ患者阴道乳酸杆菌消失或缺乏，与同龄对照组比较有显著差异。结论：绝经后ＢＶ患者的临床表现、实验室检查与生育年龄ＢＶ患者相似。     

北京地区9103例体检人群骨密度流行病学调查研究

目的调查北京地区9103例体检人群骨密度,探讨本地区原发性骨质疏松症流行病学情况。方法选择2012年3月-7月在我院体检的9103例汉族体检人群为研究对象,年龄16～93岁,采用韩国osteosys公司生产的ExA-3000型骨密度仪,检测受试者非受力侧前臂尺桡骨中远端1/3处骨密度,建立信息采集表,记录体检人群骨密度、身高、体重、体重指数(BMI)等情况,将检测结果以每10岁为一年龄段分组,分析每组骨密度、t、z评分、患病率及相关影响因素。结果北京地区男性、女性峰值骨量均发生在30～39岁年龄段,骨峰值分别为0.528±0.072、0.451±0.067,随着年龄的增长,骨密度逐渐降低,骨质疏松症发病率逐年增高;男性、女性30岁以前骨密度分别为0.47±0.107、0.436±0.060,骨质疏松症发病率分别为21.88%、1.33%;30～39岁骨密度分别为0.528±0.072、0.451±0.067,骨质疏松症发病率分别为7.31%、1.71%;40～49岁骨密度分别为0.52±0.071、0.445±0.065,骨质疏松症发病率分别为9.88%、2.3%;50～59骨密度分别为0.49±0.076、0.396±0.082,骨质疏松症发病率分别为20.83%、18.94%;60～69岁骨密度分别为0.463±0.085、0.328±0.071,骨质疏松症发病率分别为35.49%、52.21%;70～79岁骨密度分别为0.416±0.086、0.268±0.072,骨质疏松症发病率分别为57.31%、77.59%;80岁以上骨密度分别为0.384±0.091、0.222±0.059,骨质疏松症发病率分别为71.37%、95.24%。低BMI人群骨质疏松症发病率明显高于正常和高BMI人群,差距具有统计学意义(P0.05)。结论峰值骨量过后,随着年龄的增加,骨密度均呈下降趋势,骨质疏松症发病率显著上升,且女性绝经后骨量丢失明显加快,骨质疏松症发病率较同龄男性明显升高,差异具有统计学意义(P0.05)。值得关注的是,30岁以前的年轻男性骨密度状况也并不理想,可能跟工作繁忙,生活压力大,缺乏锻炼,生活方式不健康有关。因此,将骨密度检测作为中老年人体检的常规检查项目,早期发现,积极干预,同时加强年轻人群的健康宣教,倡导健康生活方式,提高峰值骨量,对于防治骨质疏松症具有重要意义。     

Withdrawal of Hormone Replacement Therapy is Associated with Significant Vertebral Bone Loss in Postmenopausal Women

This study aimed to assess the changes in vertebral bone mineral density (BMD) after cessation of hormone replacement therapy (HRT) in postmenopausal women who had been treated on a long-term basis. Fifty healthy postmenopausal women who had been followed both during the course of HRT and after cessation of treatment in our menopause clinic were included in this study. All women had started HRT within the first 3 years after the postmenopause and had received HRT (either 1.5 mg/day of 17β-estradiol given percutaneously or 50 μg/day of 17β-estradiol given as a transdermal patch, combined in all women with natural progesterone or a 19-norprogesterone derivative) for a mean 5 ± 2.4 years. In all women, vertebral BMD was assessed during the course of HRT up to the last 6 months before estrogen withdrawal, then at least once within the first 18 months after cessation of treatment. Of the initial population, 30 women were additionally reviewed later on and up to 8 years after cessation of treatment (mean duration of follow-up for the whole population: 3.9 ± 1.7 years). Rates of changes in vertebral BMD were compared with those determined in a group of healthy untreated women who had been followed within the first years of postmenopause during the same time period as the study population. In the study group, bone loss was found to accelerate within the first 2 years after HRT withdrawal and the annual rate of loss was identical to that which occurs within the first 2 years of postmenopause in untreated women (−1.64%± 1.3% vs −1.52 ± 0.9%, NS). Beyond this first 2-year time period, the annual rate of bone loss decreased as a function of time following cessation of treatment, as was observed following the menopause in untreated women (between 3 and 5 years: −0.83%+ 1.35% in the study group vs −0.70%± 0.8% in the control group, NS). On average, 3 years after cessation of HRT mean vertebral BMD when expressed as a Z-score was significantly higher (−0.13 vs −0.89, p<0.01) than at baseline, before HRT was started, which suggested a lasting beneficial effect on bone mass. However, even though our findings do not support the hypothesis that bone loss might continue to be accelerated several years after cessation of treatment we cannot fully address the question as to whether any residual benefit on bone mass over a longer period of time may be observed. In conclusion, the pattern of bone loss observed after cessation of estrogen therapy was found to be comparable to that which occurs in younger women within the first years after the menopause. Such a pattern needs to be kept in mind when the decision to stop HRT is taken, especially in women who were given HRT to prevent osteoporosis. The issue of assessing their risk of fracture several years after cessation of treatment thus needs to be addressed. Received: 25 July 2000 / Accepted: 5 December 2000     

阴道使用雌激素治疗绝经后妇女反复泌尿系统感染的初步观察

目的探讨阴道使用雌激素治疗绝经后妇女反复泌尿系感染的效果及可行性.方法将45例有反复泌尿系感染病史的绝经后妇女分成两组,分别使用结合雌激素(商品名倍美力),软膏30例(结合雌激素组),口服抗生素15例(抗生素组),疗程3个月.用药前、后分别行清洁中段尿尿常规检查、尿及阴道细菌培养,对阴道细胞成熟值及阴道健康情况进行评估.同时测定子宫内膜厚度及血清雌二醇水平.结果除结合雌激素组有3例自行停止治疗外,其余均完成治疗.治疗后结合雌激素组泌尿系感染的发生率(2/27)明显低于抗生素组(12/15),两组比较,差异有极显著性(P＜0.001).结合雌激素组阴道乳酸杆菌检出率达59.3%,抗生素组无乳酸杆菌出现.结合雌激素组阴道健隶评分(13.4±25)分;阴道细胞成熟值(74.6±14.1),分别明显高于抗生素组(5.2±0.4分;10.8±8.3),两项组问比较,差异均有显著性(P＜0.05).结论阴道局部使用雌激素,能有效减少绝经后妇女泌尿系感染的反复发作,较使用抗生素副反应轻,治疗效果明显提高.     

绝经后妇女腔内超声特点

目的通过腔内超声建立绝经后妇女正常子宫与卵巢体积的数值及形态图像,以便筛查异常子宫病变与异常卵巢体积与卵巢肿瘤.方法经阴道对绝经后3026例妇女进行TVS检查,测量子宫、卵巢的长、宽、厚三径.结果按具体公式计算出萎缩子宫三径之和＜11cm,卵巢体积应＜10cm3或8.8ml.结论经TVS检查是测量子宫与卵巢体积与形态的最佳方法,是筛查绝经后子宫病变与卵巢癌的首选方法.