克龄蒙用于围绝经期女性激素补充疗法68例临床分析

围绝经期是女性从育龄期到老年期的过渡阶段,随着卵巢功能的衰退,性激素缺乏所致的相关临床问题与疾病严重影响到中、老年女性的生活、工作及生命质量。有临床资料统计,70%的围绝经期妇女会发生月经紊乱,大约有2/3的45~60岁妇女有更年期症状,如潮热、出汗、失眠、阴道干涩、性交困难、抑郁、焦虑、精神紧张、易激惹等[1]。激素紊乱首先表现为孕激素的下降,其次是雌激素波动性下降,最终导致女性内分泌紊乱。激素补充疗法（HRT）能有效治疗妇女更年期症状,提高围绝经妇女生活质量[2]。克龄蒙是一种雌、孕激素模拟人体生理周期的复方制剂,主要成分为戊酸雌二醇片及雌二醇环丙孕酮片,其雌孕激素剂量对于围绝经期是合适的,可以从根本上解决围绝经期女性月经紊乱及更年期症状,明显改善血脂代谢,从而保护心血管。现将我院采用克龄蒙进行HRT治疗的68例围绝经期患者的临床资料报道如下。     

戊酸雌二醇用于围绝经期及绝经后激素补充治疗65例临床分析

目的探讨戊酸雌二醇(商品名:克龄蒙)用于围绝经期和绝经后激素补充治疗(HRT)的临床疗效。方法选择65例有更年期症状的围绝经期及绝经后妇女,使用克龄蒙进行HRT 6个月,用药前后行Kupperman评分,测定促卵泡刺激素(FSH)、雌二醇、总胆固醇(CHOL)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)水平。结果治疗后更年期症状开始缓解,Kupperman评分下降、雌二醇升高,达增生期水平,血FSH、CHOL、TG、LDL下降,差异均有统计学意义(P<0.05)。结论克龄蒙能有效缓解围绝经期及绝经后症状,保护子宫内膜、调节血脂代谢、预防心血管疾病,是安全、有效的HRT药物。     

炔雌醇环丙孕酮联合戊酸雌二醇治疗围绝经期功能失调性子宫出血的效果

目的研究炔雌醇环丙孕酮联合戊酸雌二醇治疗围绝经期功能失调性子宫出血的临床效果。方法选取2016年1月至2018年7月信阳市第一人民医院收治的119例围绝经期功能失调性子宫出血患者,按随机数表法分为观察组(60例)和对照组(59例)。对照组患者接受戊酸雌二醇治疗,观察组患者接受炔雌醇环丙孕酮联合戊酸雌二醇治疗。比较两组疗效、不良反应和治疗前后血清孕激素(P)、雌二醇(E_2)、卵泡刺激素(FSH)水平。结果观察组治疗总有效率为100.00%(60/60),较对照组[86.44%(51/59)]高(P<0.05)。治疗1个疗程后,观察组血清FSH水平与对照组比较,差异无统计学意义(P>0.05);观察组血清P、E_2水平低于对照组(P<0.05)。观察组不良反应发生率[5.00%(3/60)]与对照组[3.39%(2/59)]比较,差异无统计学意义(P>0.05)。结论炔雌醇环丙孕酮联合戊酸雌二醇治疗围绝经期功能失调性子宫出血的效果显著,能有效调节激素水平,且不增加不良反应。     

补肾益气固冲汤加减联合醋酸甲羚孕酮、戊酸雌二醇治疗围绝经期功能性子宫出血的临床效果

目的 观察补肾益气固冲汤加减联合醋酸甲羚孕酮、戊酸雌二醇治疗围绝经期功能性子宫出血的效果.方法 本研究纳入2017年2月至2019年5月河南省生殖健康科学技术研究院收治的142例围绝经期功能性子宫出血患者,按照治疗方式分为两组(每组71例),醋酸甲羚孕酮联合戊酸雌二醇治疗为对照组,补肾益气固冲汤加减联合醋酸甲羚孕酮、戊...     

低剂量雌激素对围绝经期综合征女性患者性激素水平、骨代谢、骨密度、子宫内膜厚度的影响

目的 探讨短期应用小剂量雌激素对更年期女性患者性激素、骨代谢指标、骨密度、子宫内膜厚度的影响.方法 选取92例围绝经期综合征女性患者,随机分为观察组和对照组,每组46例.对照组予以口服醋酸甲羟孕酮治疗,观察组在对照组治疗的基础上加用口服戊酸雌二醇片.治疗6个月后观察2组患者Kupperman评分及临床结局,评估低剂量雌...     

