行激素补充疗法的绝经后妇女子宫内膜安全性监测

目的　探讨应用激素补充疗法(HRT)的绝经后妇女子宫内膜安全性的监测方法。　方法　对60例绝经后行HRT妇女进行血清雌二醇(E2)测定；阴道B超(TVS)监测子宫体积和子宫内膜厚度；对部分患者行子宫内膜的病理学检查和雌激素受体(ER)、孕激素受体(PR)半定量检测。　结果　应用HRT后，子宫内膜明显增厚，均值从2.8mm升至3.9mm(P＜0.05)；E2显著上升，由(20.6±6.9)ng/L升至(33.8±11.7)ng/L（P＜0.01）；子宫内膜厚度与E2呈正相关关系(r=0.94，P＜0.01)；20例送检内膜中，2例简单型增生过长，1例复杂型增生过长，余为萎缩型；ER(+)19例，ER(++)1例；PR均为(+)。　结论　根据临床表现，并结合血清E2和TVS检测子宫内膜厚度，可对子宫内膜安全性进行初步评估；当E2＞45ng/L，子宫内膜厚度≥5mm时，则需进一步行子宫内膜病理学检查和ER测定。

Monitoring endometrial safety in the postmenopausal women receiving hormone replacement therapy

Objective　To find out the methods of monitoring the endometrial safety in postmenopausal women receiving hormone replacement therapy (HRT). 　Methods　Blood E2, size of uterus and thickness of endometria by transvaginal ultrasonography (TVS) in 60 patients receiving HRT were detected. The pathology of endometria and the semiquantitative analysis of estrogen receptor (ER) and progesterone receptor (PR) were also examined in some cases. 　Results　The endometrial thickness was increased significantly from 2.8 mm to 3.9 mm (P＜0.05), the blood E2 was also increased significantly from (20.6±6.9)ng/L to (33.8±11.7)ng/L (P＜0.01) in women receiving HRT. Therefore, a positive correlation between the blood E2 and the endometrial thickness was observed (r=0.94). Among the 20 cases being pathologically diagnosed, 2 cases were simple hyperplasia, 1 case was complex hyperplasia, and the others were considered atrophy. By semiquantative determination, ER showed positive (+) in 19 cases, ER(++) in 1 case, and all cases showed PR(+). 　Conclusions　The endometrial safety could be preliminarily evaluated according to clinical features, blood E2 and endometrial thickness; when blood E2 ≥45 ng/L, and endometrial thickness ≥5 mm, endometrial pathology and ER level should be further examined.