超声观察绝经后长期小剂量激素替代疗法对子宫、卵巢和乳腺的影响

目的观察长期小剂量激素替代疗法(HRT)对绝经后妇女子宫、卵巢和乳腺的影响。方法52例绝经后妇女,根据不同用药方案分为利维爱组和雌孕激素组,分别给予小剂量激素利维爱或雌激素联合孕激素替代治疗,用药时间5~31年,采用经阴道超声及高频超声观察子宫、卵巢和乳腺的形态结构特征。结果利维爱组和雌孕激素组妇女的子宫体积、内膜厚度、双侧卵巢面积、双侧乳腺厚度及导管宽度均大于对照组,其中利维爱组和雌孕激素组内膜厚度与对照组之间差异均有显著性(P<0.05);雌孕激素组的子宫体积和乳腺腺体厚度显著大于对照组(P<0.05)。两种用药组间比较差异均无显著性。乳腺结构改变方面,小叶增生型中利维爱组和雌孕激素组的发生率均显著高于对照组(P<0.05,P<0.005);导管增生型中仅雌孕激素组较对照组差异具有显著性(P<0.05)。结论长期小剂量HRT能够延缓子宫、卵巢和乳腺的萎缩进程,子宫体积、内膜厚度、双侧卵巢面积及乳腺腺体层厚度均大于对照组;不同的用药方案对上述靶器官的影响有所不同;小剂量HRT对发生子宫内膜癌、卵巢癌和乳腺癌的危险性无明显影响;在应用HRT过程中,运用超声检查监测子宫、卵巢和乳腺的变化具有重要意义。

Observing the effects of long-term and low dose hormone replacement therapy on the uterus, ovary and breasts of postmenopausal women by ultrasonography

Objective: To investigate the effect of long-term and low dose hormone replacement therapy (HRT) on the uterus, ovary and breasts of postmenopausal women by ultrasonography.Methods: A total of 52 healthy postmenopausal women were divided into two groups. Low dose Livial was given in one group and estrogen and progestin in the other group. All women were treated for 5~31 years. Transvaginal ultrasonography and mammary ultrasonography were performed to observe the features of uterus, ovary and breasts.Results: When compared with the non-HRT women, the uterine volume, endometrial thickness, (ovarian) area, breast glandular section thickness and breast duct width in HRT-treated women were larger, but the significant difference in endometrial thickness was found (P<0.05). The uterine volume and breast glandular section thickness in the women with estrogen and progestin were significantly different form those in the non-HRT women (P<0.05). The occurrence of breast structure changes in HRT women was significantly higher than that of non-HRT women (P<0.005). Conclusion: The long-term and low dose hormone replacement therapy can delay the shrinkage of uterus, ovary and breasts. The different regimes have different effects on uterus, ovary and breasts. Long-time and low dose HRT has no significant risk of endometrial carcinoma, ovarian carcinoma and mammary carcinoma. Using the ultrasonography to monitor the changes of uterus, ovary and breasts is of important significance during the HRT treatment.