戈舍瑞林联合戊酸雌二醇片/雌二醇环丙孕酮片治疗子宫内膜异位症

目的研究戈舍瑞林联合戊酸雌二醇片/雌二醇环丙孕酮片复合包装对子宫内膜异位症患者术后血清性激素水平及妊娠率的影响。方法选取永城市人民医院收治的98例子宫内膜异位症患者,按照治疗方案分为对照组和观察组,各49例。对照组接受戊酸雌二醇片/雌二醇环丙孕酮片复合包装治疗,观察组接受戈舍瑞林联合戊酸雌二醇片/雌二醇环丙孕酮片复合包装治疗,观察两组治疗前后血清性激素水平[雌二醇(E2)、黄体生成激素(LH)、卵泡生成激素(FSH)]变化情况,观察两组治疗后妊娠成功率。结果观察组总有效率(89.80%)高于对照组(73.47%),差异有统计学意义(P<0.05)。治疗后观察组E2、FSH低于对照组(均P<0.05)。治疗后观察组妊娠成功率(91.84%)高于对照组(63.27%),差异有统计学意义(P<0.05)。结论给予子宫内膜异位症患者戈舍瑞林联合戊酸雌二醇片/雌二醇环丙孕酮片复合包装治疗可改善患者血清性激素水平,提高妊娠成功率。     

香芍颗粒治疗女性围绝经期综合征的疗效分析

目的：评价中成药香芍颗粒治疗围绝经期综合征疗效及卵巢功能状态对其影响。方法：采用随机对照研究2个月,患者随机分为香芍颗粒组,香芍颗粒一次1袋,一日3次,8周为一疗程。克龄蒙组,克龄蒙(前11片含戊酸雌二醇2mg/片,后10片并含醋酸环丙孕酮1mg/片),连服21天。停药后等月经来潮,在月经来潮的第5天开始口服下一疗程药物,连续用药两个疗程。研究期间患者记录症状、乳胀等,随访时进行改良Kupperman症状(K)评分评估围绝经期症状,检测血清雌二醇(E2)、卵泡刺激素（FSH）,评估治疗反应。结果：治疗后,香芍颗粒组和克龄蒙组K评分临床有效率分别为76.7%和80%,潮热评分有效率分别为90%和93.33%,两组之间均无显著性差异(P＞0.05)。香芍颗粒组血清FSH水平显著下降(P＜0.01),E2水平呈显著增加(P＜0.01)。但变化幅度略低于克龄蒙组(P＞0.05)。两组均无严重不良反应。结论：香芍颗粒对改善围绝经期综合征症状有效,安全性好,无严重不良反应。     

功能失调性子宫出血中西医结合治疗探讨

目的 探讨中西医结合治疗功能失调性子宫出血(简称功血)的临床效果.方法 88例功血患者随机分为治疗组和对照组,治疗组采用戊酸雌二醇醋酸环丙孕酮(克龄蒙)联合妇科养荣胶囊治疗功血,对照组单用戊酸雌二醇醋酸环丙孕酮治疗功血.分析两组治疗前后血红蛋白变化及治疗前后的月经周期、经期、经量的变化.结果 治疗组临床有效率为97.8%,对照组临床有效率为84.1%;两组治疗后月经周期、经期、经量与治疗前比较,差异均有统计学意义(P<0.01);治疗后治疗组血红蛋白值、月经周期、经期、经量与对照组比较,差异均有统计学意义(P<0.05).结论 戊酸雌二醇醋酸环丙孕酮联合妇科养荣胶囊治疗功血有良好临床效果.     

戈舍瑞林联合戊酸雌二醇片/雌二醇环丙孕酮片治疗子宫内膜异位症临床观察

目的:分析子宫内膜异位症(EM)应用戊酸雌二醇片/雌二醇环丙孕酮片与戈舍瑞林联合治疗的临床效果。方法:选取2015年1月—2017年2月我院收治的78例EM患者,随机分组进行对照观察,两组均实施腹腔镜手术,对照组(39例)术后3～5d予以戈舍瑞林治疗,观察组(39例)术后3～5d予以戈舍瑞林联合戊酸雌二醇片/雌二醇环丙孕酮片治疗,比较两组总有效率、复发率、妊娠率、不良反应。结果:两组总有效率、复发率、妊娠率相比,差异无统计学意义(P>0.05);观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:戈舍瑞林联合戊酸雌二醇片/雌二醇环丙孕酮片治疗EM,不会增加疾病复发率,但能明显减少不良反应的发生,有助于提高患者治疗安全性与耐受性。     

替勃龙联合雌二醇片/雌二醇地屈孕酮片治疗围绝经期综合征的效果分析

目的：分析替勃龙联合雌二醇片/雌二醇地屈孕酮片治疗围绝经期综合征的效果。方法：选取2021年1—12月北京市丰台区青塔街道社区卫生服务中心与航天中心医院永定路社区卫生服务中心收治的64例围绝经期综合征患者作为研究对象,采用随机数字表法分为对照组与观察组,各32例。对照组应用雌二醇片/雌二醇地屈孕酮片治疗,观察组在对照组基础上应用替勃龙治疗。比较两组治疗效果。结果：两组治疗总有效率比较,差异无统计学意义(P>0.05)。治疗前,两组促黄体生成素(LH)、促卵泡生成素(FSH)、雌二醇(E₂)水平比较,差异无统计学意义(P>0.05)。治疗后,两组LH、FSH水平低于治疗前,E₂水平高于治疗前,差异有统计学意义(P<0.05);两组间比较,差异无统计学意义(P>0.05)。治疗前,两组匹兹堡睡眠质量指数量表(PSQI)、更年期评定量表(MRS)评分比较,差异无统计学意义(P>0.05);治疗后,两组PSQI、MRS评分低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。两组不良反应总发生率比较,差...     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.